ID-7H Non-Entitlement to Sickness Benefits and Information on

FORM APPROVED
OMB NO. 3220-0039
U.S. RAILROAD RETIREMENT BOARD
Office of Program- Operations
P.O. Box 10695
Chicago, Illinois 60610-0695

In rQply reier to
SS No.
REQ NOTICE OF DETERMINATION

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SICKNESS BENEFITS

According to information on your recent Application for Sickness Benefits,
In addition,
the first day for which you can'claim benefits is
medical information submitted with your application shows that you were
Accordingly, you do not have a
able to return to work on
sufficient number of days of sickness to establish a valid claim. A
minimum of five days of sickness is required in a claim period for
benefits to be payable, or for the claim to satisfy a waiting period
requirement.

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If you were unable to work f0r.a longer period of time, you may request
reconsideration of our determination. Your request must be in writing
and should include a statement from your doctor indicating the date you
were able to return to work, or are expected to be able to work. This
information may be furnished on the doctor's own form or by letter. If
you request reconsideration, your request and the doctor's statement must
be received within 60 days of the date of this letter.
If you are unemployed, able to work, and available for work, you may be
eligible for unemployment benefits. You can obtain an Application for
Unemployment Benefits from your local Railroad Retirement Board office.
Applications are also available through railroad employers and many labor
organizations. If you file for unemployment benefits, your application
must be received within 30 days of the first day for which you want to
claim benefits, or you may lose benefits.
Robert J. Duda
Director of Operations