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 **U.S. Railroad Retirement Board**
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 Paperwork Reduction Act Notice
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          Sickness Benefits for Railroad Employees
          Notices
          Paperwork Reduction Act Notice
 Topics
    

      
              Introduction
          Qualification Requirements
          Amount and Duration of Benefits
          Eligibility Requirements
          Medical Statements
          Sick Pay and Supplemental Sickness Benefits
          Disqualifications
          Benefit Reductions
          Personal Injury Settlements
          Reconsideration and Waiver
          When Sickness Benefits are Taxable
          Instructions for Completing Forms
          Notices
                                Privacy Act Notice
          Computer Matching and Privacy Protection Act Notice
          Paperwork Reduction Act Notice
          Nondiscrimination on the Basis of Disability
          Fraud and Abuse Hotline
          Checking Your Benefits by Telephone
          Important Reminders 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 time, to the Chief of Information Resources Management, Railroad Retirement Board, 844 N. Rush Street, Chicago Illinois 60611-1275. Be sure to include the form title and control number (in parentheses) with your comments.

Form No.
			Title
			Estimated Completion Time (Min)SI-1a
			Application for Sickness Benefits (3220-0039)
			10SI-1b
			Statement of Sickness (3220-0039)
			8SI-3
			Claim for Sickness Benefits (3220-0039)
			5SI-3
			Internet Claim for Sickness Benefits (3220-0039)
			5SI-10
			Statement of Authority to Act for Employee (3220-0034)
			6ID-7h
			Notice of Non-Entitlement to Sickness Benefits and Information on Unemployment Benefits (3220-0039)
			5
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U.S. Railroad Retirement BoardWilliam O. Lipinski Federal Building844 North Rush Street
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 Last updated: 04/14/2017