# Agency Forms Submitted for OMB Review
**SUMMARY:**
In accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. Chapter 35), the Railroad Retirement Board (RRB) 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:* Railroad Unemployment Insurance Act Applications.
(2) *Form(s) submitted:* SI-1a, SI-1b, SI-3, SI-7, SI-8, ID-7H, ID-11A, ID-11B.
(3) *OMB Number:* 3220-0039.
(4) *Expiration date of current OMB clearance:* 4/30/2001.
(5) *Type of request:* Revision of a currently approved collection.
(6) *Respondents:* Individuals or Households, Business or other for-profit.
(7) *Estimated annual number of respondents:* 55,400.
(8) *Total annual responses:* 271,900.
(9) *Total annual reporting hours:* 27,971.
(10) *Collection description:* Under Section 2 of the Railroad Unemployment Insurance Act, unemployment and sickness benefits are provided for qualified railroad employees. The collection obtains information needed to determine eligibility for an amount of such benefits from railroad employees and physicians. Also collects information from individuals acting on behalf of sick or injured employees and supplemental information from railroad employers regarding settlement of injuries or accidents for which sickness benefits were paid.
**Additional Information or Comments**
Copies of the forms 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, Joe Lackey (202-395-7316), Office of Management and Budget, Room 10230, New Executive Office Building, Washington, DC 20503.
Chuck Mierzwa,
Clearance Officer.