UI-38 (proposed) UI Claimant's Report of Efforts to Find Work

Form Approved
OMB NO.3220-0164

In reply refer to

To receive unemployment benefits, you must be unemployed, ready to work, and willing to work on
all days for which you claim benefits. In your case, this means that you must be actively seeking
work to be eligible for unemployment benefits. This includes both railroad and nonrailroad work.
Your efforts to find work should include the local newspaper want-ads, employers and businesses
listed in the telephone yellow pages who need the skills you have, union halls and employment
services.
Please follow the instructions for the item@)checked below:

[7 Read Booklet UB-12 for guidance and tips on how to conduct a successful job search.
Report in person to the State Employment Service in
on or before
to apply for
work. Present that office with the Form ES-21 you have been given. Failure to report as
instructed can cause you to lose unemployment benefits for 30 days.

[7 Record your work-seeking efforts on page two of this form and mail the completed form to
this office by

[7 Record the work-seeking efforts you made in the last 60 days on page two of this form and
mail the completed form to this office within 15 days of the date of this letter.

[7 Record the work-seeking efforts you made in the last 60 days on page two of this form and
present the completed form to the Railroad Retirement Board (RRB) representative at your
next interview.

[7 Apply for work with the following employers:
If you have been instructed to complete and return the second page of this form, failure to do so
may result in denial of benefits. Contact the RRB office shown above if you need more information
or if you become employed.
Railroad Retirement Board

REPORT OF EFFORTS TO FlND WORK
Paperwork Reduction Act and Privacy Act Notices
This notice is iven under the Privacy Act of 1974 and Papetwork Reduction Act of 1995. Under section 12(1)
of the Ra~lroa Unemployment Insurance Act, the RRB is authorized to collect the information requested on
this form. The information will be used to determine your availability for work and your eligibility for benefits.
Wh~leyou are not required to provide us with this information, your failure to do so may prevent us from
paying you additional benefits.

i

We estimate this form takes an average of 11% minutes per response to complete, includin the time for
reviewing the com leted form. Federal agencies may not conduct or sponsor, and respon ents are not
required to respon to, a collection of information unless it displays a valid OMB number. If you wish, send
comments regarding the accuracy of our estimate or any other aspect of this form, including suggestions for
reducing the completions time to Chief of Information Resources Management, Railroad Retirement Board,
844 North Rush Street, Chicago, IL 6061 1-2902.

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B

PLEASE GIVE THE FOLLOWING INFORMATION ABOUT YOUR ATTEMPTS TO FlND WORK

EMPLOYER

ADDRESS

KIND OF
WORK

DATE
CONTACTED

RESULTS

A.

B.
C.
D.
E.

F.
G.

H.
I.
J.

K.
L.
CERTIFICATION: I know that disqualifications and civil and criminal penalties may be imposed on
me for false or fraudulent statements or for withholding information to get benefits. I certify that all
the information given on this form is true, correct, and complete.
Signature:

Date
UI-38 (99-99)