UB-11, Sickness Benefits for Railroad Employees

Sickness Benefit
Application Enclosed

Sickness Benefits
for
Railroad Employees

United States of America
Railroad Retirement Board
Visit our Web site at www.rrb.gov

Form UB-11

CONTENTS

Introduction
Qualification Requirements

1
2

Amount and Duration of Benefits
Waiting Period
Normal Benefits
Extended Benefits
Accelerated Benefits
Daily Benefit Rate
Number of Days of Sickness
Tier I Tax Deductions

2
2
2
2
3
3
3

Eligibility Requirements

3

Medical Statements

3

Sick Pay and Supplemental
Sickness Benefits
Disqualifications
Separation Allowance
False or Fraudulent Claim
Benefits Under Other Laws
Medical Examination
Benefit Reductions
Personal Injury Settlements

4

4
4
4
4

Reconsideration and Waiver
Employee Rights
Employer Rights

5
5

When Sickness Benefits are Taxable

5

Instructions for Completing Forms
General Instructions
Important Information
Application for Sickness
Benefits (SI-1a)
Statement of Sickness (SI-1b)
Statement of Authority
to Act for Employee (SI-10)
Claim for Sickness Benefits (SI-3)
Notices
Privacy Act
Computer Matching and Privacy
Protection Act
Paperwork Reduction Act
Nondiscrimination on the Basis
of Disability

5
5
6
8
8
8

10
10
11
11

Checking Your Benefits by Telephone
or Online

12

Important Reminders

13

Fraud and Abuse Hot Line

13

4
4

INTRODUCTION

IF YOU ARE SICK OR INJURED, you may be eligible to receive sickness benefits
from the Railroad Retirement Board (RRB). This booklet provides information about
the requirements for receiving sickness benefits, the amount of benefits payable, and
procedures for claiming benefits.
To receive sickness benefits, you must complete and file the enclosed Forms SI-1a/b,
Application for Sickness Benefits and Statement of Sickness, within 10 days from the
first day you want to claim benefits. An application is considered filed on the day it is
received by the RRB; if you file late you may lose benefits.
You can file your claims for sickness benefits online at the RRB’s Web site at
www.rrb.gov. To use online services you must have a PIN and Password (PPW) account.
The Web site explains how to open a PPW account.
For other qualifications for sickness benefits see “Eligibility Requirements” on page 3.
If you are able to work but unemployed, you may be able to receive unemployment
benefits. Those benefits are described in booklet, UB-10, Unemployment Benefits for
Railroad Employees.
IMPORTANT: If there is no application enclosed with this booklet or you wish to obtain
a copy of the booklet UB-10, contact any RRB office, your railroad employer, your labor
organization, a union official, or visit the RRB’s Web site at www.rrb.gov.

This booklet contains general information and does not have the effect of law, regulation, or
ruling. Certain exceptions, limitations, and special cases are not covered. If you have any
questions about sickness or unemployment benefits, contact the RRB at 877-772-5772.
Spanish translation booklets concerning railroad sickness and unemployment benefits are
available from any office of the RRB.
Tenemos un librete en Espanol que explica los beneficios de los enfermos del
ferrocarril. Para obtener una copia, entre en contacto con cualquier oficina de
la RRB, su empleador ferroviario, su organizacion laboral, un oficial de un
sindicato o otraves del web site RRB: www.rrb.gov.

UB-11 (03-12)

1

Qualification Requirements
Base Year – Benefit Year
Only qualified employees can receive benefits under the
Railroad Unemployment Insurance Act. A new benefit
year begins every July 1. To qualify for benefits in a benefit year, you must have creditable railroad earnings in the
preceding calendar year (base year), counting no more
than a certain amount in any month. In addition, a new
employee must have railroad service in at least 5 months
of his or her first year of work in order to be eligible for
benefits in the following benefit year.
The amount of earnings needed to qualify for benefits in a
benefit year depends on the monthly compensation base in
the base year. An employee is required to have base year
earnings of not less than 2-1/2 times the monthly compensation base applicable to months in that base year. As the
monthly compensation base increases, the amount of compensation needed to qualify for benefits also increases.
Example
Benefit Year Beginning July 1, 2011
Earnings Needed in Base Year—$3,325.00 in 2010 (2-1/2 x
$1,330.00 = $3,325.00). If 2010 was your first year of
railroad work, you must also have railroad service in 5
months in 2010.
In this example, $1,330.00 is the monthly compensation
base for base year 2010. The monthly compensation base
for base year 2011 is $1,330.00.
Contact your local RRB field office if you need information about the monthly compensation base for other
years.

Amount and Duration
of Benefits
Waiting Period
To satisfy a one-week waiting period requirement, no
benefits are payable for your first 7 days of sickness in
your first claim in a period of continuing sickness,
unless you have already served a waiting period in the
benefit year. Benefits are payable for each remaining
day of sickness in your first claim. For example, if you
claim all 14 days in your first claim, you will be paid
benefits for 7 days. If you are eligible and your claims
are continuous from one benefit year to another, you
generally will serve only one waiting period in your
period of continuing sickness.

2

If you have at least 4 consecutive days of sickness and
5 days of sickness overall, you should file a claim for
benefits. Even though no benefits may be payable if the
claim is your first claim in the benefit year, your claim
must be filed in order to satisfy the waiting period
requirement. If you have more than 7 days of sickness in
your waiting period claim, benefits will be paid for the
number of days of sickness over 7. After your first claim,
benefits will be paid for all days over 4 for other claims
in the benefit year.
A “period of continuing sickness” means either (1) a period
of consecutive days of sickness, whether from one or more
causes or (2) a period of successive days of sickness due
to a single cause without interruption of more than 90
consecutive days which are not days of sickness.

Normal Benefits
You can receive normal benefits for as many as 130
days (26 weeks) in a benefit year, but your benefits
cannot be more than your base year wages counting
not more than a prescribed amount for any month.
Benefit rights are exhausted when a benefit year ends
(normally June 30) or earlier if benefit payments equal
base year creditable earnings.
Example
For purposes of determining maximum normal benefits
payable in the general benefit year beginning July 1, 2011
monthly earnings of up to $1,718.00 are counted for
months in base year 2010. For base year 2012, the monthly
compensation base for maximum benefits is $1,763.00.

Extended Benefits
If you have 10 or more years of service and exhaust your
normal sickness benefits, you may be eligible to receive
extended benefits for up to 65 days (7 consecutive 14-day
claim periods having 10 days payable in each). Also, if you
are not qualified for benefits in the current benefit year, but
received normal benefits in the previous year, you may still
be eligible for extended benefits.
To qualify for extended benefits, you must not have
voluntarily retired. Extended sickness benefits are not
payable once you attain age 65.

Accelerated Benefits
Under certain special provisions, if you have 10 or more
years of service, you can receive benefits before the regular
beginning date of a benefit year. To qualify, you must be
qualified for the next benefit year, but not the current year.
You must also have 14 or more consecutive days of
sickness and not have voluntarily retired. Accelerated
sickness benefits are not payable once you attain age 65.

Daily Benefit Rate



obtain Form SI-1a, Application for Sickness
Benefits from your employer, labor organization, or
RRB office;



have your doctor complete Form SI-1b, Statement
of Sickness in support of your claim for sickness
benefits; and



complete and file the Application for Sickness
Benefits (SI-1ab) within 10 days of the first day you
become sick or injured. You may lose benefits if you
file late. An application is considered filed on the day
it is received by any office of the RRB.

Your daily benefit rate is 60 percent of the daily rate of pay for
your last job in the base year, but not less than $12.70 a day or
more than 5 percent of the monthly compensation base.
For example, the monthly compensation base for 2011 is
$1,330.00, which results in a maximum daily benefit rate
of $66.00 for periods beginning after June 30, 2012. The
maximum benefit rate is subject to increases under indexing rules reflecting the growth in average national wages.
Contact your local RRB field office if you need information about the maximum benefits rates for other periods.
Your daily rate of pay is your straight-time rate of pay
including any cost-of-living allowances, but not including
overtime or other extra pay.
For mileage employees in train and engine service, the
straight-time rate is the rate of pay for the number of
miles in a basic workday, depending on occupation and
class of service. Earnings for miles run over the number
of miles in a basic workday do not count.

Number of Days of Sickness
After you have satisfied the benefit year waiting period
requirement, benefits are generally paid for days of
sickness over 4 in 14-day claim periods.

Tier I Tax Deductions
Except for benefits paid for on-the-job injuries, sickness
benefits are subject to Tier I railroad retirement taxes if
paid within 6 months after the month in which you last
worked. Tier I tax deductions reduce the amount of
benefits payable for a claim.

Medical Statements
To receive sickness benefits, you must have your doctor
complete Form SI-1b, Statement of Sickness in support
of your claim. In addition, you may be asked to have your
doctor provide the RRB with additional (supplemental)
medical information in order to continue to receive your
sickness benefit payments. How often supplemental
medical information is required depends on several factors,
including when you are expected to return to work. In
determining when you may return to work, we consider
your diagnosis, medical condition, age, normal occupation
and the estimated disability period previously provided to
the RRB by your doctor.
Form SI-1b, Statement of Sickness, may be completed by:


a licensed medical doctor trained in medical and
surgical diagnosis;



a licensed dentist if the infirmity relates to the
teeth and gums;



a licensed podiatrist if the infirmity relates to the feet;



a licensed chiropractor;



a licensed doctor of clinical psychology;



a certified nurse/midwife in cases of pregnancy,
miscarriage, or childbirth;



a superintendent or other supervisory official of a
hospital, clinic, or similar organization;



a Christian Science practitioner;



a Physician Assistant – Certified; or



a nurse practitioner.

Eligibility Requirements
To receive sickness benefits you must:




be unable to work due to sickness, injury, pregnancy,
or the birth of a child;
receive no wages, salary, pay for time lost,
vacation pay, holiday pay, military reservist
pay, pay under a wage continuation plan, sick pay
or other remuneration from railroad or nonrailroad
employment for the days you claim benefits. You
must report such pay on your claim. However, payments under your own health or accident insurance
policy, or group insurance policy, or under a supplemental sickness benefit plan administered by your
employer or an insurance company do not prevent the
payment of sickness benefits and should not be reported on your claim forms (see the section Sick Pay and
Supplemental Sickness Benefits on page 4);

3

Sick Pay and
Supplemental Sickness Benefits

the medical examination when required, you may be
disqualified from receiving sickness benefits.

Sickness benefits are not payable for any day for which
you receive sick pay from your employer. But benefits
may be paid if you receive supplemental sickness benefits
from your employer or an insurance company. Sick pay is
a continuation of part or all of your wages while you are
unable to work. Sick pay is generally subject to all regular payroll deductions. You must report sick pay on your
claim form; failure to do so may result in an overpayment
of RRB sickness benefits that you will have to refund.

Benefit Reductions

Supplemental sickness benefits are different from sick
pay. Supplemental sickness benefits are payments made
by your employer or an insurance company to supplement
your RRB benefits and are not subject to Tier II retirement tax. Supplemental benefits are paid under plans submitted by your employer and approved by the RRB. Do
not report supplemental sickness benefits on your claim.
If you do not know whether payments you are receiving
are supplemental under an RRB-approved plan, contact
the RRB office nearest you for assistance.

Disqualifications
Separation Allowance (Severance pay, Buyout)
If you have been paid a separation allowance by your
employer, you cannot receive sickness benefits for
approximately the period of time it would have taken
you to earn the amount of the allowance.

False or Fraudulent Claim
You will be disqualified for both unemployment and sickness benefits for 75 days if you make a false or fraudulent
statement or claim in order to receive benefits. You may
also be subject to fine or imprisonment. The RRB conducts
checks, including computer matching checks, with State
and Federal agencies as well as railroads, in order to detect
fraudulent benefit claims.

Benefits are not payable to you in the full amount if you
are also receiving:


social security benefits,



a pension, annuity, or other retirement pay under a
Federal, State, or local law (such as a railroad retirement annuity, military retirement pay, a policeman’s
or fireman’s pension, etc.),



certain workers’ compensation payments, or



any other social insurance payment under any law.

If you meet the other eligibility requirements, you may
receive benefits only in the amount by which your sickness benefits exceed the other payments.
Be sure to report all such other payments on each claim
you file. If you do not, you may later be required to
refund benefits. If the other payments are awarded after
you claim sickness benefits, but cover some or all of the
same days, contact the RRB immediately about repayment of the benefits you received.
If you are awarded an annuity under the Railroad
Retirement Act that is for days you were already paid sickness benefits, you will have to refund some or all of your
benefits. Generally, the amount you must repay is withheld
from your accrued annuity. Your annuity award letter or
notice of annuity adjustment will show the amount of any
sickness benefits withheld. Verify the amount by comparing it to the amount of sickness benefits you received for
the same period. Contact your local RRB office immediately if you believe the amount withheld is incorrect. You will
be required to refund benefits to the RRB if the full amount
was not withheld from your accrued annuity.

Benefits Under Other Laws
You will be disqualified from receiving railroad sickness
insurance benefits for any day you:


receive sickness benefits under any other law; or



receive unemployment benefits under the Railroad
Unemployment Insurance Act or any similar law.

Medical Examination
In certain situations you may be required to be examined
by a doctor selected by the RRB. If you fail to take

4

Personal Injury Settlements
You may receive benefits for any kind of injury or illness
whether it occurs on or off the job; but if you are paid a
settlement, judgment or collect damages as a result of the
injury or illness, the amount of your benefits must be
refunded to the RRB. This is true regardless of a State’s
“no-fault” law. The RRB will normally notify the liable
party, and the person or company making the settlement
or paying the damages usually reimburses the RRB for
the amount due. However, if the RRB is not reimbursed
in full at the time of settlement, you may have to repay
benefits to the RRB.

Verify the accuracy of the amount of benefits withheld
from your settlement or judgment by checking your own
record of RRB payments or by contacting the RRB.
Notify the RRB immediately if you believe the correct
amount was not withheld.

Reconsideration and Waiver
Employee Rights
Reconsideration - If you do not agree with any decision
denying you benefits or with an overpayment decision,
you may request reconsideration. Your request must be in
writing and should explain why you disagree. If you
request reconsideration, your request must be received at
an office of the RRB within 60 days of the date of the
letter notifying you of the adverse decision. Be sure to
sign your name and include your social security number
on your request.
Waiver - You may request waiver of recovery of your overpayment only if ALL of the following conditions are met:
1. The amount of the overpayment is more than 10
times the current maximum daily benefit rate;
2. you were not at fault in causing the overpayment;
and
3. recovery would cause you financial hardship to the
extent that you would not be able to meet your ordinary and necessary living expenses or recovery
would be unfair for some other reason.
If your request for waiver is received at an office of the
RRB within 60 days from the date of the letter notifying
you of your debt, we will not recover the overpayment
until a decision is made on your request.

Employer Rights
The Railroad Unemployment Insurance Act requires the
RRB to notify your base year employer(s) each time you
file a claim for benefits, and to give the employer(s) an
opportunity to submit information relevant to your claim
before the RRB makes an initial determination on the
claim. The RRB must also notify your employer each
time benefits are paid to you. Your employer may appeal
the decision to pay benefits. The appeal does not prevent
the timely payment of benefits. However, you may be
required to repay benefits if the appeal is successful.

When Sickness Benefits are Taxable
Sickness benefits paid under the Railroad Unemployment
Insurance Act, with the exception of sickness benefits paid

for an on-duty injury, are considered income for Federal
income tax purposes. Each year, the RRB sends railroad
employees Form W-2, Wage and Tax Statement, showing
the amount of sickness benefits paid during the preceding
calendar year. The amount shown on Form W-2 is the
amount of benefits payable before deduction of Tier I railroad retirement tax. The amount includes benefits payable
but withheld to offset a debt to the RRB. A Form W-2 is not
issued if all benefits paid to an employee were for an on-thejob injury. A Form W-2 is also not issued if all benefits paid
to an employee in a tax year are repaid in the same year.
You may file Form W-4s, Voluntary Tax Withholding, with
the nearest RRB office if you want the RRB to withhold
Federal income tax from your benefits. To change or end
withholding you must file another Form W-4s with the
RRB. Form W-4s is available upon request from the
Internal Revenue Service.
The Railroad Unemployment Insurance Act specifically
exempts railroad sickness benefits from State income taxes.

Instructions for Completing Forms
General Instructions
Complete all items by typing or printing neatly in ink. Do
not skip any items unless directed to do so. If you need
more space to answer a question, enclose a separate sheet
of paper. Be sure to sign your name and date the form
before mailing. Have your doctor complete Form
SI-1b, Statement of Sickness. Do not separate the
Forms SI-1a and SI-1b.
Read the following instructions carefully before
completing your SI-1a application. If your application
is not completed correctly, your benefits may be
delayed. Contact your local RRB office if you have
questions or need assistance in completing the form. If
you are completing the application for the employee, refer
to page 8 for instructions on completing Form SI-10,
Statement of Authority to Act for Employee.

Important Information
The completed and signed form must be received by an RRB
office within 10 days of the first day for which you want to
claim benefits. You may lose benefits if your application is
filed late. If the form is late, enclose an explanation.
Once your application has been processed, a claim form
will be mailed to you for completion. You must complete
and return the claim to the address of the RRB office that
appears on the claim. A notice of the claim will be sent to
your employer. A claim for the next 14-day period will
be mailed to you on or about the last day of the period
covered by the claim.

5

Application for Sickness Benefits
(Form SI-1a)



Driver – Enter the complete name and address of the driver of the other car or vehicle involved in the accident. If
more than one other vehicle was involved, give information for all vehicles on a separate sheet of paper.



Insurance Company – Enter the complete name and
address of the insurance company of the owner of the
other vehicle involved in the accident.



Policy Information – Enter the policy number of the insurance policy held by the owner of the other vehicle and the
claim number assigned by the insurance company, if you
know it.

SECTION A - Identifying Information

Items 1– 6 are self-explanatory.
SECTION B - Infirmity and Employment Information

Item 7 is self-explanatory.
Item 8 – Enter the date you last worked for your last railroad employer before you became sick and unable to work.
For example, if you last worked on 12/31 and became sick
on 1/1, you would enter 12/31 as the date last worked.
Items 9 and 10 are self-explanatory.
Item 11 – Enter the title of your job. For example, “Road
Brakeman.”
Item 12 – Enter the department of the railroad in which
you work. For example, “Train and Engine Service.”
Item 13A-C – Complete this item if you worked for a nonrailroad employer or were self-employed after the last day
you worked for a railroad employer.


Item 13A - Enter the name of the company for which
you worked most recently. For example, “Acme
Accounting.”



Item 13B - Enter the title of your job. For example,
“Accountant.”



Item 13C - Enter the date you last worked outside the
railroad industry before you became sick and unable to
work. For example, if you last worked on 12/31 and
became sick on 1/1, you would enter 12/31 as the date
last worked.

SECTION C - Accident and Insurance Information

Item 14 is self-explanatory.
Item 15 – Check “Yes” if you filed or expect to file a lawsuit
or claim against any person or company for personal injury.
Items 15A is self-explanatory.
Item 15B – Enter the location where your injury or illness
occurred. For example, “Hwy 51/County Rd 12, Toledo, Ohio.”
Item 15C – Check “Yes” if you were injured in an automobile accident.
Item 15D – If you checked “Yes” in Item 15C, complete
the following items about all the vehicles involved in the
accident, other than your own.


6

Owner of Car – Enter the complete name and address of
the owner of the other vehicle involved in the accident.

SECTION D - Claim for Sickness Benefits Information

Your first sickness benefit claim is Items 16 through 20
on your SI-1a, Application for Sickness Benefits. After
your application and claim have been received and processed, your next sickness claim will be mailed to you.
Item 16 is self-explanatory.
Item 17 – Check “Yes” if you want to claim every day
from the date you entered in Item 16 through the current
date as a day of sickness. Check “No” if you do not wish
to claim every day. Remember that you cannot claim
benefits for any day on which you worked or otherwise
earned wages, holiday pay, vacation pay, sick pay
(excluding supplemental sickness benefits) or other pay.
This includes pay from full-time and part-time work in
either railroad or nonrailroad employment, and from
self-employment. You may claim rest days on which you
were sick or injured and for which you do not receive
pay from your employer.
Item 18 – If you checked “No” in Item 17, enter the dates
that you do not wish to claim.
Item 19 – If you have recovered from your infirmity and
have returned to work, enter the date you returned to work.
However, if you worked one or more days, but then continued to be unable to work, do not enter a date in this item. For
example, if you attempted to return to work but found that
you were not able to continue working, indicate the days you
worked and received wages in Item 18, but do not enter a
date in Item 19.
Item 20A-C – Each item must be checked “Yes” or
“No” to indicate the type of payments, if any, that you
have received or will receive for days in the claim period.
Also furnish the dates and/or other information requested
about the payment. The types of payments are explained
below.
Item 20A - Wages – Payments that you receive from your
railroad employer, from a nonrailroad employer, or your
own business for services you performed. Benefits are not
payable for any day for which you receive wages.

United States of America
Railroad Retirement Board

Form Approved
OMB No. 3220-0039

Application for Sickness Benefits
Section A
1.

Identifying Information
2. Social Security Number

Employee’s Name (First, Middle Initial, and Last)

–
3.

4. Date of Birth
Month
Day

Employee’s Street Address, City, State and ZIP Code
(Including Apartment Number)

–
5. Sex

Year

 Male
 Female

6. Telephone Number (Include Area Code)

(
Section B

)

Infirmity and Employment Information

7.

Date You Became Sick or Injured

8.

Date You Last Worked for a Railroad

9.

Last Railroad Employer (Name of Company)

10. Location of Last Railroad Employment (City/State)
11. Last Railroad Occupation
12. Department
13. If you worked for a nonrailroad employer after the date shown in Item 8, complete Items A, B, and C, below. Otherwise, go to Item 14.
A. Last Nonrailroad Employer (Name of Company)
B. Last Occupation After Railroad Work
C. Date Last Worked After Railroad Work

Section C

Accident and Insurance Information

14. Are you applying for sickness benefits because you were injured at work or have a work-related illness?  Yes
15. Have you filed or do you expect to file a lawsuit or claim against any person or company for personal injury?
 Yes - Complete Items A-D, below  No - Go to Item 16
A. Furnish the name and complete address of the person or company.

 No

Name
Address
City, State, ZIP Code
B. Give the place where the injury occurred.
C. Were you injured in an automobile accident?

 Yes

 No - Go to Item 16

D. If you were injured in an automobile accident, provide information about all the vehicles, other than your own, that were
involved in the accident that caused your injury. Information about your vehicle and insurance company is not needed. If you
need more space attach a separate sheet of paper.

Owner of Car (other vehicle)

Driver (other vehicle)

Name

Name

Address

Address

City, State, ZIP Code

City, State, ZIP Code

Insurance Company (other vehicle)

Policy Information (other vehicle)

Name

Policy Number

Address

Claim Number

City, State, ZIP Code

Continued on Reverse Side

SI-1a (03-12)

Section D

Claim for Sickness Benefits Information

16. Enter the earliest date you wish to claim sickness benefits. _________________________________________________________
17. Are you claiming all the days of sickness beginning with the date you entered in Item 16? (Note: You may claim rest days if you
 Yes - Go to Item 19  No - Go to Item 18
were unable to work and did not receive pay from your employer.)
18. Enter any dates that you do not wish to claim. ___________________________________________________________________
19. Enter the date you returned to work (if applicable). _______________________________________________________________
20. You must complete all boxes to indicate if you have received or will receive any of the following payments for your days of sickness.
If you check “YES” for any item, be sure to provide the requested information.
A. WAGES (Include Railroad and Nonrailroad Wages)
YES NO If “YES,” show the dates for which you were paid in Month/Day/Year format below.

 Regular Wages. . . . . . . . . . . .. . . . . ________________________________________________________________

 Vacation Pay . . . . . . . . . . . . . . . . . . ________________________________________________________________

 Holiday Pay . . . . . . . . . . . . . . . . . . ________________________________________________________________

 Military Reservist Pay . . . . . . . . . . ________________________________________________________________

 Wage Continuation Pay . . . . . . . . . ________________________________________________________________

 Earnings from Self-Employment . . ________________________________________________________________

 Sick Pay from Your Employer . . . . ________________________________________________________________
(but not payments supplementing Railroad Retirement Board (RRB) benefits. See Booklet UB-11)
B. GOVERNMENTAL PAYMENTS (Not RRB Sickness Benefits)
YES NO If “YES,” enclose copy of award letter and complete Items 1 - 3 below.

 Sickness or Unemployment Benefits Under Any Other Law
1. Beginning Date of Payment

 Social Security Benefits
2. Gross Amount of Payment $ __________________

 Railroad Retirement or Disability Annuity
3. How often do you receive the payment?

 Military Retirement Pay
 Weekly  Monthly  Yearly

 Worker’s Compensation
 Other: ________________________________

 Retirement Payments Under Another Law
C. OTHER PAYMENTS
YES NO If “YES,” complete Items 1 and 2.

 Settlement, Judgment or Damages for Personal Injury

 Advances

 Separation Allowance (Buyout, Severance Pay)

1. Date of Payment
2. Paid By: __________________________________

21. If the date you are submitting this form is more than 30 days after the date you entered in Item 16, answer the following:
A. Why did it take more than 30 days to submit this form? If more space is needed, attach a separate sheet of paper.
______________________________________________________________________________________________________
B. How did you obtain this form? _____________________________________________________________________________
C. Who provided this form to you? ____________________________________________________________________________
D. On what date did you obtain the form? ______________________________________________________________________
E. Furnish the name and title of any person from whom you asked for help in completing and filing the forms.
NAME_______________________________________________________ TITLE ___________________________________

Section E

Direct Deposit Information

22. Benefits are normally paid by Direct Deposit to your bank, savings and loan, credit union, or other financial institution. To provide

the information we need to correctly deposit your payments, attach a voided personal check and go to Item 23, or call your
financial institution for the information you need to complete Items A-E.
A. Routing Transit Number
C. Account Type:
 Checking  Saving

Section F

B. Account No. _______________________________
D. Name of Financial Institution: _________________________________________
E. Telephone No. (Include Area Code) (_______)____________________________

Certification and Signature

23. I waive any ”doctor-patient privilege” I may have with respect to the disclosure of information concerning the period of sickness or injury on

which my claim is based. I certify that I understand and agree to the requirements in Booklet UB-11. I know that disqualification and civil and
criminal penalties may be imposed on me for false or fraudulent statements or claims or for withholding information to get benefits from the
RRB. I affirm that the information given on this form is true, correct and complete. NOTE: If the sick or injured employee is unable to sign
this form, sign your name and complete Section 1 of the attached Form SI-10, Statement of Authority to Act for Employee.

SIGNATURE ______________________________________________________________________ DATE __________________
SI-1a (03-12)

HAVE YOUR DOCTOR COMPLETE THE ATTACHED STATEMENT OF SICKNESS

United States of America
Railroad Retirement Board

Form Approved
OMB No. 3220-0039

Statement of Sickness
Instructions: This form is to be executed by (1) a doctor trained in medical, surgical, dental or psychological diagnosis of
the infirmity described, (2) a certified nurse/midwife in cases of pregnancy or childbirth, (3) a supervisory official of a
hospital or similar institution, (4) a chiropractor, (5) a Physician Assistant - Certified, or (6) a nurse practitioner. This form
should be completed and returned to the patient immediately for prompt mailing; otherwise he/she may lose benefits.
Supplementary medical information may be attached or furnished directly to the Railroad Retirement Board (RRB) at the
address shown below. If such information is furnished, please include the patient's social security number and name on the
report. Please complete section 2 on the reverse side if patient is incapable of signing forms.
The RRB is not liable for any charge in connection with completing this form.
1. Patient's Name (First, Middle, and Last)

2. Patient's Social Security Number

3. Have you examined or treated the patient for his or her injury or illness?
a. Date patient became sick or injured

 Yes

 No – Go to Item 9

b. List all dates of examination and treatment for this infirmity

c. Probable date of next examination
4. Diagnosis and concurrent conditions

5. Does the patient's condition require surgery?

 Yes 

No – Go to Item 6

a. Date on which surgery was or will be performed

b. Surgical procedure that was or will be performed

6. Does the patient's condition require hospitalization?




Yes – Enter the period of hospital confinement: From

To

No

7. If patient is not working because of maternity or childbirth, complete 7a and 7b.
b. Estimated or actual date of delivery





a. Date patient became unable to work

8. Give the date you believe the patient became or will become able to resume work in his or her occupation.


(If indefinite or unknown, please give an estimated date.)

9. 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 or prevent payment of benefits by the RRB.
Please print or type:
Name of Doctor

Signature of Doctor

Degree/ Title

Address

Office Telephone Number (Include Area Code)

Date

(

)

National Provider Identifier

PAPERWORK REDUCTION ACT NOTICE TO DOCTOR
Medical evidence is needed to support the payment of claims for sickness benefits under the Railroad Unemployment Insurance Act (RUIA). The RRB is
authorized to collect this information under section 12(i) of the RUIA. You are not required to furnish this information. If you do not, however, no benefits
can be paid to your patient. We estimate this form and the form on the back of this page take an average of 8 and 6 minutes to complete, respectively.
The estimates include the time for reviewing the instructions, getting the needed data, and reviewing the completed forms. 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 the Chief of
Information Resources Management, Railroad Retirement Board, 844 N Rush Street, Chicago, Illinois, 60611-2092. Send completed forms to:

U.S. RAILROAD RETIREMENT BOARD
OFFICE OF PROGRAMS — OPERATIONS
POST OFFICE BOX 10695
CHICAGO, ILLINOIS 60610-0695

Doctor: See Reverse Side

FORM SI-1b (06-09)

United States of America
Railroad Retirement Board

Form approved
OMB No. 3220-0034

Statement Of Authority To Act For Employee
It is not necessary to complete this form for an employee who can sign papers or can
sign by mark and understands transactions relating to his or her sickness benefits.

Instructions
Instructions:
1. Complete Section 1 and have the employee's medical doctor complete Section 2. If you are not related to the employee by blood or marriage, state your relationship and explain why no relative is acting for the employee. For example, an employee's union representative might explain: “I am his union chairman. He has no immediate family.”
2. Complete this statement by following the instructions in the UB-11 booklet under “Instructions for
Completing Forms, Statement of Authority to Act for Employee (SI-10).” Signing this statement gives you the
authority to sign any claim forms on behalf of the employee. When signing claim forms use your full name,
and beneath your signature, write “On behalf of ” and the employee’s full name.
3. Return this form with the next application or claim form you file with the RRB.

Section 1

Statement of Individual Acting for Employee

It is my belief that
(Employee's Name)

(Social Security Number)

whose address is
(Employee's Address)

is at this time incapable of signing forms in connection with obtaining sickness benefits under the Railroad
Unemployment Insurance Act; of transacting the necessary business relative to his or her application and claims
for such benefits; and of applying the proceeds of any sickness benefit payments.
I believe the employee to be incapable because

(Briefly describe employee's condition)

My relationship to the employee is
I affirm that, in the transaction of business relating to the application and claims of this employee, including the use
of any benefit payments, I will act on behalf of and in the best interest of the employee. I will promptly notify the
RRB at such time as this employee's condition changes so that I need no longer act for him or her. I understand that
criminal and civil penalties may be imposed on me for providing false, incomplete, or fraudulent statements; using
the benefits received on something other than the claimant; or for withholding information to cause the payment of
benefits. I certify that, to the best of my knowledge, the information I have provided is true, complete, and correct.
Name (please print)

Signature

Phone Number
(

Street Address (please print)

Section 2

City

)

State ZIP Code Date

Statement of Employee's Doctor

I have examined the employee named above and find that he/she is incapable of signing forms and transacting
business relative to his/her claims for sickness benefits under the Railroad Unemployment Insurance Act.
Name of Doctor (please print)

Office Street Address (please print)

National Provider Identifier

SI-10 (06-09)

Signature of Doctor

City

State ZIP Code Date



Regular Wages – Pay for time worked, including
full-time and part-time work.



Vacation Pay – Pay for scheduled or assigned vacation days. Vacation pay does not include “pay in lieu
of vacation.” If you do not know if the payment you
received was “pay in lieu of vacation,” check with
your payroll office before completing this item.



Holiday Pay – Pay from your employer for a holiday.



Military Reservist Pay – Wages paid to you by the
Federal Government based on your military service.







Wage Continuation Pay – Salary or wages paid by
your railroad employer when you have been injured on
duty. The purpose of the payments is to continue your
wage or salary, not to supplement RRB benefits. The
payments are subject to normal payroll deductions.
Earnings from Self-Employment – Pay for services
performed.
Sick Pay from Your Employer – A continuation of
all or part of your wages while you are unable to
work. The term “Sick Pay” does not include supplemental sickness benefits. For an explanation of supplemental sickness benefits, see page 4.

Item 20B - Governmental Payments – Annuities or
other payments made to you by a county, city, state or the
Federal Government. If you are receiving a governmental
payment, check the appropriate box and enter the beginning date, the gross amount, and the frequency of the
payment. For an explanation of how governmental payments affect the payment of sickness benefits by the
RRB, see the section Benefit Reductions on page 4 .


Sickness or Unemployment Benefits Under Any
Other Law – Benefits paid to you by a county, city,
state or other Federal agency due to sickness or
unemployment.



Social Security Benefits – Benefits paid to you by
the Social Security Administration, excluding supplemental security income payments (SSI).



Railroad Retirement or Disability Annuity –
Monthly payments made to you by the RRB based on
your age and railroad service or on disability. An
RRB annuity under the Railroad Retirement Act is
not the same as RRB sickness benefits.





Worker’s Compensation – Disability payments
made to you under a state law when you have been
injured on the job.



Retirement Payments Under Another Law – An
annuity or pension paid to you by a county, city, state
or the Federal Government.

Item 20C - Other Payments – If you are receiving some
type of other payment, check the appropriate box and give
the date of the payment and who made the payment to you.


Settlement or Damages for Personal Injury – A
payment received as a result of a judgment or the
settlement of a personal injury claim against your
railroad employer or another party that you held
liable for your injury or illness.



Advances – A payment received in anticipation of a
settlement of a personal injury claim against your
railroad employer.



Separation Allowance (Buyout, Severance Pay) – A
payment received when you resign in return for a
specified sum of money. The payments are also
referred to as “buyouts” or “severance pay.” Payment
may be made in a lump sum or installments in return
for your resignation.

Item 21 is self-explanatory.
SECTION E - Direct Deposit Information

Item 22 – The Department of the Treasury (Treasury)
requires all federal benefit payments to be made electronically. You will need to choose an electronic payment option. You can choose to have your payments
made by Direct Deposit to a bank, savings and loan,
credit union account or other financial institution or to a
Direct Express® Debit Mastercard®. Both options save
money by eliminating the need to print and mail checks.
An electronic payment has many advantages. Payments are
generally available 2 or 5 days sooner than payment by
check. You do not have to worry about a check being lost,
stolen or misplaced and you can be away from home without the worry of a check sitting unprotected in your mailbox. There is no need to wait for mail delivery of a check
or to make a special trip to your financial institution.
To provide the information we need to correctly
deposit your benefit payments, attach a voided personal check to your application or call your financial institution for the information needed to complete Item 22A-E.

Military Retirement Pay – Retainer pay, an annuity, or pension paid to you by the Federal
Government based on your military service.

7

If you change financial institutions or your account
while claiming benefits, be sure to give the RRB information to establish Direct Deposit to your new account.
Do not close your old account until you receive the first
RRB payment in your new account.
If you do not have an account at a financial institution or you prefer to receive your benefit payments on
a prepaid debit card, you can call 1-888-544-6347 or
v i s i t w w w. G o D i r e c t . o rg f o r i n f o r m a t i o n about
enrolling in the Direct Express® program.
Electronic Payment Waiver Conditions
Treasury will allow benefit payments to be paid via paper
check to individuals who:


were born before May 1, 1921,



have a mental impairment and do not have a
representative payee,



live in a remote area of the country that lacks
infrastructure to support electronic financial
transactions, or



had a Direct Express® Debit Mastercard® that
was suspended or cancelled.

You will need to contact Treasury directly at 1-800-3331795 to apply for a waiver.

Statement of Authority to Act for
Employee (Form SI-10)
Completion of Form SI-10, Statement of Authority to
Act for Employee, is not required for an employee
who can sign papers or can sign by a mark and who
understands transactions related to his or her application
for benefits.
SECTION 1– Statement of Individual Acting for
Employee

This section is to be completed by the individual who
signed the SI-1a, Application for Sickness Benefits, and
who will act on behalf of the employee. Enter the
employee’s name, social security number, and address.
Briefly explain why you believe the employee is incapable,
and enter your relationship to the employee. If you are not
related to the employee by blood or marriage, state your
relationship and explain why no relative is acting for the
employee. For example, an employee’s foreman might
explain: “My relationship to the employee is his foreman.
He has no immediate family.”
Completing Form SI-10, gives the signer the authority to
sign any claim form on behalf of the employee.
When signing claim forms use your full name, and
beneath your signature write “On behalf of” and the
employee’s full name.

SECTION F - Certification and Signature

Item 23 – By signing and dating this item you certify that
the information contained on the form is true, correct, and
complete.
If the sick or injured employee is unable to sign in Item
23, the person completing the application should sign in
Item 23, and complete the enclosed Form SI-10,
Statement of Authority to Act for Employee.

Statement of Sickness (Form SI-1b)

SECTION 2 – Statement of Employee’s Doctor

Have the employee’s medical doctor complete this section.

Claim for Sickness Benefits
(Form SI-3)
The following instructions are for claim forms mailed to
you by the RRB. Read the instructions carefully before
completing your claim forms. Failure to complete your
claim correctly could delay the payment of benefits.

The SI-1b, Statement of Sickness, must be completed by
your doctor or other qualified medical provider (see the
section Medical Statements on page 3). If possible, have
your doctor complete the statement while you are at the
office, rather than leaving the form for completion. If you
must leave the form for completion, explain to your doctor
that the form is needed for you to receive bi-weekly benefit
payments and that the form must be received by the
Railroad Retirement Board within 10 days of the first day
you became sick or injured or you may lose benefits.

IMPORTANT INFORMATION
Claims for days after your first claim, which is included on
the SI-1a, Application for Sickness Benefits, will be
mailed to you for as long as you remain unable to work
and eligible for benefits. You must complete and return
each claim promptly or you may lose benefits. The time for
filing a claim, including time for mailing, is limited to 30
days from the last day of the claim period, or 30 days from
the date the claim form was mailed to you, whichever is later.

Do not separate the SI-1b, Statement of Sickness, from
your SI-1a, Application for Sickness Benefits.

If you return to work and stop claiming benefits, but
become sick or injured again later in a benefit year, you
must file a new SI-1a, Application for Sickness Benefits.

8

RAILROAD RETIREMENT BOARD

FORM APPROVED OMB 3220-0039

CLAIM FOR SICKNESS BENEFITS

090 112811 112911

120211

J SMITH

02 02 700

1. This claim is for sickness benefits for the period shown below. To claim benefits, mark the box under each date with the
appropriate code (X, E, P, or O).
X – Claimed day of sickness
(Including rest days)

P – Vacation, holiday, sick pay, or other pay from your employer
(Do not report supplemental sickness benefits)

E – Day employed (Include railroad, nonrailroad, or self-employment)

O – Day not claimed, other reason

This claim is for
11- 21- 11 through 12-04-11
Mark each box with X, E, P, or O

21

22

23

24

25

26

27

28

29

30

1

2

3

4

X

X

X

P

P

X

X

X

X

X

E

E

O

O

Item 1 - This item shows the days in the claim period.
Below each day of the claim period, you must enter the
correct letter code (X, E, P, O) to show whether you
want to claim benefits for the day (X); or whether you
worked (E), received vacation pay, holiday pay, or other
pay from your employer (P); or that you do not want to
claim benefits for some other reason (O).
Remember that you cannot claim benefits for any day
on which you worked or otherwise earned regular
wages, vacation pay, holiday pay, military reservist pay,
wage continuation pay, sick pay (excluding supplemental
sickness benefits), or other pay. This includes pay from
full-time and part-time work in either railroad or
nonrailroad employment.
Use the following letter codes to show whether you are
claiming benefits for the days in the claim period:
X – Enter an “X” if you did not work on that day, will
not receive any type of pay for that day, and were
unable to work because of injury or illness on that day.
Any day you mark with an “X” is considered to be a
day of sickness for which you are claiming benefits.
Use an “X” to claim normal rest days on which you
were unable to work. Do not claim your rest days if
you were able to work, did work, or otherwise
received pay from either a railroad or nonrailroad
employer for the days.
E – Enter an “E” if you were employed either full
time or part time on the day. Include work for
either a railroad or nonrailroad employer, and any
self-employment.

or nonrailroad employer. This includes vacation pay,
holiday pay, wage continuation pay, sick pay (excluding
supplemental sickness benefits), daily wage guarantee
pay, and pay for time lost.
Do not enter “P” for days you receive payments
under a supplemental sickness benefit plan paid or
financed by your employer, such as benefits paid by
Trustmark Insurance Company or Provident Life
Insurance Company. Such payments are normally
paid in addition to your sickness benefits from the
RRB. For an explanation of the difference between
regular sick pay, which you must report, and supplemental sickness benefits, see the back of your claim
form or the section Sick Pay and Supplemental
Sickness Benefits on page 4 of this booklet.
O – Enter an “O” for days on which you did not work
and did not receive any type of payment, but which
you do not wish to claim for some other reason.
An example of how the boxes are to be completed is
shown above.
Item 2A - If you have recovered from your infirmity and
have returned to work, answer Item 2A “Yes” and enter
the date you returned to work in Item 2B. If you attempted to return to work but found that you were not able to
continue working, answer Item 2A “No” and enter an “E”
in Item 1 for any day you worked and received wages.
Do not enter a return-to-work date in Item 2B.
Item 3 - This item is prefilled with the name and
address of your local RRB office. Mail your completed
claim to that office.

P – Enter a “P” for any day that you were not
employed, but will receive payment from a railroad

9

Item 4 - This item is prefilled with your name and
address. If necessary, show corrections to your name and
address in the box.
Item 5A-C - See Item 20A-C on page 6 of this booklet
for instructions on completing Item 5A-C. Reference
Item 20A to complete Item 5A; Item 20B to complete
Item 5B; and Item 20C to complete Item 5C.
Item 6 - By signing and dating this item you certify that
the information contained on your claim form is true and
complete. Do not complete and sign the claim form
before the last day of the claim period. If your claim is
mailed to the RRB before the last day of the claim period,
benefits due you may be delayed or denied.

Privacy Act Notice
To receive sickness benefits you must apply for them and
furnish information. Information that the RRB asks you
to furnish is used to determine if you are eligible for benefits and the amount of benefits payable to you. Although
furnishing information, including your social security
number, is voluntary, the RRB cannot pay you benefits
without this information. The RRB’s authority for
requesting information is Section 5(b) of the Railroad
Unemployment Insurance Act.
The RRB may routinely furnish information to the following individuals, organizations, and/or agencies for the
purpose of administering the Railroad Unemployment
Insurance Act, the Social Security Act, or other benefit
programs under Federal or State laws:
1. The U. S. Treasury Department and the U.S. Postal
Service, to issue benefit payments and to report nondelivery, forgery, theft or loss of a benefit payment.
2. A person or company which the claimant reports may
award pay for time lost or some similar payment for the
same period for which the RRB pays benefits.
3. Persons or companies named by the claimant as liable
for paying damages for the same injury or illness for
which the RRB pays sickness benefits.
4. The Internal Revenue Service for use in administering
Federal tax laws.
5. A private collection agency, the Government
Accountability Office, the Department of Justice, or the
Internal Revenue Service for the collection of an overpayment.
6. Employers or insurance companies for use in administering supplemental benefit or health insurance plans.

10

7. Law enforcement agencies and the Department of
Justice for investigating or prosecuting a violation of law
.
8. Employers to verify entitlement to benefits and to
provide notice of benefit payment determinations.
9. State unemployment agencies to verify entitlement to
benefits.
Other than information that may be disclosed routinely, no
information about your claim may be disclosed without
your consent.

Computer Matching and Privacy
Protection Act Notice
In addition to the uses of information described in the
preceding Privacy Act Notice, information you provide may be used, without your consent, in automated
matching programs. These matching programs are a
computer comparison of Railroad Retirement Board
records with records kept by other Federal agencies or
State and local governmental agencies. Information
from these matching programs can be used to establish
or verify a person’s eligibility for benefits and for
repayment of benefits or delinquent debts.
What Are Computer Matching Programs?
Computer matching programs compare our records with
those of other Federal, State, or local governmental
agencies. All agencies may use matching programs to
find or prove that a person qualifies for benefits paid for
by the Federal Government.
How Do Computer Matching Programs Affect You?
On forms that you fill out for us you give us facts about
yourself. Sometimes, we check the facts you and others
give us. We use computer matching to do the checking.
The law allows us to check this way even if you do not
agree to it. We can also give any facts we have about
you to other governmental agencies for them to use in
their computer matching programs.

Paperwork Reduction Act Notice
To receive sickness benefits, you must complete an
application and claim form(s). You may also be asked to
complete other forms. Some of these forms are listed
below along with estimates of how long we think it takes
to complete them. The estimates include 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 estimates or any other aspect of the
forms, including suggestions for reducing completion
times, to the Chief of Information Resources
Management, Railroad Retirement Board, 844 N. Rush
Street, Chicago Illinois 60611-2092. Be sure to include
the form title and control number (in parentheses
below) with your comments.

Form No.

Title

Estimated
Completion
Time
(Minutes)

SI-1a

Application for Sickness
Benefits (3220-0039)

10

SI-1b

Statement of Sickness
(3220-0039)

8

SI-3

Claim for Sickness
Benefits (3220-0039)

5

SI-3

Internet Claim for Sickness
Benefits (3220-0039)

5

SI-10

Statement of Authority
to Act for Employee
(3220-0034)

6

ID-7h

Notice of Non-Entitlement to
Sickness Benefits and
Information on
Unemployment Benefits
(3220-0039)

5

Nondiscrimination on the
Basis of Disability
Under Section 504 of the Rehabilitation Act of 1973 and
RRB regulations, no qualified person may be discriminated
against on the basis of disability. RRB programs and
activities must be accessible to all qualified applicants
and beneficiaries, including those who are vision- or
hearing-impaired. Disabled persons needing assistance
(including auxiliary aids or program information in
accessible formats) should contact the nearest RRB
office.
Complaints of alleged discrimination by the RRB on the
basis of disability must be filed within 90 days in writing
with the Director of Administration, Railroad Retirement
Board, 844 North Rush Street, Chicago, Illinois 60611-2092.
Questions about individual rights under this regulation may
be directed to the RRB’s Director of Equal Opportunity at
the same address.

11

Checking Your Benefits by Telephone or Online
You can obtain detailed information about your sickness benefit payments and claims at any time, by
calling our national automated telephone service.
Calling this number gives you access to:






the amount and date of your latest benefit
payment, and the claim period for which the
payment was made;

To access your benefit information by telephone:


Call the Railroad Retirement Board at
877-772-5772.



Press “1” to select our automated HelpLine services.



Press “1” again to access the Sickness Benefits
Menu.

information about your last 5 benefit payments; and
confirmation of whether we have received your
application.

We update payment information once each night; we
update information about applications, claims and
Supplemental Doctor’s statements as we receive the
forms.
You will need your social security number and your
Personal Identification Number (PIN) to get information
about your benefit payments and claims. Your PIN is
printed on the back of each claim form we mail to you.

Note: People who are deaf or hard of hearing may
call our TTY number at 312-751-4701.
You can also access your benefit information
online. In order to do so, you must have or establish
an online account. To learn more about establishing
an account, visit our Website at www.rrb.gov, select
Benefit Online Services, go to “Claim Sickness
Benefits More info” and click on More info. Once you
have established an account, click on Claim to access
your benefit information.

Each claim you receive will have a record of your last 3 payments. Use the HelpLine services and the tables below
to keep track of your claims and payments.
Please allow at least 15 days from the date you mail your claim to receive a payment. That time is needed for delivery
of your claim and payment, and to allow your employer to submit information about your claim.

Record of
Claims Submitted
Beginning Date
of Claim

12

Number of
Days Claimed

Date Mailed
to RRB

Record of
Payments Received
Amount of
Payment

Date Payment
Received

Important Reminders
Filing Requirements—To avoid losing sickness
benefits, your benefit application must be
received by a Railroad Retirement Board (RRB)
office within 10 days of the first day for which
you want to claim benefits. Your sickness claims
must be filed within 30 days of the last day of the
claim or 30 days from the date we mail the form
to you, whichever is later.
Benefit Year/Base Year—A new benefit year
begins each July 1. Eligibility for benefits in a
benefit year is based on your earnings in the
previous calendar year (base year). For an
example, see the section titled Qualification
Requirements.
Waiting Period Requirement—To satisfy a
one-week waiting period requirement, no benefits
are payable for your first 7 days of sickness in
your first claim in a period of continuing sickness,
unless you have already served a waiting period in

the benefit year. Even though no benefits are
payable for the first 7 days of sickness, you must
file a claim for your days of sickness during the
waiting period; otherwise you may lose benefits
for claims after the waiting period.
Do Not Claim Benefits for Days You Work
or Receive Pay—Benefits are not payable for
any day for which you receive pay. This
includes wages from military reservist duty,
full- or part-time work for a railroad, nonrailroad
employer, or self-employment. It also includes
vacation pay, holiday pay, pay for time lost,
guarantee pay and other types of remuneration.
Reconsideration Rights—You may request
reconsideration of any decision denying you
benefits. A request for reconsideration must be
made in writing within 60 days of the date of
notice of the Railroad Retirement Board’s
adverse decision.

Fraud and Abuse Hot Line
Call the toll-free Hot Line if you have reason to
believe that someone is receiving railroad
unemployment or sickness benefits to which he
or she is not entitled. The Hot Line has been
installed by the Railroad Retirement Board’s
Inspector General to receive any evidence of
fraud or abuse of the RRB’s benefit programs.

The toll-free Hot Line number is 1-800-772-4258.
Or you may send your complaints in writing to:
RRB, OIG, Hot Line Officer, 844 North Rush
Street, Chicago, Illinois 60611-2092. Please do not
call the Inspector General’s Hot Line with questions
about eligibility requirements, delayed claims, or
similar problems. Such matters should be directed
to the nearest Railroad Retirement Board office.

Did You Know. . .
Railroad employees do not pay for their sickness benefits protection. The funds come from
a payroll tax on employers.
A fine, jail sentence, and disqualification
may be imposed upon any person found to
have withheld information or to have made
false or fraudulent statements or claims for
the purpose of causing benefits to be paid.

We encourage you to file certain proofs in
advance of retirement–age, military service,
and marriage. If married, you should also
submit proof of your spouse’s age. We record
and store the information electronically until
your retirement. Filing proofs in advance
speeds the application process and helps avoid
any delay in processing that could occur due
to inadequate or missing proofs.

13