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Federal forms, ICRs, and supporting documents

OMB control number

Railroad Unemployment Insurance Act Applications

OMB 3220-0039 · RRB.

OMB 3220-0039

Under Section 2 of the Railroad Unemployment Insurance Act, sickness benefits are payable to qualified railroad employees who are unable to work because of illness or injury. The collection obtains information from railroad employees and physicians needed to determine eligibility to and the amount of such benefits.

The latest form for Railroad Unemployment Insurance Act Applications expires 2028-07-31 and can be found here.

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OMB Details

Railroad Unemployment Insurance Act Applications

Federal Enterprise Architecture: Income Security - Unemployment Compensation

Form SI-1A (08-21)Application for Sickness BenefitsPrintable OnlyForm
Form ID-11A (04-17)Requesting Reason for Late Filing of Sickness BenefitPaper OnlyForm and instruction
Form SI-3 (Internet)(08-21)Claim for Sickness BenefitsFillable Fileable SignableForm and instruction
Form SI-3 (08-21)Claim for Sickness BenefitsPaper OnlyForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.