95-16022. Agency Forms Submitted for OMB Review

[Federal Register Volume 60, Number 125 (Thursday, June 29, 1995)]
[Notices]
[Pages 33883-33884]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-16022]



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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: Supplemental Information on Accident and 
Insurance.
    (2) Form(s) submitted: SI-1c, SI-5, ID-30q, ID-3s, ID-3u, ID-
30k, ID-30k-1.
    (3) OMB Number: 3220-0036.
    (4) Expiration date of current OMB clearance: June 30, 1996.
    (5) Type of request: Revision of a currently approved 
collection.
    (6) Respondents: Individuals or households.
    (7) Estimated annual number of respondents: 33,550.
    (8) Total annual responses: 33,500.
    (9) Total annual reporting hours: 1,987.
    (10) Collection description: The RUIA provides for recovery of 
sickness benefits paid if the employee receives a settlement for the 
same injury for which benefits were paid. The collection obtains 
identifying information about the person or company responsible for 
such payments and 

[[Page 33884]]
information needed for determining the amount of the RRB's entitlement.

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 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. 95-16022 Filed 6-28-95; 8:45 am]
BILLING CODE 7905-01-M