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Agency Forms Submitted for OMB Review

Document Details

Information about this document as published in the Federal Register.

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This document has been published in the Federal Register. Use the PDF linked in the document sidebar for the official electronic format.

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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: Statement of Authority to Act for Employee.

(2) Form(s) submitted: SI-10.

(3) OMB Number: 3220-0034.

(4) Expiration date of current OMB clearance: 08/31/2005.

(5) Type of request: Extension of a currently approved collection.

(6) Respondents: Individuals or households, Business or other for-profit.

(7) Estimated annual number of respondents: 400.

(8) Total annual responses: 400.

(9) Total annual reporting hours: 40.

(10) Collection description: Under 20 CFR 335.2, the Railroad Retirement Board (RRB) accepts claims for sickness benefits by other than the sick or injured employees, provided the RRB has the information needed to satisfy itself that the delegation should be made.

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Copies of the forms and supporting documents can be obtained from Charles Mierzwa, the agency clearance officer (312-751-3363) or

Comments regarding the information collection should be addressed to Ronald J. Hodapp, Railroad Retirement Board, 844 North Rush Street, Chicago, Illinois, 60611-2092 or and to the OMB Desk Officer for the RRB, at the Office of Management and Budget, Room 10230, New Executive Office Building, Washington, DC 20503.

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Charles Mierzwa,

Clearance Officer.

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[FR Doc. 05-11033 Filed 6-2-05; 8:45 am]