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: Appeal under the Railroad Retirement and Railroad Unemployment Insurance Act.

(2)Form(s) submitted: HA-1.

(3)OMB Number:3220-0007.

(4)Expiration date of current OMB clearance:08/31/2004.

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

(6)Respondents: Individuals or households.

(7)Estimated annual number of respondents:860.

(8)Total annual responses:860.

(9)Total annual reporting hours:285.

(10)Collection description: Under section 7(b)(3) of the Railroad Retirement Act and section 5(c) of the Railroad Unemployment Insurance Act, a person aggrieved by a decision on his or her application for an annuity or other benefit has the right to appeal to the RRB. The collection provides the means for the appeal action.

Additional Information or Comments: 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.

Charles Mierzwa,

Clearance Officer.

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