Form ID-5I (12-00) ID-5I (12-00) Form Letter; Request for Employment Information

Form Approved
OMB NO.3220-0025

In reply refer to
SS No.:
Name:

REQUEST FOR EMPLOYMENT INFORMATION
Our files indicate that the individual named above has been employed by you. This individual claimed
benefits under the Railroad Unemployment lnsurance Act, a Federal law. Since these benefits are paid on
a daily basis, we need to know the exact days the individual worked for you. This request involves a
routine check of our records and is not an indication that the employee has filed improper benefit claims.
Please furnish the information requested on the second page of this letter about each day worked, complete
the employer certification and return this letter using the enclosed postage-free envelope. If you wish, you
may provide the information requested by submitting a computer printout or other company records which
clearly show the employee's
earnings. Be sure, however, to complete the employer certification and
return this letter with the other records. Thank you for your cooperation.
Railroad Retirement Board
Enclosure
AUTHORITY FOR REQUEST

The Railroad Retirement Board (RRB) is a United States Government agency and is responsible for the
administration of the Railroad Unemployment lnsurance Act (45 U.S.C. 351 et. seq.). This Act provides for
payment of unemployment and sickness benefits to qualified employees in the railroad industry.
Our authority for requesting information is contained in provisions of the Railroad Unemployment lnsurance
Act (45 U.S.C. 355(b), 359(a) and 362(a)). Although the Act gives the RRB the authority to compel
disclosure through use of a.subpoena, the RRB's experience has been that employers voluntarily release
earnings information when they know that the RRB uses that information only for the purpose of verifying a
claim for benefits.
The RRB realizes that many companies have adopted policies regarding disclosure of personal information
needed for proper administration of the Railroad Unemployment lnsurance Act. lnformation that the RRB
acquires about a person is protected from disclosure except as provided by law.
PAPERWORK REDUCTION ACT NOTICE
We estimate this form takes an average of 15 minutes to complete, including the time for reviewing the instructions,
getting the needed data, and reviewing the completed form. Federal agencies may not conduct or sponsor, and
respondents are not required to respond to, a collection of information unless it displays a valid OMB number. If you
wish, send comments regarding the accuracy of our estimate or any other aspects of this form, including suggestions for
reducing completion time, to the Chief of Information Management, Railroad Retirement Board, 844 N. Rush St.,
Chicago, IL 6061 1-2092.

UNITEDSTATES
RAILROAD
RETIREMENT
BOARD - 2

Form Approved OMB No. 3220-0025
SS No.:

Name:

OCCUPATION:
EMPLOYED FROM:

TO

REASON FOR TERMINATION (if not now employed):
EMPLOYER CER'IIFICATION: THE INFORMATION IN THIS REPORT IS CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.
SIGNATURE

TITLE

OFFICIAL TO CONTACT FOR
ADDITIONAL INFORMATION:
NAMErrlTLE

DATE

u
TELEPHONE NUMBER