UB-10, Unemployment Benefits for Railroad Employees (11-06)

Unemployment Benefit
Application Enclosed

Unemployment
Benefits
for
Railroad Employees

United States of America
Railroad Retirement Board
Visit our Web site at http://www.rrb.gov

Form UB-10 (11-06)

CONTENTS
Page
Introduction

1

Qualification Requirements

2

Amount and Duration of Benefits:
Waiting Period
Normal Benefits
Extended Benefits
Accelerated Benefits
Daily Benefit Rate
Number of Days
of Unemployment
Strike Benefits
Eligibility Requirements
Eligibility Interviews
Benefit Reductions
Disqualifications:
Separation Allowance
Voluntary Quit
Refusing Suitable Work
Illegal Strike
False or Fraudulent Claim
Benefits Under Other Laws

2
2
2
3
3
3
3

Page
Special Rules for Train and Engine Service
and Passenger Service:
Standby and Layover
Work Restrictions
Pool Service
Full-Time Work

5
5
5
5

Reconsideration and Waiver
Employee Rights
Employer Rights

5
6

Taxability of Unemployment Benefits

6

Job Placement Service

6

Instructions for Completing Application

6

Instructions for Completing Claims

8

Record of Attempts to Find Work

11

3
4
4

4
4
5
5
5
5

Notices
Privacy Act
Computer Matching and Privacy
Protection Act
Paperwork Reduction Act
Nondiscrimination on Basis
of Disability
Fraud and Abuse Hot Line

11
12
12
13
13

INTRODUCTION

IF YOU ARE UNEMPLOYED, you may be eligible to receive
unemployment benefits from the Railroad Retirement Board
(RRB), the Federal agency responsible for administering the
Railroad Unemployment Insurance Act (RUIA). This booklet
provides information about the requirements for receiving railroad unemployment insurance benefits, the amount of benefits
payable and procedures for claiming benefits.
You can file your application and claims 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.
If you become sick or injured, you may be eligible to receive
sickness benefits. Those benefits are described in a separate
booklet (Booklet UB-11) which can be obtained from any RRB
office, your employer, your labor organization, or the RRB’s
Web site at www.rrb.gov.
Be sure to read the important notices at the back of this
booklet about the Privacy Act, Paperwork Reduction Act,
Computer Matching and Privacy Protection Act, and the
Rehabilitation Act.

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 unemployment or sickness benefits, contact
the nearest office of the RRB. When writing to the RRB, be
sure to include your social security number.
Spanish translation booklets concerning railroad unemployment
and sickness benefits are available from any office of the RRB.
Tenemos un librete en Espanol que explica los beneficios de los
desempleados del ferrocarril. Lo pueden obtener en su oficina
mas cercana del RRB.

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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, 2005

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 unemployment.
A period of continuing unemployment means a period of time for which you file claims for unemployment
benefits where (1) each claim has 5 or more valid days
of unemployment and (2) each claim begins within 15
days after the previous claim ends. For example,
claims for the 14-day periods beginning June 17 and
July 15 are in the same period of continuing unemployment. The second claim starts within 15 days after June
30, the last day of the claim period beginning June 17.
So benefits are payable for days over 4 in the claim
period beginning July 15. If the second claim period
began July 16, however, a 7-day waiting period would
apply because that claim would start the first period of
continuing unemployment in the new benefit year.
If you have at least 5, 6, or 7 days of unemployment in
a 14-day period, you should file a claim for benefits.
Even though no benefits would 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. After your first claim, benefits will be paid for
all days over 4 for other claims in the benefit year.

Earnings Needed in Base Year—
$2,825.00 in 2004 (2 1/2 x $1,130.00 = $2,825.00).
If 2004 was your first year of railroad work, you
must also have railroad service in 5 months in 2004.
In this example, $1,130.00 is the monthly compensation
base for base year 2004. The monthly compensation
base for base year 2005 is $1,150.00. Contact your local
RRB field office if you need information about the
monthly compensation base for other years.

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:

Amount and Duration
of Benefits
Waiting Period
To satisfy a waiting period requirement, no benefits are
payable for your first 7 days of unemployment in your
first claim in a period of continuing unemployment,
unless you have already served a waiting period in the
benefit year. Benefits are payable for each remaining
day of unemployment in your first claim. For example,
if you claim all 14 days in your first claim, you will be

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For purposes of determining maximum normal benefits
payable in the general benefit year beginning July 1,
2005, monthly earnings of up to $1,460.00 are counted
for months in base year 2004. For base year 2005, the
monthly compensation base for maximum benefits is
$1,485.00.

Extended Benefits
If you have 10 or more years of service and exhaust
your normal unemployment 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.

an illegal strike, but who are unemployed because of
the strike, may receive benefits after the first 2 weeks
of the strike.

To qualify for extended benefits, you must not have
voluntarily quit work without good cause or voluntarily
retired.

Eligibility Requirements

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. In addition to having 10 or more years of service, you must
be qualified for the next benefit year, but not the current year, and have 14 or more consecutive days of
unemployment.

To receive unemployment benefits you must:
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be unemployed and receive no wages, salary, military reservist pay, pay for time lost, vacation pay,
holiday pay, guarantee pay, or other remuneration
from railroad or nonrailroad employment for the
days you claim benefits. Under certain conditions,
part-time work does not affect entitlement to
benefits. However, you must report all full-time
and part-time work you perform to the
Railroad Retirement Board (RRB) on each claim
for benefits you file. The RRB will then determine
whether your pay is “subsidiary remuneration” and
whether benefits are payable for days on which you
worked part-time. Contact your local RRB office for
additional guidance on the effects of part-time work.

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be able to work. You must not be sick or injured.

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be ready and willing to work. If you do not have
good prospects of returning to work soon, you
must be looking for work. You may be called in
for an interview and asked where you have looked
for work. An RRB representative may also suggest
places for you to apply for work. If you are looking for work, use the form on page 11 to record
your efforts to find work.

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pass the earnings test for each claim. Your total
earnings in the claim period must not exceed the
monthly compensation base for the calendar year
(base year) that precedes the benefit year (begins
July 1). Earnings include pay from railroad, nonrailroad, part-time, and self-employment. Earnings
also include pay that you would have earned except
for your failure to mark up or report for duty on
time, or because you missed a turn in pool service
or were otherwise not ready or willing to work.
Earnings do not include payments you receive during the claim period that are for days outside the
claim period. All earnings for a work shift are
attributable to the day the shift begins. The earnings test amount increases with each benefit year.

Daily Benefit Rate
Your daily benefit rate is 60% of the daily rate of pay for
your last job in the base year, but not less than $12.70 a
day nor more than 5% of the monthly compensation base.
For example, the monthly compensation base for 2004 is
$1,130.00, which results in a maximum daily benefit rate
of $56.00 for periods beginning after June 30, 2005. The
maximum daily 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 benefit 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 Unemployment
After you have satisfied the benefit year waiting period
requirement, benefits are generally paid for days of
unemployment over 4 in 14-day claim periods.

Strike Benefits
If you are unemployed because of a strike, benefits are
not payable for your first 14 days of unemployment due
to the strike. If a strike is in violation of the Railway
Labor Act or is not authorized by the national office of
the striking labor organization, unemployment benefits
are not payable to employees participating in the strike.
However, employees not among those participating in

Example A: An employee works 6 days in the
period December 13 through 26, 2005, and receives

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holiday pay for December 25. The gross earnings
and holiday pay total $1,150.00. Because
$1,150.00 exceeds the 2004 monthly compensation
base of $1,130.00, no benefits are payable for the
claim period.
Example B: An employee has total gross earnings
of $850 from 4 days of work and 2 days of vacation
pay in the period October 1 through 14, 2005.
During the period, the employee also missed a turn
in pool service for which $300 would have been
earned. No benefits are payable for the claim period
because the actual earnings of $850 plus the earnings that would have come from the missed turn in
pool service total $1,150.00. This is more than the
2004 monthly compensation base of $1,130.00.
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obtain an application for unemployment
benefits from your employer, labor organization,
the RRB, or file online at www.rrb.gov.

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complete and file the application for unemployment benefits during your first 30 days of unemployment. You may lose benefits if you file late. An
application is considered filed on the day it is
received by the RRB. If you claimed benefits earlier
in the benefit year, stopped claiming, and now want
to claim benefits again, you must request a claim
form from your local RRB office within 30 days.
Only one application is required in each benefit year.

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file online at www.rrb.gov or mail the completed application to the RRB district office serving
your area. After your application is processed,
your first unemployment claim will be mailed to
you for completion.

Eligibility Interviews
In order to establish your eligibility for benefits and to
explain your rights and responsibilities in claiming
benefits, you may be required to personally report to a
Railroad Retirement Board (RRB) representative for
an interview. The RRB representative will also answer
any questions you may have about your benefits.
The RRB’s authority for conducting such interviews is
contained in the Railroad Unemployment Insurance
Act. Failure to report for an interview could result in a
loss of benefits for 30 days if you do not have a good
reason for failing to report.

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Benefit Reductions
Benefits are not payable to you in the full amount if
you are also receiving:
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social security benefits,

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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.),

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certain workers’ compensation payments, or

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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
unemployment 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 unemployment 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 for days you were already paid unemployment 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 unemployment benefits withheld.
Verify the amount by comparing it to the amount of
unemployment 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.

Disqualifications
Separation Allowance (severance pay, buy-out)—
If you have been paid a separation allowance by your
employer, you cannot receive unemployment or sickness benefits for roughly the period of time it would
have taken you to earn the amount of the allowance.
Voluntary Quit Without Good Cause—If you
leave either your railroad job or nonrailroad work
voluntarily and the Railroad Retirement Board (RRB)

determines you left without good cause, you will be
disqualified for railroad unemployment benefits until
you return to railroad work and earn wages sufficient
to qualify for benefits again.
Voluntary Quit With Good Cause—If you leave
either railroad or nonrailroad work voluntarily and the
RRB determines you had good cause for doing so, you
will be disqualified from receiving railroad
unemployment benefits for any day that you are qualified to receive State unemployment benefits. If you are
not qualified for State unemployment benefits, you
may receive railroad unemployment benefits.
Refuse Suitable Work/Fail to Apply for Work—
If you refuse to accept suitable work, or fail to follow
instructions to apply for work, or to report to a State
employment office, or to a RRB office for an interview, you may be disqualified for unemployment
benefits for 30 days.
Illegal Strike—You will be disqualified for unemployment benefits for any day on which you take part in a
strike which began in violation of the Railway Labor
Act or in violation of the established rules and practices
of your labor organization.
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 also be
disqualified from receiving railroad unemployment
insurance benefits for any day for which you
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receive unemployment benefits under any other
law;
or
receive sickness benefits under the Railroad
Unemployment Insurance Act or any similar law.

Special Rules for
Train and Engine Service
and Passenger Service
For employees in train and engine service and
passenger service, benefits are not payable for:

Standby and Layover––Days on which you are
standing by for or laying over between regular
assigned trips. For example, if an engineer has a regular
assignment which runs every third day, the days
between the regular runs do not count as days of
unemployment.
Work Restrictions––Any day on which you do not
work because of a mileage limitation or other similar
work restriction. For example, a brakeman does not
work in January after the 20th day of the month
because he has worked the maximum mileage for the
month. In his case, the days January 21 through
January 31 do not count as days of unemployment.
Pool Service––Any day on which you do not work
because you miss a turn in pool service.
Full-Time Work––Any day in a registration period in
which you have the equivalent of full-time work.
If you work in train and engine service or passenger
service, you must report on your unemployment claim
the number of miles or hours credit earned in each
claim period. You must also report days on which you
did not work because of a layover or standby rule,
mileage restriction, or because you missed a turn in
pool service.

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:

1. The amount of the overpayment is more than 10
times the current maximum daily benefit rate;

2. you were not at fault in causing the overpayment;
and

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3. 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.

help you find new employment. You may be referred
by an RRB representative to a suitable railroad job;
otherwise, an effort will be made to place you in a
nonrailroad job for which you are qualified.

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.

The RRB maintains a list of job vacancies reported by
railroads to its field offices. Information about job
vacancies is available at all offices of the RRB, and
online at www.rrb.gov.

Employer Rights

RRB Booklet UB-12, How to Find a Job, is available
upon request from any RRB office.

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.

Taxability of
Unemployment Benefits
Unemployment benefits paid under the Railroad
Unemployment Insurance Act (RUIA) are considered
income for Federal income tax purposes. Each year,
the Railroad Retirement Board (RRB) sends railroad
employees Form 1099-G showing the total amount of
unemployment benefits paid during the preceding
calendar year. You must report that amount on your
Federal income tax return.
You may file Form W-4v with the nearest RRB office
if you want the RRB to withhold Federal income tax
from your benefits. To end withholding you must file
another Form W-4v with the RRB. Form W-4v is
available upon request from the Internal Revenue
Service. The RUIA specifically exempts railroad
unemployment benefits from State income taxes.

Job Placement Service
The RRB operates a free job placement service with
the primary purpose of helping experienced railroad
workers who have lost their jobs find new employment. When you apply for unemployment benefits,
you also apply for employment service. You will be
interviewed by an RRB representative who will try to

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Instructions for Completing
Application for Unemployment
Benefits and Employment
Service (Form UI-1)
To apply for unemployment benefits, complete the
application enclosed with this booklet and mail it to
the Railroad Retirement Board’s office whose address
appears on the enclosed return envelope. If there is no
application enclosed with this booklet, you can obtain
an application from your railroad employer, union official, any RRB office or the RRB’s Web site at
www.rrb.gov. Your application must be received at the
RRB within 30 days of the first day for which you
wish to claim benefits. You may lose benefits if your
application is filed late.
Complete only one application during a benefit year
even if you become unemployed more than once during that benefit year. When the RRB district office
receives your completed application, the RRB will
notify your employer that you have applied for benefits. Your employer may respond to the district office
with any information relating to your eligibility.
Once we process your application, we will mail you a
claim form. You must complete and return the claim to
the RRB district office. A notice of your claim will
then be sent to your employer.
Read the following instructions carefully before
completing your 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.
SECTION A - IDENTIFYING INFORMATION
Items 1-6 are self-explanatory.

SECTION B - EMPLOYMENT INFORMATION

Item 7
Show in Item 7a the name of the railroad company
for which you worked most recently. (For example,
“Conrail.”)
Show in Item 7b the title of your job (for example,
“Trainman.”)
Show in Item 7c the city and state where you last
performed your railroad job.
Check the box in Item 7d that indicates why you are
not now working for your last railroad employer. If
you check box 9 “Other,” write an explanation in
the space provided.
If you have quit or resigned any railroad or nonrailroad
job within the past 3 years, answer Item 7e “Yes.” You
must specify the date you resigned or quit, and the
name of your former employer in Items (1) and (2).
If you are claiming unemployment benefits
because you were discharged or suspended from
your last railroad job, you must complete Item 7f.
Be sure to complete all parts of the question. If you
are suspended, give both the beginning and ending
dates of the suspension period in Item 7f (1).
Only complete Item 7g if you are unemployed due
to a strike or work stoppage and give the name of
your labor union.

Item 10
Check Item 10 “Yes” if you have been paid a
severance, termination, or separation allowance or
buy-out. In Item 10a, enter the date of separation
and in Item 10b, enter the name of the employer
that paid the allowance.

Item 11
If you have been self-employed in the past 2 years
or you are currently self-employed, you must
answer this question “Yes.” In addition, provide
the type of self-employment in Item 11a (for
example, “tax-preparer,” “carpenter”), and give the
date you were last self-employed in Item 11b.

Item 12
If you answer “Yes” to Item 12a, give the name,
address, date last worked, and your job title for the
last nonrailroad employer for whom you worked
during the past 2 years in Item 12a (1-4). Also
show why you are not now working for that
employer in Item 12a (5). If you have worked for
more than one nonrailroad employer in the past 2
years, answer Item 12b “Yes.”
Item 13 is self-explanatory.
SECTION C - SCHOOL INFORMATION
Item 14 is self-explanatory.
SECTION D - OTHER BENEFITS

Item 15
Item 8
Show in Item 8a the date that you want your first
unemployment claim to begin. The date you enter
should be the first day after you last worked for
either a railroad or nonrailroad employer and for
which you were available for work and did not
receive any pay. The date will be the first day of
your waiting period.
Show in Item 8b the date you last worked for your
last railroad employer prior to the date you
entered in Item 8a.

Unemployment benefits under the Act are not
payable, or are payable at a reduced amount, if you
are also receiving social security benefits, military
retirement pay or retainer pay, or any other retirement
or survivor benefits provided by law.
If you are receiving any other benefits under any law,
you must answer this question “Yes” and specify the
type of benefit(s), the effective date, and the monthly
amount you receive before deductions.
SECTION E - DIRECT DEPOSIT INFORMATION

Item 16
Item 9
Check Item 9 “Yes” if you are covered by a job
protection plan under the National Job
Stabilization Agreement or under a similar plan.
You should also check “Yes” if you are affected by
a merger or line sale, and may be entitled to a
guaranteed wage. Also enter the name of the
employer providing the guarantee.

Direct Deposit - Federal law requires the RRB to
pay your benefits by Direct Deposit. With Direct
Deposit, your benefit payments are sent directly to
your bank, savings and loan, credit union or other
financial institution. Payments are sent electronically,
which saves money by eliminating the need to print
and mail checks.

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Direct Deposit has the following advantages for you.
Direct Deposit payments are generally available 2 to
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 bank.
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 this item.
If you change banks or accounts while claiming
benefits, be sure to give the RRB information to
establish Direct Deposit in your new account. Do
not close your old account until you receive the
first RRB payment in your new account.
There are some exceptions that allow payments to
be made by check. You may receive your payments
by check if: (1) receiving your payments by Direct
Deposit would cause a hardship because you have a
physical or mental disability, or because of a geographic, language, or literacy barrier; (2) you do
not have a checking or savings account at a bank or
other financial institution; or (3) if receiving your
payment electronically would cause you a financial
hardship because it would cost you more than
receiving your payments by check. If any of these
apply to you, check box (e.) in Item 16.
SECTION F CERTIFICATION AND SIGNATURE
Item 17 is self-explanatory.

Instructions for Completing
Claim for Unemployment
Benefits (Form UI-3)
After we receive your application, we will mail your
first claim to you. Claims for subsequent 14-day periods will be mailed to you for as long as you remain
unemployed and eligible for benefits. You must complete and return each claim promptly by mail, or file
online at www.rrb.gov, or you may lose benefits. The
time for filing a claim, including time for mailing,
is limited to 15 days from the last day of the claim
period or 15 days from the date the claim form was
mailed to you, whichever is later.

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If you return to work and do not have at least 5
claimed days during a claim period, do not return the
claim form. This will stop the release of additional
claims to you.
If you stop claiming benefits during a benefit
year, but become unemployed again and need a
new claim form, contact your local Railroad
Retirement Board office to obtain a new claim.
You must request your new claim within 30
days of the first day for which you wish to
claim benefits or you may lose benefits.
Read the following instructions carefully before
completing your claim form. Failure to complete
your claim correctly could delay the payment of
your benefits.

Item 1a
This item shows the 14-day period of your claim.
Below each day of the claim period, you must
enter the correct letter code showing whether you
want to claim benefits for the day, or whether you
worked, received vacation pay, holiday pay, or
other earnings, or cannot claim benefits for some
other reason.
Remember that you cannot claim benefits for any
day on which you worked or otherwise earned
wages, holiday pay, vacation pay, or other pay.
This includes pay from full-time and part-time
work in either railroad or nonrailroad employment,
and from self-employment. In addition, you cannot
claim benefits for any day on which you were not
available for work. This means that you must not
have been sick or injured on any day for which
you claim benefits, and you must have been
willing and ready to work on the day.
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 the
day, will not receive any type of pay for the
day, were not sick or unable to work
because of injury or mental infirmity on the
day, and were willing and ready to work.
Any day you mark with an “X” is considered
to be a day of unemployment for which you
are claiming benefits.

Use an “X” to show your normal rest days,
unless you worked or otherwise received pay
from either a railroad or nonrailroad employer
for the day, or unless you were sick or otherwise unable or not available for work on the
day.

Show an “O” for days that you:

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. Also show an “E” for days you were on
active duty with the National Guard or a
Reserve unit.
P—Enter a “P” for any day that you were
not employed, but will receive payment
from a railroad or nonrailroad employer.
This includes such payments as vacation pay,
holiday pay, daily wage guarantee payments,
and pay for time lost.
If you receive guarantee pay or pay for time
lost for days for which you previously claimed
unemployment benefits, the benefits paid to
you must be refunded to the RRB. You should
notify us if you are eligible for guarantee pay
or claiming pay for time lost so we can arrange
for your employer to deduct the proper amount
for refund to the RRB. Verify the accuracy of
the amount of benefits withheld from your pay
by checking your own record of RRB payments or by contacting the RRB. Notify us
promptly if you believe the correct amount was
not withheld.
Do not show a “P” for payments under a supplemental unemployment insurance plan paid
or financed by your employer. Such payments
are normally paid in addition to your unemployment benefits from the RRB. However, if
railroad retirement taxes are deducted from
payments by your employer, the payments are
not “supplemental” payments and must be
reported on your claim form.
O—Enter an “O” for days on which you did
not work and did not receive any type of
payment, but which you cannot claim
because you were not able and available for
work on the day.

l

were unable to work due to sickness or
injury;

l

marked off, missed a call to work, or did
not report to work because of personal
business or family obligations;

l

did not work due to laying over or standing
by between regularly assigned trips;

l

failed to exercise seniority to obtain a
suitable job for which you are qualified;

l

did not work because the day is an extra rest
day after you worked four 10-hour days;

l

did not perform work which was available
to you.

An example of how the boxes are to be completed is
shown on page 10.

Item 1b
Write in this item the dollar amount of your total
gross earnings from all full-time and part-time
work performed in the claim period. Include earnings from railroad, nonrailroad, and self-employment. Include pay for personal and vacation days
and any other paid leave for days in the claim period. Also include any pay you would have earned
except for your failure to mark up in time or report
for duty, or because you missed a turn in pool service or were otherwise not available for work. Do
not include payments you receive during the claim
period that were earned on days outside the claim
period. All earnings for a work shift are
attributable to the day the shift begins. Do not
include payments received under a supplemental
unemployment benefit plan. See Examples A and B
on pages 3 and 4.

Item 2
You must enter the complete company name of
your last railroad employer in Item 2a, and your
last railroad occupation in Item 2b. In addition,
complete Item 2c by entering an “X” in the appropriate box to show the reason why you are not
now working for your last railroad employer.

9

(Copy of front of Form UI-3)

$

X

b. Enter the gross amount of wages and/or other pay (before deductions) you received
or will be paid for days in this period. Do not include RRB benefits or payments received
under a supplemental unemployment benefit plan. This item must be completed
if you entered “E” or “P” for any day in Item 1a.

Mark each box with X, E, P or O

X

X

E

P

O

X

X

X

X

E

E

E X

550.00

Item 4

1a. This claim is for unemployment benefits for the 14 consecutive days shown below. To claim benefits, mark the box
under each date with the appropriate code (X, E, P, or O).
X — Claimed day of unemployment (Including rest days); E — Day employed; P — Vacation or holiday pay;
O — Day not claimed, other reason
This claim is for
4 5 6 7 8 9 10 11 12 13 14 15 16 17
11/04/05 Through 11/17/05

201
01- 02
C. SMITH
110905

CLAIM FOR UNEMPLOYMENT BENEFITS
Railroad Retirement Board

10

This item is prefilled with the name and address of
your local Railroad Retirement Board office. Your
completed claim is to be mailed to that office.

123-45-6789

Form Approved OMB 3220-0022

Item 3

This item is prefilled with your name and address.
If necessary, show corrections to your name and
address in the box.

Item 5
If you answer “Yes” that you have worked for a
nonrailroad employer since your last day of railroad work, enter that nonrailroad employer’s name
and address in Item 5b and the date last worked
before this claim for the nonrailroad employer, in
Item 5c. Also, if you have stopped working for
that nonrailroad employer, give the reason why in
Item 5d. If you have not stopped working for that
nonrailroad employer, enter “Still Working” in
Item 5d.

Item 6
If you worked in train and engine service or passenger
service, enter the number of miles or hours you worked
during the 14-day claim period in Item 6b. Include
miles or hours earned for regular pay, premium
pay, overtime, and deadheading. Also show the
days that you did not work because of a layover or
stand-by rule, mileage restriction, or because you
missed a turn in pool service in Item 6c.

Item 7
You must answer all of the questions in Item 7. Be
sure to explain your answer if you complete a box
that has an asterisk (*) in front of it. Unless otherwise indicated, the questions should be answered
for days included in the claim period.

Item 8
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 before the last day
of the claim period, benefits due you may be
delayed or denied.

Record of Attempts To Find Work
If you do not have good prospects of returning to work soon, you must be looking for work. Keep a record of your
attempts to find work. You may start your record by using the form below. Continue your record on a separate
sheet of paper or notebook.
Name and Address
of Employer

Date Contacted

Results

1.
2.
3.
4.
5.
6.

Privacy Act Notice
To receive unemployment benefits you must apply and
furnish information. Information that the Railroad
Retirement Board (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.

1. The U.S. Treasury Department and the U.S. Postal

The RRB may routinely furnish information from its
records to other government agencies and to other persons or companies for the purpose of administering the
Railroad Unemployment Insurance Act, the Social
Security Act, or other benefit programs under Federal
and State laws.

liable for paying damages for the same injury or
illness for which the RRB pays sickness benefits.

The RRB routinely furnishes information from its
records to the following individuals, organizations,
and/or agencies:

Service, to issue benefit payments and to report
non-delivery, forgery, theft, or loss of a benefit
check.

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

4. The Internal Revenue Service for use in
administering Federal tax laws.
(Continued on next page)

11

5. A private collection agency, the General
Accounting 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 plans.

7. Law enforcement agencies and the Department of

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.

Justice for investigating or prosecuting a violation
of law.

Paperwork Reduction
Act Notice

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 is 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 government agencies. All agencies may use matching programs to find or
prove that a person qualifies for benefits paid for by the
Federal Government.

12

To receive unemployment benefits, you must complete
an application and claim form(s). Estimates of how
long we think it takes to complete these forms are
shown below. The estimates include time for reviewing
the instructions, getting the needed information, 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 other aspect of the forms, including suggestions for
reducing completion time, to the Chief of Information
Resources Management, Railroad Retirement Board,
844 North Rush Street, Chicago, Illinois 60611-1275.
Be sure to include the form title with your comments.

Form
No.

Title

Estimated
Completion Time
(Minutes)

UI-1

Application for
Unemployment
Benefits and Employment
Service (3220-0022)

10

UI-1

Internet Application for
10
Unemployment Benefits and
Employment Service (3220-0022)

UI-3

Claim for
Unemployment
Benefits (3220-0022)

6

UI-3

Internet Claim for
Unemployment
Benefits (3220-0022)

6

Nondiscrimination on the
Basis of Disability
Under Section 504 of the Rehabilitation Act of 1973 and Railroad Retirement Board (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 60611-1275. Questions about
individual rights under this regulation may be directed to the RRB’s Director of Equal
Opportunity at the same address.

Fraud and Abuse Hot Line
Call the toll-free Fraud and Abuse Hot Line if you have reason to believe that someone is
receiving railroad retirement or unemployment/sickness benefits to which (s)he is not entitled;
that persons responsible for the financial affairs of minors or incompetent beneficiaries are
misappropriating benefits; or that a doctor, hospital, or other provider of health care services is
performing unnecessary or inappropriate services or is billing Medicare for services not
received. You may also use the Hot Line to report any suspected misconduct by a Railroad
Retirement Board (RRB) employee. The Hot Line has been installed by the RRB’s Inspector
General to receive any evidence of fraud or abuse of the RRB’s benefit programs.
Call (toll-free) 1-800-772-4258. Or you may send your complaints in writing to the RRB, OIG,
Hot Line Officer, 844 North Rush Street, Chicago, Illinois 60611-1275.
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 RRB field office.

Did You Know. . .
Railroad employees do not pay for their unemployment 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.

13

Form Approved
OMB No. 3220-0022

United States of America
Railroad Retirement Board

Application for Unemployment Benefits
and Employment Service
Instructions
Before completing this application, read the section Instructions for Completing Application for Unemployment Benefits and
Employment Service (Form UI-1) in the UB-10 booklet, which explains information needed to answer questions on this
application. PRINT all answers in ink or use a typewriter. See the UB-10 booklet for the Privacy and Paperwork Reduction Act Notices.

Section A

Identifying Information
2. Social Security Number

1. Name (First, Middle Initial, Last)

4. Date of Birth
Month
Day

3. Mailing Address (Include Apartment Number)

City, State, ZIP Code

o Male
o Female

County

6a. Home/Cell/Message Telephone Number (Include Area Code)

Section B

5. Sex
Year

6b. Work Telephone Number (Include Area Code)

Employment Information

7a. Last Railroad you worked for
b. Last Railroad Job Title (i.e., Clerk, Trainman, etc.)
c. Location of Last Railroad Job (City and State)
d. Why are you not now working for your last railroad employer? Check one:

o 1. Laid Off/Furloughed/Abolished/Bumped
o 2. Extra Board/Part-Time
o 3. Sick or Injured
Explanation
e. Have you quit or resigned any work
(railroad or other) during the last 3 years?

o 4. Quit or Resigned
o 5. Retired
o 6. Discharged

o 7. Suspended
o 8. Strike/Work Stoppage
o 9. Other, explain below

o Yes - Complete (1) & (2) below

o No - Go to Item 7f.

o Yes - Complete (1) - (4) below

o No - Go to Item 7g.

(1) Date resigned or quit and Employer’s Name
(2) Date resigned or quit and Employer’s Name
f. Are you discharged or suspended?
(1) Date of discharge or suspension period: From

To

(2) Are you seeking reinstatement to your job?

o Yes

o No

(3) Will you claim pay for time lost?

o Yes

o No

(4) Name of Union Official
Address

City, State, ZIP Code
Telephone Number (Include Area Code)

(

)

g. Complete this item ONLY if you are unemployed due to a strike or work stoppage.
Name of your labor union
Refer to the instructions in Booklet UB-10 before completing Item 8.
8a. Date you want your first claim to begin.
b. Date you last worked for a railroad before date in Item 8a.
CONTINUE ON NEXT PAGE

UI-1 (03-04)

9. Are you covered by a job protection plan guaranteeing you a certain amount of work or pay?

o Yes

o No

If “Yes,” enter name of employer providing the guarantee, below.
Employer
10. Have you been paid severance pay or a separation allowance?

o Yes - Complete a. and b., below o No - Go to Item 11

a. Date of separation
b. Name of employer that paid

o Yes - Complete a. and b., below o No - Go to Item 12

11. Have you been self-employed in the past 2 years?
a. Type of self-employment
b. Date you were last self-employed
12. a. Have you been employed by a nonrailroad
employer in the past 2 years?

o Yes - Complete (1) -(5) and b., below o No - Go to Item 13

(1) Employer Name
(2) Employer Address (Street, City, State, ZIP Code)
(3) Date Last Worked

(4) Occupation

(5) Reason Not Working
b. Did you have other nonrailroad employment in the past 2 years?
13. Are you an active member of the National Guard or a military reserve unit?

Section C

o Yes - Go to Item 15
o Yes

o No - Complete b., below
o No

o Yes - Complete a.- c., below

o No - Go to Item 16

Other Benefits

15. Are you receiving social security benefits, military retirement
or retainer pay, or any other retirement or survivor benefits
provided by law?
a. Type of benefit(s)

b. Effective date

c. Monthly amount before deductions

Section E

o No
o No

School Information

14. a. Are you now attending school?
b. Do you plan to attend school in the next 6 months?
If “Yes,” enter the month and year you will begin school

Section D

o Yes
o Yes

$

Direct Deposit Information

16. 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 17, or
call your financial institution for the information you need to complete Items a. through d. If you do not have a bank account,
or receiving your payments by Direct Deposit would cause you a hardship, go to Item e.
a. Routing Transit Number
c. Account Type:

o Checking

b. Account Number

o Savings

d. Name of Financial Institution
e. o Check this box if you do not have a checking or savings account, or if Direct Deposit would cause you a hardship.

Section F

Certification and Signature

17. I certify that the information I have provided on this form is true, correct, and complete. I know that I must immediately
report to the Railroad Retirement Board any changes which might affect my entitlement to benefits. I understand that
disqualifications and civil and criminal penalties may be imposed on me for false or fraudulent statements or claims or for
withholding information to get benefits. I understand and agree to the requirements set forth in Booklet UB-10.

SIGNATURE

UI-1 (03-04)

DATE

Mail your signed application immediately to the Railroad Retirement Board using the enclosed envelope.

Important Reminders
Filing requirements ––To avoid losing unemployment benefits, your benefit application must be
received by a Railroad Retirement Board (RRB) office within 30 days of the first day for which you
want to claim benefits. Your unemployment claims must be filed within 15 days of the last day of the
claim or 15 days from the date we mail the form to you, whichever is later.
File only one application during a benefit year even if you become unemployed more than once
during the year. In that case, you must request a new claim form from an RRB office within 30
days of the first day for which you want to claim benefits. Do not forget to sign and date your
application and each claim form.
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 example, see the section
titled Qualification Requirements.
Waiting period requirement––Benefits are payable for your days of unemployment over 7 in your
first claim in each benefit year in order to satisfy a waiting period requirement. Even though no
benefits are payable for the first claim if it has only 5, 6, or 7 days of unemployment, you must file
the claim for your days of unemployment 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-time 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.
If you are fully protected under a wage guarantee plan, it is not to your advantage to claim benefits
since your unemployment benefits are subject to recovery by the RRB from your wage guarantee
payable for the same period.
Reconsideration rights––You may request reconsideration of any decision denying you benefits.
A request for reconsideration must be made in writing within 60 days from the date of notice of the
Railroad Retirement Board’s adverse decision.
Please allow at least 15 days from the date you mail your claim to receive a payment. That amount
of time is needed for delivery of your claim and payment, and to allow your employer time to submit
information about your claim. If you do not receive payment within 15 days, you should contact your
local RRB office about your claim.
When reporting earnings for a claim period, report only pay you are entitled to for days in the claim
period. Do not include pay you received during the claim period that was earned on dates outside of
the claim period. All earnings for a work shift are attributable to the day the shift begins.

RRB HelpLine 1-800-808-0772
The RRB HelpLine is an automated telephone service
available 24 hours a day, 7 days a week. You can call
the RRB HelpLine toll-free from either a touch-tone or
rotary telephone to get the following information about
your unemployment benefits:
l

The amount and date of your latest benefit payment, and the claim period for which the payment
was made.

l

Information about your last 5 benefit payments.

l

Confirmation of whether we have received your
application or latest claim.

We update the RRB HelpLine once each weeknight with
payment information; we update information about
applications and claims 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. Each
claim will also have a record of your last three payments.
Use the record of payments, the RRB HelpLine, and the
tables below to keep track of your claims and payments.

Record of Claims Submitted
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.
Beginning Date
of Claim

Number of
Days Claimed

Date Mailed
to RRB

Record of
Payments Received
Amount of
Payment

Date Payment
Received