ID-4U Form Letter; Advising of Service and Earnings Requiremen

C~iZi?%-rJ-i-

Form Approved
3220-0025

OMB NO.

U.S. RAILROAD RETIREMENT BOARD
O f f i c e of Programs - O p e r a t i o n s
P.O. Box 10695
Chicago, I l l i n o i s 60610-0695

In reply r e f e r t o
SS No.
REQ

-

According t o o u r r e c o r d s , you a r e n o t q u a l i f i e d f o r b e n e f i t s under t h e
. R a i l r o a d Unemployment I n s u r a n c e Act based on your 1999 r a i l r o a d e a r n i n g s .
To be q u a l i f i e d f o r b e n e f i t s i n t h e g e n e r a l b e n e f i t y e a r J u l y 1, 200
+ t r o u g h June 3n 200:. you must have had r a i l r o a d e a r n i n g s of a t l e a s t
. .
i n ; - , c o u n t i n g no more t h a n $ 970 f o r any month.
I f you t h i n k
o u r r e c o r d s a r e wrong and you b e l i e v e you a r e q u a l i f i e d , complete and
r e t u r n t h e e n c l o s e d Form UI-9.
Even though you are n o t q u a l i f i e d f o r b e n e f i t s based on your 1999 e a r n i n g s
you may now be e l i g i b l e f o r b e n e f i t s f o r which you would normally
become q u a l i f i e d on J u l y 1, 200 . To be e l i g i b l e f o r t h e s e b e n e f i t s you
must have a t leas+ 1.0 y e a r s of r a i l r o a d s e r v i c e , r a i l r o a d e a r n i n g s of a t
l e a s t $2
in , and you must n o t have v o l u n t a r i l y q u i t work
w i t h o u t good c a u s e o r v o l u n t a r i l y r e t i r e d . I f you b e l i e v e t h a t you meet
t h e s e r e q u i r e m e n t s , p l e a s e answer t h e q u e s t i o n s below, s i g n your name i n
t h e space p r o v i d e d and r e t u r n t h i s l e t t e r t o t h e a d d r e s s shown above.
Robert J . Duda

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D i r e c t o r of O p e r a t i o n s

1. I n c o u n t i n g your t o t a l months of s e r v i c e , d i d you i n c l u d e m i l i t a r y

Yes- No -

service?

2 . F u r n i s h t h e f o l l o w i n g i n f o r m a t i o n f o r each employer f o r whom you worked

o r from whom you r e c e i v e d v a c a t i o n pay o r pay f o r t i m e l o s t i n 2000.
I f you need more s p a c e , u s e t h e o t h e r s i d e of t h i s n o t i c e .
Railroad :
Occupation:
P l a c e of Employment

-

C i t y and S t a t e :

L i s t months of s e r v i c e i n 2 0 0 ~
PLEASE READ THE IMPORTANT NOTICES ON THE REVERSE SIDE OF THIS FORM.
I u n d e r s t a n d t h a t c i v i l and c r i m i n a l p e n a l t i e s may be imposed on me f o r
f a l s e o r f r a u d u l e n t statements, o r f o r withholding information t o cause
I a f f i r m t h a t t o th.e b e s t of my
payment of b e n e f i t s by t h e RRB.
knowledge, t h e i n f o r m a t i o n I have g i v e n i s t r u e , c o m p l e t e , and c o r r e c t .

Signature
Enclosure:

Date
Form UI-9

PAPERWORK REDUcTION/PRIVACY ACT NOTICE
The R a i l r o a d R e t i r e m e n t B o a r d ' s a u t h o r i t y f o r r e q u e s t i n g t h i s i n f o r m a t i o n
i s s e c t i o n 2 ( c ) o f t h e R a i l r o a d Unemployment I n s u r a n c e A c t .
The
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