| 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 from its records to other government agencies
and to other persons or companies (see list below) for the
purpose of administering the Railroad Unemployment Insurance
Act, the Social Security Act, or other benefit programs
under Federal or State laws.
The RRB may routinely furnish
information to the following individuals, organizations,
and/or agencies:
- The U.S. Treasury Department
and the U.S. Postal Service, to issue benefit payments
and to report non-delivery, forgery, theft or loss of
a benefit payment.
- 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.
- 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.
- The Internal Revenue Service
for use in administering Federal tax laws.
- A private collection agency,
the General Accounting Office, the Department of Justice,
or the Internal Revenue Service for the collection of
an overpayment.
- Employers or insurance companies
for use in administering supplemental benefit or health
insurance plans.
- Law enforcement agencies
and the Department of Justice for investigating or prosecuting
a violation of law.
- Employers to verify entitlement
to benefits and to provide notice of benefit payment determinations.
- 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
government 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.
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 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
aspects of the forms, including suggestions for reducing
completion time, to the Chief of Information Management,
Railroad Retirement Board, 844 N. Rush Street, Chicago Illinois
60611-2092. Be sure to include the form title and control
number (in parentheses) with your comments.
|
Form No. |
Title |
Estimated
Completion Time (Minutes) |
| SI-1a |
Application
for Sickness Benefits
(3220-0039) |
10 |
| SI-1b |
Statement
of Sickness (3220-0039) |
8 |
| SI-3 |
Claim for
Sickness Benefits
(3220-0039) |
5 |
| SI-10 |
Statement
of Authority to Act for Employee
(3220-0034) |
6 |
| ID-7h |
Notice of
Non-Entitlement to Sickness Benefits and Information
on Unemployment Benefits
(3220-0039) |
5 |
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 60611-2092. Questions about
individual rights under this regulation may be directed
to the RRB's Director of Equal Opportunity at the same address.
RRB
HelpLine 1-800-808-0772 — The
RRB HelpLine in 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 or
sickness benefits:
- 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've received your latest claim,
application, or supplemental doctor's statement.
We update the RRB HelpLine once each night with payment
information; 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. Each claim will
also have a record of your last 3 payments.
Fraud
and Abuse Hotline — 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
or 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 60611-2092.
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 RRB field office.
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