UI-44 (Proposed) Claim for Credit for Military Service

PROPOSED

United States of America
Railroad Retirement Board

Form Approved
OMB No. 3220-0025

SS NO.

CLAIM FOR CREDIT FOR
MILITARY SERVICE

NAME

INSTRUCTIONS
If you want your military service to be included in determining the total number of years of your
creditable service under the Railroad Unemployment Insurance Act (RUIA), read the important notices
on the next page and complete the Employee’s Statement below.
Attach your certificate of discharge or release to inactive duty (if such record shows the beginning and
ending dates of active service), or any other official military record issued by the military branch in
which you served showing the period of active service. A photocopy may be submitted. If an original
document is submitted, we will return it to you.
Generally, military service may be credited if you entered active service in the Armed Forces when the
United States was at war or in a state of national emergency. The war and national emergency
periods currently being used to calculate creditable military service for unemployment and sickness
purposes are:



National Emergency which began December 16, 1950, and ended September 14, 1978, and
National Emergency which began August 2, 1990.

We will credit your military service only if you began your military service after your railroad service in
the same or preceding calendar year. For example, Employee A worked for ABC Railroad from
March 1989 to September 1990. He was engaged in active military service from October 1990 until
August 1992, after which he returned to work in the railroad industry. Under the provisions of the
RUIA, Employee A would be credited with 23 months of military service.
EMPLOYEE’S STATEMENT
I claim credit for active military service in the Armed Forces of the United States as follows.
Branch of Service: _________________________________________________________________
Date of Entry: ___________________________

Place of Entry: __________________________

Date of Discharge: _______________________

Place of Discharge: _______________________

Military Organization
or Vessel at Time
of Discharge: ____________________________

Serial No.
(If none, enter
rank): __________________________________

I certify that the information I am giving is true, complete, and correct. I understand that criminal and
civil penalties may be imposed on me for false or fraudulent statements, or for withholding information
to cause payment of benefits by the RRB.

Signature: ______________________________________________

Date: ___________________

UI-44 (XX-XX)

Paperwork Reduction Act and Privacy Act Notices
The Railroad Retirement Board’s authority for requesting this information is Section 5(b) of the
Railroad Unemployment Insurance Act. This information will be used to verify your years of service,
counting both railroad service and military service. You do not have to provide this information; but if
you fail to respond, you may lose some benefits.
We estimate this form takes an average of 5 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 aspect of this form, including suggestions for reducing completion time, to Associate
Chief Information Officer for Policy and Compliance, Railroad Retirement Board, 844 Rush Street,
Chicago, Illinois 60611-1275.

UI-44 (XX-XX)