ID-4K(INTERNET) Prepayment Claims Verification Notice (Internet)

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ID-4K for 2112-Springfield Terminal Rwy
Instructions: Notify the RRB within 3 business days, of information related to payments of benefits. For an explanation of what information to provide, click this link.
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To provide information to RRB about application or claim, Click the SSN link.
2) If it is OK for RRB to pay, click the OK To Pay box. This will also delete the record from your New Items. No reply is necessary if the information provided by the employee is correct
and you have no other information to provide. However, this record will remain in your Completed Items up to 5 PM CST. If no information is provided on a claim, payment is made within
3 business days. If no claim information is shown, the report is for an application.
If no 'reason unemployed', the claim is for sickness benefits.
An 'N' following the 'Date Last Worked' indicates that the date is for a non-railroad employer.
For an explanation of claim profile codes, click this claim profile codes link.

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9/24/2008

0000000000 08/19/08

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Discharged

U S. Ra~lroadRet~rernenlBoard

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11111111111111 BOSTON MA

09/03/08

844 North Rush Street
Chicago Illmoss. 6061 1-2092
Telephone (312) 751-7139 TPI (312) 751-4701
Contact an RRB oftice near vou

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(617)223-8550

Paper Work Reduction Act

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Section 5(b) of the Radroad Unemployment Insurance Act (RUIA) requires the RRB to provide notice of claims for
benefits to base-year employers. Employer responses to these notices are voluntary. F d u r e to provide informahon
about questionable claims for benefits, however, may aEFect the amount that an employer is charged in benefits and the
employer's tax contribution rate under the RUIA.
The amount of time required for an employer to participate in the prepayment claims verification process varies
dependmg upon the extent to whch the employer is able to use automated systems. We estimate the average
respondmg burden for employers to be:
Internet Form ID-4K 2 minutes per response
Internet Form ID-4E 2 minutes per response
These estimates are based on employer experience nationwide. The estimates include time for r e v i e w instructions,
obtauvng needed data, and r e v i e w the completed responses. Federal agencies may not conduct or sponsor, and
respondents are not required to respond to a collection of information unless it &splays a vahd OMB number. If you
wish, send comments concerrwg the accuracy of our estimates or any other aspect of h s program, includmg
suggestions for reduclng reportvlg time, to the Chef of Information Management, Radroad Retirement Board, 844 N.
Rush Street, Chicago, Unois 6061 1-2092 and the Office of Management and Budget, Paperwork Reduction Project
(3220-0171), Waslungton, D C 20503.

Thursday, Sep 25,2008 01:21 PM

lnformation Submitted By: 21 12
SSN:
Employee Name:

Providing lnformation on a Claim
To provide information specific to this claim, enter the code to describe why benefits should not be paid for specific days. The employe
information can still be provided for those days. If one code applies to the entire claim, select it in the first dropdown box and click App
you are providing information.
Reply Codes generally used if employee received Dav .
Reply Codes generally used if emplayee-meiued no pay.

Sickness Claim

Click Here to see an interpretation for the Dav Codes as shown above.
Person to Contact for additional information about this protest:

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Name: I

Telephone: I

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Send Reply

Cancel

P a ~ e w o r kReduction Act Notice

-Ti*%* t

Date posted: 10/25/2007
Date updated: 10/25/2007

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U.S. Railroad Retirement Board

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used if employee recerved no pay.

09/05

09106

09/07

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09108

09/09

09/10

09/11

09/12

09/13

Ito see an interpretation for the Day Codes as shown above.

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Contact for additional information about this protest:

Information:
Done

Thursday, Sep 25,2008 11:18 AM

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