ID-49R Form Letter; Letter to Railroad Employer for Payroll Inf

Form Approved
OMB NO.3220-0025

In reply refer to
Name:
SS No.:
Occupation:
Dept. and Location:

The individual identified above has claimed railroad unemployment insurance benefits.
Please check your payroll or work assignment records for the period shown on the next page, and indicate
the employment status of the claimant for each day in the period. For train and engine service employees,
please enter in the appropriate box the miles or hours for which the employee was paid. In addition, please
answer the following questions.
Has the employee received pay for time lost for days in the period?

OYES q NO

Is the employee covered by a wage guarantee?

OYES q NO

Instead of completing the next page, you may submit a computer printout or other company records which
clearly show the information requested about the employee's
payroll or employment status. Regardless
whether you complete the back of this letter or submit other records, please complete the employer
certification and return this letter using the enclosed postage-free envelope. Thank you for your cooperation.
Sincerely,

Enclosure
PAPERWORK REDUCTION ACT NOTICE
This notice is given under the Paperwork Reduction Act of 1995. Under section 12(1) of the Railroad Unemployment Insurance Act, the
Railroad Retirement Board is authorized to collect the information requested on this form. The information is needed to verify whether
the claimant is entitled to unemployment benefits. Your obligation to provide us with the information is voluntary.
We estimate this form takes an average of 15 minutes to complete including the time for reviewing the instructions, getting the needed
data, 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 estimate or
any other aspects of this form, including suggestio'ns for reducing completion time, to the Chief of Information Management, Railroad
Retirement Board, 844 N. Rush St., Chicago, IL 6061 1-2092.

Name:

SS No.:

PLEASE USE THE CODES BELOW AND ENTER THE WORK STATUS IN THE APPROPRIATE BOX FOR EACH DAY

EMPLOYER CERTIFICATION: THE INFORMATION IN THIS REPORT IS CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.

SIGNATURE
TELEPHONE NO. (

)

TITLE

DATE