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1601 Provisions of the Act

1601.01 Section 4(a-1)(i)

of the Act provides, in part, that:

"There shall not be considered as a day of unemployment or as a day of sickness 

with respect to any employee...

"(i) any of the seventy-five days beginning with the first day of any registration 

period with respect to which the Board finds that he knowingly made or 

aided in making or caused to be made any false or fraudulent statement or 

claim for the purpose of causing benefits to be paid;" 

1601.02 Section 9(a)

of the Act provides, in part, that:

". . . any person . . . who shall knowingly make or aid in making or cause to be 

made any false or fraudulent statement or claim for the purpose of causing 

benefits or other payment to be made or not to be made under this Act, shall be 

punished by a fine or not more than $10,000 or by imprisonment not exceeding 

one year, or both."

1602 Provisions of the Regulations

Title 20, Part 355, Regulations under the Program Fraud Civil Remedies Act of 

1986 (20 CFR 355) provides procedures for civil penalties and assessments 

against persons who make false or fraudulent statements or claims.

1603 Provisions of the Basic Board Orders

Basic Board Order No. 1, Section 6, Fraud, Waste, Abuse or Other Wrongdoing 

in Agency Programs and Operations, Part B states:

All bureau and office heads shall:

1. Refer to the OIG Office of Investigations matters that appear to involve 

criminal activity, fraud, waste, abuse or other wrongdoing.

2. Ensure an OIG investigation is not jeopardized by administrative action by 

directing employees to adhere to guidance issued by the agency's 

General Counsel pursuant to the request of the OIG.

3. Provide advice and assistance to the OIG as requested. If the head of an 

office or bureau believes that a request made by the OIG is unreasonably 
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burdensome, the office or bureau head may appeal to the Chairman of the 

Board.

4. Pursue recovery of debts incurred under the Acts administered by the 

Board concurrent with investigations by the OIG; however, upon notice 

from the OIG that the case has been submitted to the Department of 

Justice for criminal prosecution, recovery shall be ceased.

In essence, the Board Order directs the Office of Programs to develop the facts, 

issue notices of determination and establish accounts receivable before referring 

a case with an appearance of fraud to the OIG.

1604 Scope of Article Confined to Fraud of Claimant

This article is confined to a discussion of fraudulent claims made by a claimant, 

since experience has shown fraudulent claims made by an individual other than a 

claimant to be uncommon. A brief should be prepared to obtain advice from the 

Director of Policy and Systems before proceeding to develop a case for 

prosecution of a non-claimant under section 9(a). 

1605 Elements of Fraud

To constitute fraud within the meaning of section 4(a-1)(i) or 9(a) of the Act, the 

following facts must be established:

a. That the claimant made or aided in making a statement or claim or caused 

a statement or claim to be made.

b. That the statement or claim was false. 

c. That when the statement was made, the claimant knew it to be false or 

made it recklessly without any knowledge of its truth.

d. That the claimant made the statement or claim with the intention that it 

should be acted upon so as to cause benefits to be paid.

1606 Types of Fraud

For the purposes of section 9(a) and section 4(a-1)(i) of the RUIA, there are three 

types of overpayment cases with respect to fraud.

1. Criminal Fraud - Cases that meet the criteria for referral to the Office of 

Inspector General for criminal prosecution and punitive action. Also may 

include the filing of a civil action to obtain a judgment against the debtor. 

A debtor may be subject to both actions.
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2. Administrative Fraud - Cases that do not meet the criteria for referral to 

the Office of Inspector General for criminal prosecution but the 75-day 

fraud disqualification period still applies.

3. "No Fraud" - Cases where evidence does not support a fraud 

determination but a denial or recovery of benefits is still warranted.

1607 Basis for Fraud

Fraud may be involved if there is information that:

1. a claim or statement made by a claimant in connection with a claim may 

be false or fraudulent, or

2. a claimant has knowingly withheld information pertinent to a claim. 

For example: a claimant was or may have been employed on a substantial 

number of days for which unemployment or sickness benefits were paid. 

Employment on a single claimed day or on a few days only ordinarily does not 

warrant investigation for fraud, although benefits paid for the days may be 

determined to be erroneous.

In nearly all cases, fraud determinations can reasonably be based upon the 

evidence in file and the circumstances of the case (e.g. number of incorrect 

certifications, repeated infractions, previous inquiries, interviews, warnings, 

booklets or notices, degree of education, number of years of railroad service and 

prior job responsibilities, health, etc.)

1607.01 Sources of fraud

Information indicating fraud may be received:

- on or with applications or claims,

- from wages shown on state wage records,

- during entitlement interviews,

- from tips or complaints from interested outsiders directed to either the field 

office, headquarters or through the OIG Hotline,

- from employers, or

- from other sources.
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1607.02 "Hot" tips

Occasionally, information is received from someone other than the claimant that 

an individual may be fraudulently claiming sickness or unemployment benefits. 

This information may be received directly at headquarters, field offices or through 

the Office of Inspector General's (OIG) Hotline. If offices need to report this 

information to the OIG, the information should be sent to the OIG Hotline e-mail 

address (Hotline@OIG.RRB.Gov). Receipt of such tips are to be treated as 

potential fraud and developed accordingly. If the OIG receives information about 

a claimant committing fraud, they may refer the information to the Director of 

Operations for further case development.

1608 Investigating for Fraud

Ordinarily, field offices and Operations are to adjudicate cases only to the extent 

needed to determine entitlement to benefits. If, in the course of adjudication, it is 

found that the claimant is not entitled to benefits and the standards of fraud 

apply, care is to be taken in developing supporting information on the alleged 

fraud.

In cases that appear to meet the OIG referral criteria, the investigation should be 

limited to obtaining facts (e.g. information not provided on forms or clarification of 

information provided.) Any investigations should not determine why answers 

were given or used as a means to confront an individual about the fraudulent 

information he or she has given. If it is necessary to contact the claimant, do so 

only through written questionnaires. There is to be no personal contact either 

face to face or by telephone. This will help to avoid alerting the parties 

suspected of fraud and compromising any subsequent investigations that may be 

initiated by the OIG.

In cases that do not meet the OIG referral criteria, an interview is to be 

scheduled, if appropriate. The basic information to be obtained and reported is 

described in Appendix 316-A. Form UI-48, Claimant's Statement Regarding 

Benefit Claims for Days on Which He or She Worked, is to be completed at the 

interview.

1609 Applying Disqualification Under Section 4(a-1)(i)

1609.01 Statement of Determination

A Statement of Determination Form UI-27 showing the basis for the 

determination that section 4(a-1)(i) is applicable is to be prepared in each case 

which it is found to be applicable. The statement should also contain information 

as to whether the case was referred to OIG for possible prosecution. 
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1609.02 Notice to claimant

When it is determined that the disqualification provided for in section 4(a-1)(i) is 

applicable, the claimant is to be notified in the body of the letter advising the 

claimant of his or her denial of benefits. If a recovery is involved, such 

disqualification notice is to be included in the billing document. 

1609.03 Application of a stop record

A stop reason 160 is to be established on the claimant's record beginning the first 

day of a registration period in which it was found that the claimant fraudulently 

claimed benefits and ending 75 days after the beginning date of the last 

fraudulent claim.

Example A:

A claimant fraudulently claimed benefits for days in the following claim periods:

03/03 - 03/16 6666999 9999999

03/17 - 03/30 9999999 9999999

03/31 - 04/13 9999999 9999999

04/14 - 04/27 9999999 9666666

A 75-day disqualification period applies to each fraudulent registration period. In 

this example, the stop should end 75 days after the beginning of the last 

fraudulent registration period beginning April 14. Therefore, one stop should be 

established beginning March 3 and ending June 27.

Example B:

A claimant fraudulently claims benefits for days in the following two claim 

periods:

10/12 - 10/25 9999999 9999999

01/02 - 01/15 9999999 9999999

In this example, two stop periods need to be established because there is more 

than 75 days between the fraudulent registration periods. Therefore, one stop 

should be established beginning October 12 and ending 75 days later on 

December 25. The other stop should begin January 2 and end March 17.

1610 Referral to OIG for Possible Prosecution

Cases referred to and returned from OIG should be logged into the Referral 

Tracking System application (see FOM1 15165 – RTS Instructions). Please see 

your supervisor for instructions on who enters cases for your Section. 
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1610.01 Actions By Headquarters- SUBS 

Personnel in SUBS will make the final fraud determinations and establish the 

receivables, including the 75-day disqualification period. If the fraud case also 

meets the case referral standards for the Office of the Inspector General (OIG), 

SUBS will refer the case to them for criminal investigation within one workday 

after establishing the account receivable and verifying it processed on FMIS 

correctly. 

1610.02 Referral Criteria

Refer the case to the OIG for their investigation if it meets any of the following 

criteria: 

Debt Amount

 The debt is equal to or greater than $7,500.00, excluding debt due to the 

75-day disqualification or; 

 The debt is less than $7,500.00 and there is evidence that the claimant:

 - previously filed fraudulent claims and; 

- - has a debt established on his/her record but no notification or bill was 

released.

Fraudulent Representation

 Regardless of whether there is an overpayment, SUBS will refer the case 

if the individual fraudulently represented that he or she is a railroad 

employee entitled to benefits.

Forged Signature

 The individual forged the signature of a person authorized under Part 335 

of the Railroad Retirement Board’s regulations to execute a statement of 

sickness or altered the statements contents.

1610.03 Notifying the Debt Recovery Section (DRS) 

SUBS will also notify BFO - Debt Recovery Section (DRS) of the referral to OIG. 

DRS will modify FMIS to suspend further collection activities. 

1610.04 Manner of referral

A memorandum summarizing the facts shall be prepared for each case to be 

referred to the OIG and shall be sent together with the following. 

For SI cases include:
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• the source documents

• the UI-27 

• the original sickness claims (SI-3’s) stored at headquarters or sent in by 

Field Service. If the SI-3’s are at the Federal Records Center (FRC), 

SUBS should request the Division of Real Property Management to 

retrieve them. SUBS should send an e-mail to the current file assistant 

with the Forms “G-50” and “Request for Forms from the FRC” completed 

and attached. Copy (CC) the assistant’s supervisor and the OIG on the email. The request should include instructions for the SI-3’s to be 

delivered directly to the OIG. The OIG will follow up and trace for these 

claims if needed.

For UI cases include:

• the source documents

• the UI-27

• the UI-35 and UI-35c (interview)

• the UI-1

• the original unemployment claims (UI-3’s) stored at headquarters or sent 

in by Field Service. If the UI-3’s are at the Federal Records Center 

(FRC), SUBS should request the Division of Real Property Management 

to retrieve them. SUBS should send an e-mail to the current file assistant 

with the Forms “G-50” and “Request for Forms from the FRC” completed 

and attached. Copy (CC) the assistant’s supervisor and the OIG on the 

e-mail. The request should include instructions for the UI-3’s to be 

delivered directly to the OIG. The OIG will follow up and trace for these 

claims if needed.

1610.05 OIG action

Upon receiving a referral from Operations, the OIG will examine the case and 

through their investigations determine if the case warrants civil or criminal 

prosecution. If, after the OIG's investigation, it is found that the case warrants 

prosecution, the case will be referred by the OIG to the appropriate United States 

Attorney. The OIG releases Referral Memos in cases that are referred to the 

United States Attorney. A copy of those memos can be found on imaging.

If the U.S. Attorney prosecutes successfully obtaining an order or agreement of 

restitution, the OIG will refer the case to DRS to reactivate the accounts 

receivable and follow-up on the restitution in keeping with the order or 

agreement. In such cases, no recovery letter is to be released to the claimant; 
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rather, funds are applied to the debt as remitted directly to DRS by the claimant 

or through the Department of Justice.

If the U.S. Attorney declines the case, the OIG will return the case to DRS with a 

closing memorandum to reactivate the debt and follow-up on repayment.

1610.06 Action if repayment is offered

If, after the case has been referred to the OIG, the claimant offers to make 

repayment or has any inquiries regarding the benefits he/she received as a result 

of his/her fraudulent claim or statement, those inquiries should be forwarded to 

the OIG. 

Field Office (FO) Actions

Written Inquiries – FO personnel are to fax written inquiries to the OIG at 

312/751-4342. Include the claimant’s social security number and the statement 

“Open Investigation” on the fax cover sheet. Forward the original to SUBS via 

Form G-26. SUBS will forward the documents to OPNS-UPSD-Tax, Clerical & 

Imaging Section (TCIS) to be imaged. Notate on the original that it was faxed to 

the OIG, initial and date. A copy of the correspondence should be retained in the 

FO for one year. 

E-mail Inquiries- FO personnel should forward the e-mail to 

Hotline@oig.rrb.gov. The subject line should include “Open Investigation” and 

the social security number. Make a copy of the email and forward it to SUBS via 

Form G-26. SUBS will forward the documents to TCIS to be imaged. Notate on 

the copy that the original was forwarded to the OIG, initial and date. A copy of 

the correspondence should be retained in the FO for one year.

Telephone or In Office Inquiries- If a claimant calls or comes into the office to 

discuss their case, the FO personnel should advise the claimant that “We do not 

have specific information on your case and a written request will have to be 

sent to headquarters for a response.” Request the claimant to prepare a 

written statement that will be forwarded to headquarters. Do not mention that the 

request will be sent to the OIG. Fax the statement to the OIG at 312/751-4342. 

Include the claimant’s SSN and the statement “Open Investigation” on the fax 

cover sheet. Forward the original to SUBS, via Form G-26. SUBS will forward 

the statement to TCIS to be imaged. Notate on the original that it was faxed to 

the OIG, initial and date. A copy of the correspondence should be retained in the 

FO for one year.

Problems or Special Needs Cases- If a claimant insists on speaking to someone 

or this case needs special attention, have the FO Manager call or e-mail the 

Assistant Director of UPSD for SUBS. They will contact the OIG for the FO and 

obtain the requested information. 
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UNDER NO CIRCUMSTANCES SHOULD FO PERSONNEL FORWARD ANY 

CLAIMANT CALLS TO THE OIG OR GIVE OUT THE OIG TELEPHONE 

NUMBER.

Note: You may take any non-overpayment related action on these cases 

(i.e. change of address, direct deposit, etc.). However, after performing the 

action, send an e-mail to Hotline@oig.rrb.gov. Notate the action taken and 

date. The subject line should include “Open Investigation” and the SSN. 

Headquarters Actions

Written Inquiries- Headquarter employees are to fax written inquiries to the OIG 

at 312/751-4342. Include the claimant’s SSN and the statement “Open 

Investigation” on the fax cover sheet. The original should be sent to TCIS, so 

that the statement can be imaged. Notate on the original that it was faxed to the 

OIG, initial and date. 

E-mail Inquiries- Headquarter employees should forward the email to 

Hotline@oig.rrb.gov. The subject line should include “Open Investigation” and 

the SSN. Make a copy of the email and forward it to TCIS via a G-156a to be 

imaged. Notate on the original that it was faxed to the OIG, initial and date. 

Phone calls- If a claimant calls to discuss their case, personnel should advise the 

claimant that “We can not provide the information over the telephone and a 

written request is required.” Have the claimant send the request to:

U.S. Railroad Retirement Board

844 N. Rush St

Chicago, Il. 60611

Attention: Sickness and Unemployment Benefits Section (SUBS)

Do not mention that the request will be sent to the OIG upon receipt. Fax the 

statement to the OIG at 312/751-4342. Include the claimant’s SSN and the 

statement “Open Investigation” on the fax cover sheet. The original should be 

sent to TCIS, via a G-156a, so that the statement can be imaged. Notate on the 

original that it was faxed to the OIG, initial and date.

Problems or Special Needs Cases- If a claimant insists on speaking to someone 

or this case needs special attention, refer it to your supervisor (Chief of SUBS). 

They will contact the OIG and obtain the requested information.

UNDER NO CIRCUMSTANCES SHOULD HEADQUARTER PERSONNEL 

FORWARD ANY CLAIMANT CALLS TO THE OIG OR GIVE OUT THE OIG 

TELEPHONE NUMBER.
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Note: You may take any non-overpayment related action on these cases 

(i.e. change of address, direct deposit, etc.). However, after performing the 

action, send an e-mail to Hotline@oig.rrb.gov. Notate the action taken and 

date. The subject line should include “Open Investigation” and the SSN. 

1611 Release of Information

1611.01 U.S. Attorney requesting RRB records

Original RRB records required by the United States Attorney shall be made 

available upon request. This means that, in any such case, the RRB consents to 

the release of information to the United States Attorney. Also, the RRB

employee may, if requested, appear as a witness for the United States 

Government taking with him or her original documents and necessary data and 

certified copies.

1611.03 Subpoena requesting RRB records

Any subpoena served on an employee in connection with such a fraud case 

should be accepted. Upon request, such copies of documents should be 

furnished for the record, but the original documents should not be placed in the 

record.

If an RRB employee is to appear as a witness, and original documents are to be 

displayed, the RRB employee shall explain that the original documents may not 

be placed in the record. RRB employees may testify fully from the files in their 

possession. Records and testimony must relate solely to the claimant whose 

case is being prosecuted. 

1612 Authority to Make Fraud Determinations

Both Field Service (FS) and Operations are authorized to make final 

determinations as to fraud in unemployment and sickness benefit cases. 

However, personnel in Operations are responsible for establishing the 

receivables and/or denial of benefits including the 75-day fraud disqualification 

period.

1613 Publicity on Fraud Cases

Notice that a claimant has been indicted for or convicted of making a fraudulent 

claim for benefits should tend to discourage others from making fraudulent 

claims. OIG will arrange to publicize any indictments or convictions for fraud. 

1614 Reconsideration and Appeal of Fraud Determinations

If the claimant shows lack of fraudulent intent in reconsideration or appeal, the 

fraud determination can be reversed. This is not to say however, that the 
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recovery for the erroneously claimed days will also be reversed. That 

determination must be made separately from the fraud reversal determination.

If there is indication that a fraud case has been submitted to the United States 

Attorney for prosecution, all reconsideration and administrative appeal 

considerations are to be suspended. If the U.S. Attorney declines the case for 

prosecution reconsideration or appeals determinations may resume.