Policy and Systems

Application for Sickness Benefits (Form SI-1a)

Section A - Identifying Information

Items 1 - 6 are self-explanatory.

Section B - Infirmity and Employment Information

Item 7 - is self-explanatory.

Item 8 - Enter the date you last worked for your last railroad employer before you became sick and unable to work. For example, if you worked on 12/31 and became sick on 1/1, would enter 12/31 as the date last worked.

Item 9 and 10 - are self-explanatory.

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Important Informtion

The completed and signed form must be received by an RRB office within 10 days of the first day for which you want to claim benefits. You may lose benefits if your application is filed late. If the form is late, enclose an explanation.

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General Instructions

Complete all items by typing or printing neatly in ink. Do not skip any items unless directed to do so. If you need more space to answer a question, enclose a separate sheet of paper. Be sure to sign your name and date the form before mailing. Have your doctor complete Form SI-1b, Statement of Sickness. Do not separate the Forms SI-1a and SI-1b.

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Instructions for Completing Forms

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When Sickness Benefits are Taxable

Sickness benefits paid under the Railroad Unemployment Insurance Act, with the exception of sickness benefits paid for an on-duty injury, are considered income for Federal income tax purposes. Each year, the RRB sends railroad employees Form W-2, Wage and Tax Statement, showing the amount of sickness benefits paid during the preceding calendar year. The amount shown on Form W-2 is the amount of benefits payable before deduction of Tier I railroad retirement tax. The amount includes benefits payable but withheld to offset a debt to the RRB.

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Employer Rights

The Railroad Unemployment Insurance Act requires the RRB to notify your base year employer(s) each time you file a claim for benefits, and to give the employer(s) an opportunity to submit information relevant to your claim before the RRB makes an initial determination on the claim. The RRB must also notify your employer each time benefits are paid to you. Your employer may appeal the decision to pay benefits. The appeal does not prevent the timely payment of benefits. However, you may be required to repay benefits if the appeal is successful.

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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.

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Reconsideration and Waiver

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Definition Of A Lump-Sum Death Payment

A lump-sum death payment is meant to help defray the costs of the employee's burial expenses. It can only be paid to a widow(er) who was living with the employee when he or she died or to the person who paid all or part of the employee's burial expenses. The lump-sum death payment cannot be paid if anyone is eligible for monthly survivor benefits in the month of the employee's death. A lump-sum death payment is not taxable for Federal income tax purposes.

There are two different types of lump-sum death payments.

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What Happens If The Employee Does Not Meet The Requirements

If the employee does not meet the requirements described in the section, Requirements The Employee Must Have Met, the RRB cannot pay you a lump-sum death payment. However, the Social Security Administration (SSA) may be able to pay you if you are the widow(er) who was living in the same household as the employee. Your application will be transferred to that agency.

A lump-sum death payment can be paid by either the RRB or SSA but not by both, even though the employee may have received payments from both agencies.

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