Application and Claim for RUIA Benefits Due at Death

ICR 201501-3220-001

OMB: 3220-0055

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2015-01-08
IC Document Collections
ICR Details
3220-0055 201501-3220-001
Historical Active 201112-3220-001
RRB
Application and Claim for RUIA Benefits Due at Death
Extension without change of a currently approved collection   No
Regular
Approved without change 04/27/2015
Retrieve Notice of Action (NOA) 01/30/2015
  Inventory as of this Action Requested Previously Approved
04/30/2018 36 Months From Approved 04/30/2015
25 0 25
3 0 3
0 0 0

The collection obtains the information needed by the Railroad Retirement Board to pay benefits accrued under section 2(g) of the Railroad Unemployment Insurance Act, but not paid because of the death of the employee.

US Code: 45 USC 362(i) Name of Law: Railroad Unemployment Insurance Act
   US Code: 45 USC 362(l) Name of Law: Railroad Unemployment Insurance Act
  
None

Not associated with rulemaking

  79 FR 66002 11/06/2014
80 FR 3998 01/26/2015
No

1
IC Title Form No. Form Name
Application and Claim for RUIA Benefits Due at Death UI-63 (02-09) Application for Benefits Due But Unpaid at Death

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 25 25 0 0 0 0
Annual Time Burden (Hours) 3 3 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
Yes
No
No
No
Uncollected
Charles Mierzwa 312-751-3363 charles.mierzwa@rrb.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
01/30/2015


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