Railroad Retirement Board

RRB

Federal Forms

Forms
OMB NumberTitle
3220-0203 Report of Stock Options and Other Payments
3220-0202 Self-Employment/Corporate Officer Work and Earnings Monitoring
3220-0201 Applicant Background Survey
3220-0200 Designation of Contact Officials
3220-0199 System Access Application
3220-0198 Request for Internet Services
3220-0197 Verification of Supplement Annuity
3220-0196 Investigation of Claim for Possible Days of Employment
3220-0195 Statement Regarding Contributions and Support of Children
3220-0194 Employee Home Address Report
3220-0193 Job Information Report
3220-0192 Customer Satisfaction Monitoring
3220-0191 Release of Canadian Tax Information
3220-0190 FOREIGN EARNINGS QUESTIONNAIRE
3220-0189 Evidence of Coverage under An Employer Group Health Plan
3220-0188 RRB Customer Satisfaction Survey
3220-0187 Continuing Disability Report
3220-0186 QUESTIONNAIRE REGARDING NAME DIFFERENCE
3220-0185 Report of Medicaid State Office on Beneficiary's Buy-In Status
3220-0184 Earnings Information Request
3220-0183 Statement of Claimant or Other Person
3220-0182 PILOT STUDY -- MEDICAL ASSESSMENT REPORTS FOR DISABILITY CLAIMANTS UNDER THE RAILROAD RETIREMENT ACT
3220-0181 Notice of Intent to Offset Federal Income Tax Refund
3220-0179 Annual Earnings Questionnaire for Annuitants in Last Pre-Retirement Non-Railroad Employment
3220-0178 Aged Monitoring Questionnaire
3220-0176 Representative Payee Parental Custody Monitoring
3220-0175 Sick Pay and Miscellaneous Payments Report
3220-0173 Railroad Separation Allowance or Severance Pay Report
3220-0171 RUIA Claims Notification and Verification System
3220-0170 RRB CLIENT SATISFACTION SURVEY
3220-0169 Repayment of Debt
3220-0168 RAILROAD SEPARATION ALLOWANCE OR SEVERANCE PAY REPORT
3220-0166 PILOT STUDY-MAIL REGISTRATION FOR UNEMPLOYMENT BENEFITS
3220-0165 Repayment of Debt
3220-0164 Availability for Work
3220-0163 PLACEMENT QUESTIONNAIRE
3220-0161 AGED MONITORING QUESTIONNAIRE
3220-0159 ANNUAL EARNINGS MONITORING
3220-0158 SICK PAY COLLECTION
3220-0156 Employer's Deemed Service Month Questionnaire
3220-0155 Supplement to Claim of Person Outside the United States
3220-0154 Employee Non-Covered Service Pension Questionnaire
3220-0153 RAILROAD VERIFICATION OF CLAIMED UNEMPLOYMENT OR SICKNESS
3220-0152 PUBLIC SERVICE PENSION INFORMATION REQUEST
3220-0151 Representative Payee Monitoring
3220-0150 FREEDOM OF INFORMATION REQUESTS
3220-0149 Withholding Certificate for Railroad Retirement Monthly Annuity Payments
3220-0146 REQUESTS FOR CONSULTATIVE MEDICAL EXAMINATION
3220-0145 Nonresident Questionnaire
3220-0144 APPLICATION/CLAIM FOR BENEFITS UNDER THE ROCK ISLAND ACT
3220-0141 Vocational Report
3220-0140 Employee's Certification
3220-0139 PROCUREMENT REQUESTS
3220-0138 Self-Employment and Substantial Service Questionnaire
3220-0136 Public Service Pension Questionnaires
3220-0135 PROTECTED EMPLOYEE BENEFITS
3220-0134 PROTECTED EMPLOYEE ELECTION
3220-0133 DESIGNATION OF CONTACT OFFICIALS
3220-0132 Gross Earnings Report
3220-0131 Request for Medicare Payment
3220-0127 Financial Disclosure Statement
3220-0124 REQUESTS FOR CONSULTATIVE MEDICAL EXAMINATIONS RL-12/ID-31A
3220-0123 Student Beneficiary Monitoring
3220-0122 Railroad Job Vacancies
3220-0121 USE OF RRB MONTHLY BENEFIT STATISTICS
3220-0119 BENEFIT ACCURACY STUDY
3220-0116 APPLICATION FOR EMPLOYMENT SERVICE
3220-0115 APPLICATION FOR REIMBURSEMENT/ VERIFICATION OF ENROLLMENT AND NOTICE OF CHANGE IN EDUCATIONAL PROGRAM FOR NEW CAREER TRAINING ASSISTANCE
3220-0114 APPLICATION/ CLAIM FOR SUPPLEMENTARY UNEMPLOYMENT INSURANCE
3220-0111 PROTECTED EMPLOYEE INVENTORY RECORD AND CLAIMS FOR REIMBURSEMENT ALLOWANCES
3220-0110 EMPLOYEE - EMPLOYER STATEMENT OF PAY RATE
3220-0109 WORK AND EARNINGS MAY AFFECT YOUR RAILROAD RETIREMENT ANNUITY
3220-0108 REQUEST FOR SUPPLEMENTAL REPORT OF COMPENSATION
3220-0107 Request to Non-Railroad Employer for Information About Annuitants Work and Earnings
3220-0106 Application for Search of Census Records (Railroad Retirement Purposes Only)
3220-0105 APPLICATION FOR PARENT'S INSURANCE ANNUITY
3220-0103 PHYSICIAN'S STATEMENT REGARDING PATIENT'S CAPABILITY TO MANAGE PAYMENTS
3220-0100 Request for Review of Part B Medicare Claim
3220-0099 Statement Regarding Contributions and Support
3220-0098 REQUEST FOR TERMINATION OF SUPPLEMENTARY MEDICAL INSURANCE
3220-0097 Pay Rate Report
3220-0096 NOTICE OF BENEFIT STATUS
3220-0095 APPLICATION AND STATEMENT OF SICKNESS - PREGNANCY, MISCARRIAGE, OR CHILDBIRTH
3220-0094 SUPPLEMENT TO APPLICATION FOR WIDOW(ER)'S INSURANCE ANNUITY
3220-0093 NOTICE OF PAYMENT OF SEPARATION ALLOWANCE
3220-0092 APPLICATION FOR CHILD'S INSURANCE ANNUITY FULL TIME STUDENT
3220-0091 REQUEST FOR PAYMENT BY QUALIFIED ORGANIZATIONS
3220-0090 EMPLOYER'S SUPPLEMENTAL PENSION REPORT
3220-0089 Pension Plan Reports
3220-0086 Application for Reimbursement for Hospital Services in Canada
3220-0085 REQUEST FOR MEDICAL PAYMENT
3220-0084 REPORT OF FORMER SPOUSE - ANNUITANT
3220-0083 Evidence for Application of Overall Minimum
3220-0082 Medicare
3220-0081 CERTIFICATION REGARDING RIGHTS TO UNEMPLOYMENT BENEFITS
3220-0079 Certification Regarding Rights to Unemployment Benefits
3220-0078 DISABILITY ANNUITANT'S REPORT TO THE U S RAILROAD RETIREMENT BOARD
3220-0077 STATEMENT OF DEATH BY FUNERAL DIRECTOR
3220-0076 CLAIMANT'S STATEMENT OF SERVICE FOR RAILROAD UNEMPLOYMENT INSURANCE BENEFITS
3220-0075 CONTINUING DISABILITY REPORT
3220-0074 CANADIAN UNEMPLOYMENT & SICKNESS BENEFIT INFORMATION
3220-0073 Annual Earnings Monitoring
3220-0072 Claim for Credit for Military Service
3220-0071 SUPPLEMENT TO APPLICATION FOR EMPLOYEE ANNUITY
3220-0070 Employer Service and Compensation Reports
3220-0068 EMPLOYEE ANNUITANT'S STATEMENT REGARDING FAMILY AND EARNINGS
3220-0067 STATEMENT OF SPOUSE OF EMPLOYEE ANNUITANT
3220-0066 REQUEST FOR INFORMATION FROM ANNUITANT (REGARDING DEPENDENTS
3220-0065 REQUEST FOR COURT STATEMENT REGARDING DIVORCE OR ANNULMENT
3220-0064 STATEMENT OF RESIDENCE
3220-0063 REQUEST FOR INFORMATION AND STATEMENT OF MARITAL STATUS (LEGAL TERMINATION OF PREVIOUS MARRIAGE)
3220-0057 Placement Service
3220-0056 APPLICATION FOR ACCRUIED BENEFITS UNPAID AT DEATH
3220-0055 Application for Benefits Due but Unpaid at Death
3220-0053 REPORT CONCERNING EMPLOYMENT
3220-0052 Application to Act as Representative Payee
3220-0051 SUPPLEMENT TO APPLICATION FOR SPOUSE'S WIDOW(ER)S AND/OR CHILD INSURANCE ANNUITY (DISABLED CHILD)
3220-0050 WAIVER OF ANNUITY OR PENSION UNDER THE RAILROAD RETIREMENT ACT
3220-0049 Investigation of Claim for Possible Days of Employment or State Benefits Received
3220-0047 SUPPLEMENTAL INFORMATION ON ACCIDENT AND INSURANCE
3220-0046 EMPLOYERS SUPPLEMENTAL REPORT OF SERVICE AND COMPENSATION
3220-0045 SUPPLEMENTAL DOCTOR'S STATEMENT
3220-0044 APPLICATION FOR RECOMPUTATION OF EMPLOYEE ANNUITY UNDER RRA
3220-0043 EMPLOYEE'S CERTIFICATION
3220-0042 Application for Spouse Annuity Under the Railroad Retirement Act
3220-0041 AUTHORIZATION OF PAYMENT AND RELEASE OF ALL CLAIMS TO A DEATH BENEFIT OR ACCRUED ANNUITY PAYMENT
3220-0040 STATEMENT REGARDING ADOPTION
3220-0039 Railroad Unemployment Insurance Act Applications
3220-0038 Medical Reports
3220-0037 ANNUITANT'S REPORT OF EARNINGS AND DISABILITY
3220-0036 Supplemental Information on Accident and Insurance
3220-0035 REPORT OF PHYSICAL CONDITION OF CLAIMANT UNDER RUIA
3220-0034 Statement of Authority to Act for Employee
3220-0033 CLAIM FOR SICKNESS BENEFITS
3220-0032 Survivor Questionnaire
3220-0031 Application for Survivor Death Benefits
3220-0030 Application for Survivor Insurance Annuities
3220-0029 APPLICATION FOR CHILD'S INSURANCE ANNUITY
3220-0028 APPLICATION FOR WIDOW'S OR WIDOWER'S AND CHILD'S INSURANCE ANNUITIES
3220-0027 REFERRAL CARD - REPORT ON PLACEMENT OR REFUSAL OF REFERRAL OR OFFER TO RAILROAD RETIREMENT BOARD
3220-0026 UNEMPLOYMENT INSURANCE CLAIMANT'S REFERRAL REPORT
3220-0025 RUIA Investigations and Continuing Entitlement
3220-0023 CERTIFICATE OF RESPONSIBILITY OF MINOR APPLICANT
3220-0022 Application and Claim for Unemployment Benefits and Employment Service
3220-0021 Evidence of Marital Relationship - Living with Requirements
3220-0020 APPEAL FROM DETERMINATIONS UNDER RAILROAD UNEMPLOYMENT INSURANCE ACT
3220-0019 CLAIM FOR UNEMPLOYMENT BENEFITS
3220-0016 Certification of Termination of Service and Relinquishment of Rights
3220-0015 CERTIFICATION IN SUPPORT OF EMPLOYER SERVICE
3220-0014 Employee Representative's Status and Compensation Reports
3220-0013 EMPLOYEE REPRESENTATIVE'S REPORT OF COMPENSATION
3220-0012 Employer's Quarterly Report of Contributions Under the RUIA
3220-0011 EMPLOYEE REGISTRATION (RAILROAD EMPLOYEES)
3220-0010 SUMMARY REPORT OF COMPENSATION OF EMPLOYEES
3220-0009 REPORT OF CREDITABLE COMPENSATION ADJUSTMENTS
3220-0008 Railroad Service and Compensation Reports/System Access Application/Report Certification
3220-0007 Claimant Appeal Under the Railroad Retirement Act or Railroad Unemployment Insurance Act
3220-0006 EMPLOYEE'S STATEMENT OF SERVICE PERFORMED BEFORE JAN. 1, 1937, TO EMPLOYERS UNDER THE RR ACT
3220-0005 Employer Reporting
3220-0004 DESIGNATION OF CHANGE OF BENEFICIARY FOR RESIDUAL LUMP SUM
3220-0003 PRIOR SERVICE REPORTS
3220-0002 Application for Employee Annuity Under the Railroad Retirement Act
3220-0001 EXTENDED BENEFIT TRIGGER RATES WITHOUT EB CLAIMS

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