SI-10, Statement of Authority to Act for Employee

Form SI-10 (05-17) stand alone.pdf

Railroad Unemployment Insurance Act Applications

SI-10, Statement of Authority to Act for Employee

OMB: 3220-0039

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 3220-0039 can be found here:

2025-01-10 - Reinstatement without change of a previously approved collection

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