ID-5R (SUP) (08-14 Report of Employees Paid RUIA Benefits for Every Day in

CURRENT
FORM APPROVED
OMB NO 3220-0025
U.S. RAILROAD RETIREMENT BOARD
OFFICE OF PROGRAMS - PROGRAM EVALUATION AND MANAGEMENT SERVICES
844 N. RUSH STREET
CHICAGO, IL 60611-2092

A comparison of unemployment and sickness benefit payment records with
annual railroad compensation reports shows that some employees of your
company were paid unemployment or sickness benefits for every day in
one or more months for which creditable service and compensation was
reported. In order to determine if the reported compensation affects the
payment of benefits for the fully claimed months, we need additional
information from you.
Enclosed is a listing of employees of your company and the month(s) for
which we need additional information about each employee's compensation.
Please furnish the information according to the instructions provided on
page 2 of this letter.
Our authority for requesting this information is explained below. If you
have any questions about this request, please contact us at (312) 751-3361.
Thank you for your cooperation.
Railroad Retirement Board
Enclosures
---------------------------------------------------------------------Paperwork Reduction Act Notice
The Railroad Retirement Board's (RRB) authority for requesting information
is contained in provisions of the Railroad Unemployment Insurance 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 for the limited purpose
of verifying a claim for benefits.
The RRB realizes that many companies have adopted policies regarding
disclosures of personal information needed for proper administration of
the Railroad Unemployment Insurance Act. Information that the RRB
acquires about a person is protected from disclosure except as provided
by law.
FORM ID-5R (08-14)
Please Read And Follow These Instructions.
_________________________________________
1.

Identify the days for which the employee received compensation and the

2.
3.
4.

5.

6.

type of compensation received (i.e., wages, holiday pay, vacation pay,
etc.) for each day in the month(s) shown on the listing. If you did not
pay the employee wages or other compensation for a particular month,
explain why you reported service for the month.
Since railroad unemployment and sickness insurance benefits are paid
on a daily basis, we need to know the exact days for which payments
were made. Be sure to list all days for each month shown.
If the employee received sick pay which was reported as creditable
compensation, please indicate the agreement under which the payment
was made.
While space is provided on the listing for your use, you may use a
separate sheet(s) to furnish the information. You may also submit a
computer printout or other company records as long as the records
clearly show the exact days for which the employee was paid and the
type of compensation paid. If separate sheets or records are used,
be sure to identify each employee by name and social security number
and attach the sheets to the listing.
If you find from your review that one or more months of creditable
service were incorrectly reported, submit a Form BA-4, Report of
Creditable Compensation Adjustments, to revise or delete the month(s)
credited in error. Submit the completed Form BA-4 with the enclosed
listing.
Complete the employer certification at the bottom of the listing. If
there is more than one page to the listing, complete the certification
on the last page only. Be sure to provide the name and telephone
number of the official to contact if we have questions about the
information you provide.

We estimate that a response to Form ID-5R (SUP) takes an average of 10 minutes
to complete, including the time for reviewing the completed response. 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 St.,
Chicago,IL 60611-2092.
FORM ID-5R (08-14) PAGE 2.