3220-0055

OMB NO. 3220-0055

Justification

Application and Claim for RUIA Benefits Unpaid at Death

RRB Form UI-63

1. Circumstances of the collection - Under Section 2(g) of the Railroad Unemployment Insurance Act (RUIA), benefits that accrued but were not paid because of the death of the employee shall be paid to the same individual(s) to whom benefits are payable under Section 6(a)(1) of the Railroad Retirement Act. The provisions relating to the payment of such benefits are prescribed in 20 CFR 325.5 and 20 CFR 335.5.

2. Purposes of collecting/consequences of not collecting the information - The collection obtains the information needed by the Railroad Retirement Board (RRB) to properly and fully pay all unemployment and sickness benefits accrued but unpaid because of the death of the employee.

Form UI-63, Application for Benefits Due But Unpaid at Death, is provided by the RRB for use in applying for accrued sickness or unemployment benefits unpaid at the death of the employee and for supplying the information needed by the RRB to identify the proper payee(s). Following the order for payment of beneficiaries under the Railroad Retirement Act, accrued RUIA benefits are distributed 1) first, to the surviving spouse; 2) if there is no surviving spouse, then to the person who paid the funeral and burial expenses (to the extent the expenses were not reimbursed under the RRA); and 3) if there are still unpaid benefits remaining, then to the children, grandchildren, parents, and brothers and sisters, in order of survivorship.

Form UI-63 is not requested if unpaid benefits under the RRA were applied for, since whoever is identified as being the proper beneficiary under the RRA is also the proper payee under the RUIA. When required, Form UI-63 must be filed within two years of the death of the employee; otherwise any unpaid RUIA benefits will revert to the RUIA account.

Form UI-63 is either completed at one of our RRB field offices or is mailed to the applicant by the field office. A transmittal letter containing instructions for completing and filing the UI-63 is on the reverse side of the form for use when the form is mailed to an applicant. On these occasions, a pre-addressed return envelope is also enclosed for returning the completed UI-63 to the field office. The name and social security number of the deceased employee are pre-filled prior to being released to the respondent for completion.

Form UI-63 can be completed during an RRB office visit or the RRB office can mail the form to the applicant, who then follows the completion instructions from the transmittal letter on the reverse side of the form. The completed form is mailed back to the RRB office in the pre-addressed envelope provided for that purpose. The name and social security number of the deceased employee are pre-filled on the form prior to being released to the applicant for completion.

The RRB proposes no changes to Form UI-63.

To our knowledge, no other agency uses a form similar to Form UI-63.

3. Planned use of improved information technology or technical/legal impediments to further burden reduction – Not cost effective due to low volume.

4. Efforts to identify duplication - This information collection does not duplicate any other information collection.

5. Small business respondents - N.A.

6. Consequences of less frequent collection - Not applicable since the information is solicited only once.

7. Special circumstances - None.

8. Public comments/consultations outside the agency - In accordance with 5 CFR 1320.8(d), comments were invited from the public regarding this information collection. The notice to the public was published on 63960 of the October 14, 2011, Federal Register. No comments or requests for additional information were received from the public.

9. Payments or gifts to respondents - N.A.

10. Confidentiality - Privacy Act System of Records, RRB 21, Railroad Unemployment and Sickness Insurance Benefit System. In accordance with OMB Circular M-03-22, a Privacy Impact Assessment for this information collection was completed and can be found at http://www.rrb.gov/pdf/PIA/PIA-BPO.pdf.

11. Sensitive questions - N.A.

12. Estimate of respondent burden - The current and proposed estimated annual burden for the information collection is as follows:

Current Burden

Form Number	Annual Responses	Time (Minutes)	Burden (Hours)
UI-63	200	7	23
Total	200		23

Proposed Burden

Form Number	Annual Responses	Time (Minutes)	Burden (Hours)
UI-63	25	7	3
Total	25		3

Responses Hours

Total burden Change -175 -20

Adjustment -175 -20

13. Estimated annual cost to respondents or record keepers - N.A.

14. Estimate of cost to Federal Government - N.A.

15. Explanation for change in burden - The change in burden is due to the improved tracking of the number of returned responses.

16. Time schedule for data collection and publication - The results of this collection will not be published.

17. Request not to display OMB expiration date - The UI-63 is a low usage form that is seldom revised. Given the costs associated with redrafting, reprinting, and distributing the forms in order to keep the appropriate OMB expiration date in place, the RRB requests the authority to not display the expiration date on the form.

18. Exceptions to Certification Statement - None

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