Application and Claim for Unemployment Benefits and Employment Service

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0022 can be found here:

Documents and Forms

Document Name Document Type
Form UI-1(03-04) Application and Claim for Unemployment Benefits and Employment Service Form
UI-1(03-04) Application for Unemployment Benefits and Employment Ser Form UI-1 (03-04) (current).pdf Form
UI-3 (04-04) Claim for Unemployment Benefits Form UI-3 (4-04)(Current).pdf Form
UI-1(INTERNET) Application for Unemployment Benefits and Employment Ser Form UI-1 (Internet) (03-04).pdf secure.RRB.gov/MainLine/PINPassword/login/Login.asp?App=RUIA Form
UI-3 (Internet) Claim for Unemployment Benefits Form UI-3 (Internet)(current 11-04).pdf secure.RRB.gov/MainLine/PINPassword/login/Login.asp?App=RUIA Form
UB-10 (04-09).pdf UB-10, Unemployment Benefits for Railroad Employees (11-06) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application and Claim for Unemployment Benefits and Employment Service	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 325

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	UI-1(03-04)	Application for Unemployment Benefits and Employment Service	Form UI-1 (03-04) (current).pdf		No		Paper Only
Form	UI-3 (04-04)	Claim for Unemployment Benefits	Form UI-3 (4-04)(Current).pdf		No		Paper Only
Form	UI-1(INTERNET)	Application for Unemployment Benefits and Employment Service	Form UI-1 (Internet) (03-04).pdf	https://secure.RRB.gov/MainLine/PINPassword/login/Login.asp?App=RUIA	Yes	Yes	Fillable Fileable Signable
Form	UI-3 (Internet)	Claim for Unemployment Benefits	Form UI-3 (Internet)(current 11-04).pdf	https://secure.RRB.gov/MainLine/PINPassword/login/Login.asp?App=RUIA	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records
Title: RRB -7, Applications for Unemployment Benefits and Placement Service	FR Citation: 75 FR 43717

Number of Respondents: 16,163	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 21 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	162,331	78,028	84,303
Annual IC Time Burden (Hours)	17,311	8,215	9,096
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
UB-10, Unemployment Benefits for Railroad Employees (11-06)	UB-10 (04-09).pdf	12/20/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.