Sickness Benefits

for

Railroad Employees

United States of America

Railroad Retirement Board

Visit our Web site at www.rrb.gov

Form UB-11 

Sickness Benefit

Application Enclosed
Introduction 1

Qualification Requirements 2

Amount and Duration of Benefits

Waiting Period 2

Normal Benefits 2

Extended Benefits 2

Accelerated Benefits 2

Daily Benefit Rate 3

Number of Days of Sickness 3

Tier I Tax Deductions 3

Eligibility Requirements 3

Medical Statements 3

Sick Pay and Supplemental

Sickness Benefits 4

Disqualifications

Separation Allowance 4

False or Fraudulent Claim 4

Benefits Under Other Laws 4

Medical Examination 4

Benefit Reductions 4

Personal Injury Settlements 4

CONTENTS

Reconsideration and Waiver

Employee Rights 5

Employer Rights 5

When Sickness Benefits are Taxable 5

Instructions for Completing Forms

General Instructions 5

Important Information 5

Application for Sickness

Benefits (SI-1a) 6

Statement of Sickness (SI-1b) 8

Statement of Authority 

to Act for Employee (SI-10) 8

Claim for Sickness Benefits (SI-3) 8

Notices

Privacy Act 10

Computer Matching and Privacy

Protection Act 10

Paperwork Reduction Act 11

Nondiscrimination on the Basis

of Disability 11

Checking Your Benefits by Telephone

or Online 12

Important Reminders 13

Fraud and Abuse Hot Line 13
INTRODUCTION

1

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.

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. 

UB-11 (03-12)

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.

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.
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.

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.

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Daily Benefit Rate

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.

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);

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.

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.

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Sick Pay and

Supplemental 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.

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 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

the medical examination when required, you may be

disqualified from receiving sickness benefits.

Benefit Reductions

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.

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.

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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:

The amount of the overpayment is more than 10

times the current maximum daily benefit rate;

you were not at fault in causing the overpayment;

and

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

1.

2.

3.
Application for Sickness Benefits

(Form SI-1a) 

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.

Owner of Car – Enter the complete name and address of

the owner of the other vehicle involved in the accident.

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 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.

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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

14. Are you applying for sickness benefits because you were injured at work or have a work-related illness?

15. Have you filed or do you expect to file a lawsuit or claim against any person or company for personal injury?

A. Furnish the name and complete address of the person or company.

Name

Address

City, State, ZIP Code

B. Give the place where the injury occurred.

C. Were you injured in an automobile accident? 

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)

Name

Address

City, State, ZIP Code

Insurance Company (other vehicle)

Name

Address

City, State, ZIP Code

United States of America

Railroad Retirement Board

Form Approved

OMB No. 3220-0039

Section A Identifying Information

Section B Infirmity and Employment Information

Section C Accident and Insurance Information

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

3. Employee’s Street Address, City, State and ZIP Code

(Including Apartment Number)

2. Social Security Number

4. Date of Birth

Month Day Year

5. Sex

❏

❏

Male

Female

6. Telephone Number (Include Area Code)

( )

7. Date You Became Sick or Injured

9. Last Railroad Employer (Name of Company)

11. Last Railroad Occupation

8. Date You Last Worked for a Railroad

10. Location of Last Railroad Employment (City/State)

12. Department

13.

❏ Yes ❏ No

Driver (other vehicle)

Name

Address

City, State, ZIP Code

Policy Information (other vehicle)

Policy Number

Claim Number

❏ Yes ❏ No - Go to Item 16

Application for Sickness Benefits

Continued on Reverse Side SI-1a (03-12)

❏ Yes - Complete Items A-D, below ❏ No - Go to Item 16

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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 

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 1. Date of Payment

❏ ❏ Advances 2. Paid By: __________________________________ ❏ ❏ Separation Allowance (Buyout, Severance Pay)

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 ___________________________________

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 B. Account No. _______________________________

C. Account Type: D. Name of Financial Institution: _______________________________________ __

❏ Checking ❏ Saving E. Telephone No. (Include Area Code) (_______)____________________________ 

22.

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

Section D Claim for Sickness Benefits Information

Section E Direct Deposit Information

Section F Certification and Signature

❏ Yes - Go to Item 19 ❏ No - Go to Item 18
5. Does the patient's condition require surgery? Yes No – Go to Item 6

6. Does the patient's condition require hospitalization? 

Yes – Enter the period of hospital confinement: From To

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.

1. Patient's Name (First, Middle, and Last)

3. Have you examined or treated the patient for his or her injury or illness? Yes No – Go to Item 9

2. Patient's Social Security Number

The RRB is not liable for any charge in connection with completing this form.

❏

❏

❏

❏

a. Date patient became sick or injured

c. Probable date of next examination

4. Diagnosis and concurrent conditions

❏

❏

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

a. Date on which surgery was or will be performed

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

a. Date patient became unable to work b. Estimated or actual date of delivery

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:

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.)

b. Surgical procedure that was or will be performed

Name of Doctor

Address Office Telephone Number (Include Area Code)

( )

National Provider Identifier

Date

Signature of Doctor Degree/Title

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)

▲

▲

▲

No 
Statement Of Authority To Act For Employee

United States of America

Railroad Retirement Board

Form approved

OMB No. 3220-0034

SI-10 (06-09)

Instructions:

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.”

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.

Return this form with the next application or claim form you file with the RRB.

1.

2.

3.

Section 1

Section 2

Statement of Individual Acting for Employee

Statement of Employee's Doctor

It is my belief that

whose address is

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

My relationship to the employee is

(Employee's Name)

(Employee's Address)

(Briefly describe employee's condition)

(Social Security Number)

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)

Street Address (please print)

Signature

City State ZIP Code Date

Phone Number

( )

Name of Doctor (please print)

Office Street Address (please print)

National Provider Identifier

Signature of Doctor

City State ZIP Code Date

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.

Instructions

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.
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.

Military Retirement Pay – Retainer pay, an annuity, or pension paid to you by the Federal

Government based on your military service.

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.

7

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●

●

●

●

●

●

●

●

●

●

●

●

●

●

●
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

visit www.GoDirect.org for information 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 1-800-333-

1795 to apply for a waiver.

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)

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.

Do not separate the SI-1b, Statement of Sickness, from

your SI-1a, Application for Sickness Benefits.

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 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.

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. 

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

●

●

●

●
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.

P – Enter a “P” for any day that you were not

employed, but will receive payment from a railroad

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.

9

CLAIM FOR SICKNESS BENEFITS

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).

090 112811 112911 120211 J SMITH 02 02 700 

X – Claimed day of sickness

(Including rest days)

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

This claim is for

11-21-11 through 12-04-11

Mark each box with X, E, P, or O

P – Vacation, holiday, sick pay, or other pay from your employer

(Do not report supplemental sickness benefits)

O – Day not claimed, other reason

21 22 23 24 25 26 27 28 29 30 1 2 34

X X X P P X X X X X E E OO

RAILROAD RETIREMENT BOARD FORM APPROVED OMB 3220-0039
10

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.

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.
11

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.

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.

SI-1a

SI-1b

SI-3

SI-3

SI-10

ID-7h

10

8

5

5

6

5

Application for Sickness

Benefits (3220-0039)

Statement of Sickness 

(3220-0039)

Claim for Sickness

Benefits (3220-0039)

Internet Claim for Sickness

Benefits (3220-0039)

Statement of Authority

to Act for Employee

(3220-0034)

Notice of Non-Entitlement to

Sickness Benefits and

Information on

Unemployment Benefits

(3220-0039)

Form No.

Estimated

Completion

Time Title (Minutes)
Beginning Date

of Claim

Number of

Days Claimed

Date Mailed

to RRB

Amount of 

Payment

Date Payment 

Received

12

Record of 

Claims Submitted

Record of 

Payments Received

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.

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:

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. 

To access your benefit information by telephone:

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.

the amount and date of your latest benefit

payment, and the claim period for which the

payment was made;

information about your last 5 benefit payments; and

confirmation of whether we have received your

application.

●

●

●

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.

●

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13

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.

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.

Important Reminders

Fraud and Abuse Hot Line

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.