UI-38 (04-19) UI Claimant's Report of Efforts to Find Work

CURRENT

Form Approved
OMB No. 3220-0164

UNITED STATES OF AMERICA

RAILROAD RETIREMENT BOARD
COMPENSATION & EMPLOYER SERVICES CENTER
844 NORTH RUSH STREET
CHICAGO, IL 60611-1275
WWW.RRB.GOV

OFFICE HOURS: M-T-TH-F 9:00 AM TO 3:30 PM
WEDS. 9:00 AM TO 12:00 PM - CLOSED FEDERAL HOLIDAYS

TOLL-FREE NUMBER: 1-877-772-5772

,
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 contacting online job search sites, union halls, state
employment services, and local businesses who need the skills you have. We maintain an online
listing of employer job vacancies on our website at www.rrb.gov. Please include proofs of your job
search.
Please follow the instructions for the item(s) checked below:
Read Booklet UB-12 for guidance and tips on how to conduct a successful job search.
Register with the State Employment Service in
on or before
. Please provide
proof of that registration. 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.
Record your work-seeking efforts on page two of this form and mail the completed form to
this office by
.
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.
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.
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

UI-38 (99-99)

UNITED STATES RAILROAD RETIREMENT BOARD - 2

REPORT OF EFFORTS TO FIND WORK
Paperwork Reduction Act and Privacy Act Notices
This notice is given under the Privacy Act of 1974 and Paperwork Reduction Act of 1995. Under section 12(l)
of the Railroad 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.
While you are not required to provide us with this information, your failure to do so may prevent us from paying
you additional benefits.
We estimate this form takes an average of 11½ minutes per response to complete, including the time for
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 aspect of this form, including suggestions for
reducing the completions time to Associate Chief Information Officer for Policy and Compliance, Railroad
Retirement Board, 844 North Rush Street, Chicago, IL 60611-1275.
PLEASE GIVE THE FOLLOWING INFORMATION ABOUT YOUR ATTEMPTS TO FIND 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)