95-784. Agency Forms Submitted for OMB Review

[Federal Register Volume 60, Number 8 (Thursday, January 12, 1995)]
[Notices]
[Pages 3006-3007]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-784]



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RAILROAD RETIREMENT BOARD


Agency Forms Submitted for OMB Review

SUMMARY: In accordance with the Paperwork Reduction Act of 1980 (44 
U.S.C. Chapter 35), the Railroad Retirement Board has submitted the 
following proposal(s) for the collection of information to the Office 
of Management and Budget for review and approval.

Summary of Proposal(s):

(1) Collection title: Application and Claim for Sickness Insurance 
Benefits
(2) Form(s) submitted: SI-1a, SI-1b, SI-3, SI-7, SI-8, ID-7H, ID-11A
(3) OMB Number: 3220-0039
(4) Expiration date of current OMB clearance: January 31, 1995
(5) Type of request: Revision of a currently approved collection
(6) Respondents: Individuals or households
(7) Estimated annual number of respondents: 93,400
(8) Total annual responses: 333,600
(9) Total annual reporting hours: 33,591
(10) Collection description: Under Section 2 of the Railroad 
Unemployment Insurance Act, sickness benefits are provided for 
qualified railroad employees. The collection obtains information from 
employees and physicians needed for determining eligibility for and 
amount of such benefits.

ADDITIONAL INFORMATION OR COMMENTS: Copies of the form and supporting 
documents can be obtained from Chuck Mierzwa, the agency clearance 
officer (312-751-3363). Comments regarding the information collection 
should be addressed to Ronald J. Hodapp, Railroad Retirement Board, 844 
North Rush [[Page 3007]] Street, Chicago, Illinois 60611-2092 and the 
OMB reviewer, Laura Oliven (202-395-7316), Office of Management and 
Budget, Room 10230, New Executive Office Building, Washington, D.C. 
20503.
Chuck Mierzwa,
Clearance Officer.
[FR Doc. 95-784 Filed 1-11-95; 8:45 am]
BILLING CODE 7905-01-M