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.
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 the of your benefits.
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 non railroad 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 non-railroad employer for the day, or unless you were sick or otherwise unable or not available for work on the day.
- E - Enter an "E" if you were employed either full-time or part-time on the day. Include work for either a railroad or non-railroad 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 non railroad 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.
Show an "O" for days that you:
- were unable to work due to sickness or injury;
- marked off, missed a call to work, or did not report to work because of personal business or family obligations;
- did not work due to laying over or standing by between regularly assigned trips;
- failed to exercise seniority to obtain a suitable job for which you are qualified;
- did not work because the day is an extra rest day after you worked four 10-hour days;
- did not perform work which was available to you.
Enter 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.
Enter the complete company name of your last railroad employer in Item 2a, and your last railroad occupation in Item 2b. Enter an "X" in the appropriate box in Item 2c to show the reason why you are not now working for your last railroad employer.
This item is pre-filled with the name and address of your local Railroad Retirement Board office. Mail your completed claim to that office.
This item is pre-filled with your name and address. If necessary, show corrections to your name and address in the box.
If you have worked for a nonrailroad employer since your last day of railroad work, answer Item 5a "Yes." Enter the nonrailroad employer's name and address in Item 5b and the date last worked before this claim for the nonrailroad employer, in Item 5c. If you have stopped working for that nonrailroad employer, enter the reason why in Item 5d. If you have not stopped working for that non railroad employer, enter "Still Working" in Item 5d.
If you worked in train and engine service or passenger service, answer Item 6a "Yes." 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. Enter 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.
You must enter an "X" in either "Yes" or "No" for all of the questions in Item 7. If you complete a box that has an asterisk (*) in front of it, be sure to explain your answer. Unless otherwise indicated, the questions should be answered for days included in the claim period.
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.