ID-5R; Form Letter, Request for Employment Information

FORM APPROVED
OHB NO 3220 - 0025
U.S. RAILROAD RETIREMENT BOARD
OFFICE OF P R O G M S - ASSESSMENT AND TRAINING
844 N. RUSH STREET
CHICAGO, IL 60611-2092

GENERAL ACCTG,/ASST. TREASURER
ELGIN JOLIET & EASTERN RY CO
P.O. BOX 68
MONROEVILLE, PA 15146-0068

A comparison of unemployment and sickness benefit payment records with
annual railroad compensation reports shows that some employees of your
company were paid unemployment or sickness benefits for every day in
one or more months for which creditable service and compensation was
reported. In order to determine if the reported compensation affects the
payment of benefits for the fully claimed months, we need additional
information from you.
Enclosed is a listing of employees of your company and the month(s) for
which we need additional information about the employee's compensation.
Please furnish the information according to the instructions provided on
page 2 of this letter.
Our authority for requesting this information is explained below. If you
have any questions about this request, please contact us at (312) 751-4805.
Thank you for your cooperation.
Railroad Retirement Board
Enclosures

......................................................................
Paperwork Reduction Act Notice
The Railroad Retirement Board's (RRB) authority for requesting information
is contained in provisions of the Railroad Unemployment Insurance Act
(45 U.S.C. 355(B), 359(A) and 362(A). Although the Act gives the RRB the
authority to compel disclosure through use of a subpoena, the RRB's
experience has been that employers voluntarily release earnings information
when they know that the RRB uses that information for the limited purpose
of verifying a claim for benefits.
The RRB realizes that many companies have adopted policies regarding
disclosures of personal information needed for proper administration of
the Railroad Unemployment Insurance Act. Information that the RRB
acquires about a person is protected from disclosure except as provided
by law.
FORM ID-5R (12-00)

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P l e a s e Read And Follow These I n s t r u c t i o n s .

1.

I d e n t i f y t h e days f o r which t h e employee received compensation and t h e
t y p e of compensation r e c e i v e d ( i - e . , wages, holiday pay, v a c a t i o n pay,
e t c . ) f o r each day i n t h e month(s) shown on t h e l i s t i n g . I f you d i d not
pay t h e employee wages o r o t h e r compensati'on f o r a p a r t i c u l a r month,
e x p l a i n why you r e p o r t e d s e r v i c e f o r t h e month.

2.

Since r a i l r o a d unemployment and s i c k n e s s insurance b e n e f i t s are p a i d
on a d a i l y b a s i s , w e need t o know t h e e x a c t days f o r which payments
were made. B e s u r e t o l i s t a l l d a y s f o r each month shown.

3.

If t h e employee r e c e i v e d s i c k pay which w a s r e p o r t e d as c r e d i t a b l e
compensation, p l e a s e i n d i c a t e t h e agreement under which t h e payment
was made.

4.

While s p a c e i s provided on t h e l i s t i n g f o r your u s e , you may u s e a
s e p a r a t e s h e e t ( s ) t o f u r n i s h t h e information. You may a l s o submit a
computer p r i n t o u t o r o t h e r company r e c o r d s a s long as t h e r e c o r d s
c l e a r l y show t h e e x a c t days f o r which t h e employee was p a i d and t h e
t y p e of compensation p a i d . I f s e p a r a t e s h e e t s o r r e c o r d s are u s e d ,
be s u r e t o i d e n t i f y each employee by name and s o c i a l s e c u r i t y number
and a t t a c h t h e s h e e t s t o t h e l i s t i n g .

5.

If you f i n d from your review t h a t one o r more months o f c r e d i t a b l e

s e r v i c e were i n c o r r e c t l y r e p o r t e d , submit a Form BA-4, Report of
C r e d i t a b l e Compensation Adjustment, t o r e v i s e o r delete t h e month(s)
c r e d i t e d i n e r r o r . Submit t h e completed Form BA-4 w i t h t h e e n c l o s e d
listing.
6.

Complete t h e employer c e r t i f i c a t i o n a t t h e bottom of t h e l i s t i n g . If
t h e r e i s more t h a n one page t o t h e l i s t i n g , complete t h e c e r t i f i c a t i o n
on t h e last page only. Be s u r e t o p r o v i d e t h e name and t e l e p h o n e
number o f t h e o f f i c i a l t o c o n t a c t i f w e have q u e s t i o n s a b o u t t h e
i n f o r m a t i o n you provide.

We e s t i m a t e t h a t a response t o Form ID-5R (SUP) t a k e s an a v e r a g e o f 1 0 minutes
t o Complete, i n c l u d i n g t h e time f o r reviewing t h e completed r e s p o n s e . I f you
wish, send comments r e g a r d i n g t h e a c c u r a c y of our e s t i m a t e o r any O t n e r a s p e c t s
of t h i s form, i n c l u d i n g s u g g e s t i o n s f o r reducing completion time t o t h e Chief
of Information Management, R a i l r o a d R e t i r e m e n t Board, 844 N. Rush S t . , Chicago,
I1 60611-2092. P l e a s e do n o t r e t u r n completed forms t o t h i s address.
Federal a g e n c i e s may n o t conduct o r s p o n s o r , and r e s p o n d e n t s a r e n o t r e q u i r e d t o
respond t o a c o l l e c t i o n of i n f o r m a t i o n u n l e s s i t d i s p l a y s a v a l i d OMB number.