Unemployment Insurance Act. This form provides for showing the employee's claim of the amount of wages he earned in each month of the year or years, the name of the employer from which they were earned, and the place of employment.

(35) Form BA-3, Quarterly Report of Creditable Compensation. This is to be used by employers in reporting the compensation paid to each employee in each month in a calendar quarter as required to be submitted under § 250.3 of this chapter.

(36) Form BA-3a, Annual Report of Creditable Compensation. This form is to be used by employers authorized by the Board to report on an annual basis to report for each employee the service months in which an individual worked, the total service months earned, and the total creditable compensation paid during the year as is required to be submitted under § 250.3 of this chapter.

(37) Form BA-4, Report of Creditable Compensation Adjustments. This form is to be prepared and submitted each month by employers to report any adjustment in creditable compensation which has been made by the employer and which would affect the amount of an employee's benefits under either the Railroad Retirement Act or the Railroad Unemployment Insurance Act.

(38) Form BA-5, Summary Report of Compensation of Employees. Employers reporting creditable compensation are also required to prepare and submit this form which is a quarterly summary of all compensation paid and any adjustments made during the quarter.

(39) Form DC-1, Employer's Quarterly or Annual Report of Contributions Under the Railroad Unemployment Insurance Act. This is a form prescribed by § 345.5 of this chapter to be filed by an employer under the Railroad Unemployment Insurance Act to show the amount of contributions being remitted for the period covered.

(40) Form DC-2, Employee Representatives Report of Compensation. This form is used by an individual serving as an employee representative under the Railroad Retirement Act for reporting employee representative

service and compensation and is to be filed annually or upon termination of employee representative service.

(41) Form DC-3, Claim for Abatement or Refund of Contributions, Interest, or Penalty. This form is to be used by employers in claiming abatement or refund of contributions, interest or penalty under the Railroad Unemployment Insurance Act.

(42) Form OE-1, Payroll Report (Quarterly) for System Subordinate Units. The form is for quarter-annual reports by system subordinate units of national-labor-organization "employ

ers" of earnings by employees and of employer "contributions" remitted pursuant to the Railroad Unemployment Insurance Act; it shows also amounts of taxes paid pursuant to the Railroad Retirement Tax Act.

(43) Form OE-2, Payroll Report (Monthly) for System Subordinate Units. This form is similar to Form OE-1 except that it is for monthly reports.

(44) Form OE-5, Service and Compensation Report by Labor Organization. This requires a report from covered labor organizations of the service and compensation of its covered employees.

(45) Form ES-1, Application for Employment Service. This form is to he used by unemployed persons in applying for placement by the employment service.

(46) Form SI-1a, Application for Sickness Benefits. This form is to be used by an employee in applying for the form on which to claim sickness benefits. The completed form supplies information necessary to determine if the applicant is eligible to claim benefits and waives any existing "doctorpatient privileges" for the purpose of supplying medical information in support of his claim.

(47) Form SI-1b, Statement of Sickness. This form is a detachable part of Form SI-1a and is to be executed by an authorized person supplying medical information in connection with an employee's application for sickness benefits.

(48) Form SI-1d, Pay Rate Report and Employer's Corrected Report of Pay Rate. This form is to be used by a claimant for sickness benefits to

report the pay rates required to determine his daily benefit rates under the Railroad Unemployment Insurance Act. The pay rate report is then verified and, if necessary, corrected by the employer.

(49) Form SI-3, Claim for Sickness Benefits. This form is sent by the Board to claimants for sickness benefits to inform the claimant of the registration period covered by the claim and to request information as to days of sickness claimed, days worked, and earnings. The form is to be returned to the office of the Board to which it is preaddressed.

(50) Form SI-62, Claim for Sickness Benefits Due Employee But Not Paid at Death. This is the form to be used in making claim for sickness benefits due an employee but unpaid at his death.

(51) Form SI-101, Application for Maternity Benefits. This is the form to be used by a female employee in applying for a claim form on which to claim maternity benefits. The form provides for a statement by the employee of prior employment and of the birth or expected birth of a child; and also for a waiver of any existing "doctor-patient privilege" with respect to the maternity sickness for which the claim is made. This form is to be mailed, together with completed Form SI-104, to the Board.

(52) Form SI-103, Claim for Maternity Benefits. This is the form to be used in making claim for maternity benefits under the Railroad Unemployment Insurance Act.

(53) Form SI-104, Statement of Maternity Sickness. This form is to be executed by a doctor of medicine in connection with an application for maternity benefits, and is to be furnished by the applicant to the Board, upon execution, together with completed Form SI-101, Application for Maternity Benefits.

(54) Form UI-1, Application for Unemployment Benefits. This forin is to be used by an employee in applying for unemployment benefits and provides for information in connection with employment service.

(55) Form UI-1a, Pay Rate Report and Employer's Corrected Report of Pay Rate. This form is given to a

claimant for unemployment benefits to provide information of his employment and pay to be used in the determination of the claimant's daily benefit rate. The employer verifies and, if necessary, corrects the pay rate reported by the claimant.

(56) Form UI-3, Registration and Claim for Unemployment Benefits. This is a form for registering for days of unemployment and claiming unemployment insurance benefits, for providing notice to the claimant of requirements upon him, and for statement to be certified to by the claimant.

(57) Form UI-63, Application for Accrued Benefits Due Under the Railroad Unemployment insurance Act and Unpaid at Death. This application is used by a survivor or other person to claim benefits under the Railroad Unemployment Insurance Act due but unpaid to a claimant at the time of his death.

(58) Form UI-85, Appeal to the Board From Referee's Decision Under Railroad Unemployment Insurance Act. This form is used to appeal to the Board from a decision of a referee on a claim for benefits under the Railroad Unemployment Insurance Act.

(59) Form UI-86, Appeal From Initial Determination Under the Railroad Unemployment Insurance Act. This form is used to appeal from an initial decision denying benefits under the Railroad Unemployment Insurance Act.

[Board Order 62-115, 27 FR 9254, Sept. 19, 1962, as amended at 35 FR 14543, Sept. 17, 1970]

(a) The following materials (more particularly described in paragraph (d) of this section), with identifying details deleted pursuant to paragraph (b) of this section, are available for public inspection and copying:

(1) All final opinions (including concurring and dissenting opinions), and all orders made in the adjudication of cases, which have precedential effect;

(2) All statements of policy and interpretations which have been adopted by the Board, or by anyone under authority delegated by the Board,

which have not been published in the FEDERAL REGISTER; and

(3) Administrative staff manuals and instructions to staff that affect any member of the public.

(b) The identifying details to be deleted shall include, but not be limited to, names and identifying numbers of employees and other individuals as needed to comply with section 12 (d) and (n) of the Railroad Unemployment Insurance Act, section 10(b)6 of the Railroad Retirement Act, and § 262.16 of this chapter, or to prevent a clearly unwarranted invasion of personal privacy.

(c) There shall be maintained in the Board's library a current index of the materials referred to in paragraph (a) of this section which will have been issued, adopted, or promulgated subsequent to July 4, 1967. This index shall be available for public inspection and copying at the Board's headquarters offices located at 844 Rush Street, Chicago, Illinois, during the normal business hours of the Board. Copies of the index or any portion thereof may be obtained for a fee equivalent to the costs of reproduction by submitting a written request therefor. Such request should comply with the form for requests as described in paragraph (h) of this section.

(d) The materials and indexes thereto shall be kept, and made available to the public upon request, in the bureaus and offices of the Board which produce or utilize the materials. The following materials currently in use shall, as long as they are in effect as precedents and instructions, be made available in offices of the Board at 844 Rush Street, Chicago:

(1) In the Bureau of Retirement Claims: The Retirement Claims Manual, RCM Circulars, Special Services Manual, Policy Decisions, Procedural Memoranda containing information on the adjudication of claims not contained in the Retirement Claims Manual or in RCM Circulars, Instructions and Circular Letters to Employers, Field Operating Manual (Parts I and VI), FOM Circulars and Memoranda, and the Occupational Disability Rating Schedule.

(2) In the Bureau of Unemployment and Sickness Insurance: the Adjudica

tion Instruction Manual, Regional Operating Manual (Part I), Field Operating Manual (Part II), FOM Circulars and Memoranda, Bureau of Unemployment and Sickness Insurance Circulars, Memorandum Opinions, memorandum instructions on adjudication, and circular letters of instruction to railroad officials.

(3) In the Bureau of Data Processing and Accounts: the Instructions to Employers, and Circular Letters to Employers.

(4) In the Bureau of Law; Legal Opinions.

(5) In the Office of the Secretary of the Board: Decisions and rulings of the Board.

Regional offices and field offices shall also make available to the extent practicable such of these materials and indexes as are furnished them in the ordinary course of business.

(e) The copies of manuals and instructions made available for public copying and inspection shall not include:

(1) Confidential statements, standards, and instructions which do not affect the public, and

(2) Instructions not affecting the public (such as those relating solely to processing and procedure, to management, or to personnel) which it is feasible to separate from instructions that do affect the public.

(f) With the exception of records specifically excluded from disclosure by section 552(b) of Title 5, United States Code, or other applicable statute, any records of or in the custody of this agency, other than those made available under paragraphs (a), (c), and (d) of this section, shall, upon receipt of a written request reasonably describing them, promptly be made available to the person requesting them.

(g) The Chief Executive Officer may charge the person or persons making a request for records under paragraph (f) of this section a fee in an amount not to exceed the costs actually incurred in complying with the request. After February 21, 1975, any such fees charged by the Chief Executive Officer shall be in accordance with the following schedule.

(1) The fee for copies shall be $.10 per copy per page.

(2) The charge for making a manual search for records shall be $6.00 per man hour.

(3) The maximum computer search charge shall be $268.00 per hour ($4.50 per minute).

(4) Any or all fees may be waived or reduced by the Chief Executive Officer whenever he or she determines that it is in the public interest to do

so.

(5) All fees shall be paid to the Board's Director of Budget and Fiscal Operations.

(h) Any person or organization requesting records pursuant to this section shall submit such request in writing to the Chief Executive Officer, Railroad Retirement Board, Room 536, 844 Rush Street, Chicago, Illinois 60611. All such requests should be clearly and prominently identified as requests for information under the Freedom of Information Act. If submitted by mail or otherwise submitted in an envelope or other cover, requests should be clearly and prominently identified as such on the envelope or cover.

(i) The Chief Executive Officer, or any other individual specifically authorized to act on behalf of the Chief Executive Officer, shall have the authority to grant or deny a request for information submitted under this section. The Chief Executive Officer or such authorized representative shall, within 10 working days following the = receipt of a request, except as provided in paragraph (j)(1) of this section, : make a determination granting or denying the request and notify the requester of his or her decision and if a denial, the reasons therefor. The requester shall be further advised that a total or partial denial may be appealed to the Board as provided in paragraph (j) of this section.

(j) In cases where a request for information is denied, in whole or in part, by the Chief Executive Officer or his or her authorized representative, the party who originally made the request may appeal such determination to the Board by filing a written appeal with the Secretary of the Board within 20 working days following re

ceipt of the notice of denial. The Board shall render a decision on an appeal within 20 working days following receipt of the appeal except as provided in paragraph (j)(1) of this section. The requester shall promptly be notified of the Board's decision and, in cases where the denial is upheld, of the provisions for judicial review of such final administrative decisions.

(1) In unusual circumstances, as enumerated in § 552(a)(6)(B) of Title 5, United States Code, the time restrictions of paragraphs (i) and (j) of this section may be extended in the aggregate by no more than 10 days by notice to the requester of such extension, the reasons therefor, and the date on which a determination is expected to be dispatched.

(2) For purposes of paragraphs (i) and (j) of this section, a request shall be received by the Chief Executive Officer of the Board when it arrives at the Board's headquarters. Provided, however, That when the estimated fee to be assessed for a given request exceeds $30.00, such request shall be deemed not to have been received by the Chief Executive Officer until the requester is advised of the estimated cost and agrees to bear it. Provided further, That a request which does not fully comply with all the provisions of paragraph (h) of this section shall be deemed to have been received by the Chief Executive Officer on the day it actually reaches his or her office.

(k) Any person in the employ of the Railroad Retirement Board who receives a request for any information, document or record of this agency, or in the custody thereof, shall advise the requester to address such request to the Chief Executive Officer. If the request received is in writing, it shall be immediately referred for action to the Chief Executive Officer.

(1) The Chief Executive Officer shall maintain records of:

(1) The total amount of fees collected by this agency pursuant to this section;

(2) The number of initial denials of requests for records made pursuant to this section and the reason for each;

(3) The number of appeals from such denials and the result of each appeal, together with the reason(s) for

60-048 0-80--7

the action upon each appeal that results in a denial of information;

(4) The name(s) and title(s) or position(s) of each person responsible for each initial denial of records requested and the number of instances of action on a request for information for each such person;

(5) The results of each proceeding conducted pursuant to section 552(a)(4)(F) of Title 5, United States Code, including a report of any disciplinary action against an official or employee who was determined to be primarily responsible for improperly withholding records, or an explanation of why disciplinary action was not taken;

(6) Every rule made by this agency affecting or in implementation of section 552 of Title 5, United States Code;

(7) The fee schedule for copies of records and documents requested pursuant to this regulation; and

(8) All other information which indicates efforts to administer fully the letter and spirit of section 552 of Title 5, United States Code.

(m) The Board shall, prior to March 1 of each year, prepare and submit a report to the Speaker of the House of Representatives and the President of the Senate covering each of the categories of records maintained in accordance with the foregoing for the preceding calendar year.

[Board Order 6784, 3. FR 9651, Sept. 4, 1967, as amended at 40 FR 7255, Feb. 19, 1975]

§ 200.4 Protection of privacy of records maintained on individuals.

(a) Purpose and scope. The purpose of this section is to establish specific procedures necessary for compliance with the Privacy Act of 1974 (Pub. L. 93-579). These regulations apply to all record systems containing information of a personal or private nature maintained by the Railroad Retirement Board that are indexed and retrieved by personal identifier.

(b) Definitions—(1) Individual. The term "individual" pertains to a natural person who is a citizen of the United States or an alien lawfully admitted for permanent residence and not to a company or corporation.

(2) System of records. For the purposes of this section, the term "system of records" pertains to only those records that can be retrieved by an individual identifier.

(3) Railroad Retirement Board. For purposes of this section, the term "Railroad Retirement Board" refers to the United States Railroad Retirement Board, an independent agency in the executive branch of the United States Government.

(4) Board. For purposes of this section the term "Board" refers to the three member governing body of the United States Railroad Retirement Board.

(c) Procedure fɔr requesting the existence of personally identifiable records in a record system. An individual can determine if a particular record system maintained by the Railroad Retirement Board contains any record pertaining to him by submitting a written request for such information to the system manager of that record system as described in the annual notice published in the FEDERAL REGISTER. A current copy of the system notices, published in accordance with paragraph (i) of this section, is available for inspection at all regional and district offices of the Board. If necessary, Board personnel will aid requesters in determining what system(s) of records they wish to review and will forward any requests for information to the appropriate system manager. Also, requests for personal information may be submitted either by mail or in person to the system manager at the headquarters of the Railroad Retirement Board, 844 Rush Street, Chicago, Illinois 60611. Prior to responding to a request for information under this subsection, the system manager shall require the individual requesting such information to provide identifying data, such as his full name, date of birth, and social security number. The system manager shall respond to a request under this subsection within a reasonable time by stating that a record on the individual either is or is not contained in the system.

(d) Disclosure of requested information to individuals. (1) Upon request, an individual shall be granted access to records pertaining to himself, other