UI-44 (11-00) Claim for Credit for Military Service

UNITED STATES OF AMERICA
RAILROAD RETIREMENT BOARD

FORM APPROVED
O.M.B. NO. 3220-0025

CLAIM FOR CREDIT FOR
MILITARY SERVICE

SS NO.
NAME

INSTRUCTIONS
Complete the Employee's Statement below if you want your military service to be included in
determinin the total number of years of your creditable service under the Railroad Unemployment
Insurance ct (RUM).

W

Generally, military service may be credited if you entered active service in the Armed Forces when the
United States was at war or in a state of national emergency. The war and national emergency periods
currently being used to calculate creditable military service for unemployment and sickness purposes
are:
National Emergency which began December 16,1950, and ended September 14,1978, and
National Emergency which began August 2,1990.
We will credit your military service only if you began your military service after your railroad service
in the same or preceding calendar year. For example, Employee A worked for ABC Railroad fiom
March 1989 to September 1990. He was engaged in active military service fiom October 1990 until
August 1992, after which he returned to work in the railroad industry. Under the provisions of the
RUM, Employee A would be credited with 23 months of military service.
Please read the Important Notices on the next page.
EMPLOYEE'S STATEMENT
[ claim

credit for active military service in the Armed Forces of the United States as follows:

Branch of Service
Date of
Entry

Place of Entry

3ate of Discharge

Place of Discharge

Military Organization or
Vessel at
rime of Discharge

Serial No. (if
None, give rank

4ttach your certificate of discharge or release to inactive duty (if such record shows the beginning and ending
lates of active service), or any other official military record issued by the military branch in which you served
;bowing the period of active service. A photocopy may be submitted. If an original document is submitted, we
will return it to you.
certify that the information I am giving is true, complete, and correct. I understand that criminal and civil
~enaltiesmay be imposed on me for false or fraudulent statements, or for withholding information to cause
~aymentof benefits by the RRB.
;ignature

Date

Paperwork Reduction/Privacy Act Notice
The Railroad Retirement Board's authority for requesting this information is Section 5(b) of the
Railroad Unemployment Insurance Act. This information will be used to verify your years of service,
counting both railroad service and military service. You do not have to provide this information; but if
you fail to respond, you may lose some benefits.
We estimate this form takes an average of 5 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 suggestions for reducing completion time, to Director of
Information Management, Railroad Retirement Board, 844 Rush Street, Chicago, Illinois 606 11-2092.