RRB booklet, RB-3 (08-04)

Form RB-3 (08-04).pdf

Application for Employee Annuity Under the Railroad Retirement Act

RRB booklet, RB-3 (08-04)

OMB: 3220-0002

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For Use With All Applications

Furnishing Evidence
to Support
Your Claim

United States of America
Railroad Retirement Board
Visit our Website at http.//www.rrb.gov

Form RB-3 (08-04)

CONTENTS

Page

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Part I General Information

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Part 2, Proof of Age
Part 3 - Proof of Relationship

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Part 4 Proof of Marriage

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Part 5 Proof of Divorce

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Part 6 Proof of Military Service

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Part 7 Proof of Death

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Part 8 Proof of payment of Burial Expenses

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Part 9 Proof of Appointment as Legal Representative

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Part 10 Proof of Citizensllip and Residence

1

Part l
General Information
Every applicant for railroad retirement benefits or
Medicare must submit some type of documentary
evidence or proof to support hislher claim for benefits.
The purpose of this booklet is to describe the types of
acceptable evidence and to assist you in obtaining
these records if they are not in your possession. If you
a r e unable to secure t h e necessary record after
following these guidelines, please contact the nearest
field office of the RRB. The people there will be glad
to assist you.
Evidence submitted in support of a n applicant's claim
should be:

Any document to be used for proof of age must show
t h e p e r s o n ' s n a m e , a g e or d a t e of b i r t h , a n d
p r e f e r a b l y , t h e d a t e on which t h e record w a s
established. Any document submitted a s proof of age
or date of birth must be based on a record that was
established more t h a n 5 years before the date on
which you filed a n application for a n annuity or
Medicare coverage with the Railroad Retirement
Board. Proof of age for a child who i s less t h a n 5
years old should be based on a record made shortly
after birth.
Best Proofs of Age

(Recorded before 5 years o f age)
Civil record of birth

An original document; or
A copy of a public record certified by the custodian
of the record.

(NOTE: Documents that are photocopied, faxed or
e-mailed are not acceotable.)
Documents that have been altered in any way are not
valid and cannot be used.
Most documents brought into the field office will be
copied for our records and returned to you right away.
If a n original document is received in the mail, it will
be carefully preserved by the RRB and returned to
you after we have made a copy for our records.

Part 2
Proof of Age
Proof of age is required of almost every applicant for
railroad retirement monthly benefits or Medicare
coverage. Various types of acceptable proofs of age
and places to secure them are listed in this chapter.
Always try to secure one of the documents listed in
"Best P r o o f s of Age." If none of these documents
can be obtained, then you should submit a document
listed under "Other Proofs of Age."
Older records a r e generally considered t h e best
records. Try to secure evidence made a t or near the
time of your birth. If you have problems securing
proof of your age, contact the nearest field office of the
RRB. The people there will be glad to assist you. If
the document submitted is not sufficient, additional
evidence may be required. If so, the field office will
contact you.

Where to Secure

Bureau of Vital
Statistics in State
capital of State of birth

Church record of birth or Church were baptized or
baptism
confirmed
Notification of
registration of birth

County or City Health
Department of county or
city of birth

Hospital birth record or
certificate

Hospital where born

If you do not h a v e one of t h e s e records i n your
possession, try to obtain one. Churches usually do not
destroy their records, and if there was a record of
your date of birth made when you were an infant or a
child, it is probably still on file a t the church. Even if
the church building itself is no longer in existence, the
records may be available a t a diocesan, state, or
regional office of the denomination.
Our field offices have a complete list of addresses and
fees for public birth records in the United States and
in many foreign countries. Call or write the field office
to find out where to write and how much to send to
obtain your birth record.
If you a r e unable to obtain a record listed under
"Best P r o o f s of Age," use the "Remarks" section
on t h e application to explain what attempts were
made to secure the record. If you do not have the
application, use a plain sheet of paper.
Try to obtain a record made early in life; old records
are generally the best records. If you have more than
one of the documents described on page 2, submit
them all.

Part 3
Proof of Relationship

Other Proofs of Age

Where to Secure

Physician's or midwife's
birth record

Doctor or midwife
attending birth

Bible or other family
record

Member of the farmly. Do
not mail a Bible. If t h s
record is being used, the
entire bible must be
brought into the field office.

Proof of relationship must be given by each person
applying for benefits a s the child, parent, brother,
sister or grandchild of the former railroad employee.
If the document used to prove the age of the person
also shows hislher relationship to t h e employee,
separate proof of relationship is not needed.

Naturalization record

Nearest district office of
the U.S. Immigration and
Naturalization Service

For example, if a child's proof of age shows t h e
employee a s hislher p a r e n t , a s e p a r a t e proof of
relationship is not necessary.

Military record

See Chapter 6 of t h s booklet.

Immigration record

Nearest district office of
the U.S. Immigration and
Naturalization Service

A wife or husband may qualify for benefits if helshe
has the employee's child in care. The term "child in
care" means the railroad employee's dependent and
unmarried natural child, adopted child, or stepchild,
or u n d e r c e r t a i n conditions a grandchild whose
parents are deceased or disabled.

Census age record

Field office of the RRB
will assist you.

Draft registration record

Field office of the RRB
will assist you.

Indian tribal record

Tribal council
headquarters or
National Archives,
Washington, D.C. 20203

Passport

If in your possession,
bring to the district
office of the RRB

School record

School attended.
Department of Public
Instruction,
Superintendent of Schools,
or similar agency if the
school has been closed

Vaccination record

City or County Health
Department

Insurance record

Insurance company
issuing policy

Labor union or fraternal
record

Secretary of local labor,
fraternal or a u x h r y lodge

Employer's record

Radroad or express
company where employed

Other records may be submitted if age is shown.
Examples of these records are marriage records and
birth records of a child if the age of the parent is shown.

If you a r e filing a s the parent of a former railroad
employee, you must submit evidence that you are the
employee's n a t u r a l p a r e n t , a d o p t i v e p a r e n t or
stepparent. This evidence would be a birth record for
the employee from the list given below which shows
that you are named a s the employee's parent. If the
employee was legally adopted, refer to the section
marked "Adoption"in this chapter.

Best Evidence of
Relationship

Where to Secure

Certified copy of the
civil birth record of the
person filing for
benefits (showing the
parents' names)

Bureau of Vital
Statistics in State
capital of State of birth

Certified copy of the
religious birth record of
the person filing for
benefits (showing the
parents' names)

Church where baptized
or confirmed

Any evidence listed in
Chapter 2 if it shows
relationship

In the following cases, it may be necessary to submit
more than one document to prove the relationship to
the employee.

A grandchild m u s t show who hislher p a r e n t s
a r e and prove t h a t hislher parent is related to
t h e employee.

A brother or sister of the employee must furnish
hislher birth record and the employee's, showing
that they both have the same parents.

A stepchild must show helshe is the child of the
person married to the employee. See Chapter 4 for
establishing proof of marriage.

A stepparent must show that the person helshe is
married to is the employee's parent. See Chapter 4 for
establishmg proof of marriage.

Part 4
Proof of Marn'age
If you a r e filing for monthly railroad retirement
benefits or Medicare a s the wife, husband, divorced
wife or husband, widow, widower, remarried widow or
widower, or surviving divorced wife or husband of a
former railroad employee, you must furnish evidence
of your marriage to the employee. If you are claiming
benefits a s a remarried widow or widower, you may
have to furnish proof of your remarriage. A person
filling a s a divorced spouse or surviving divorced
spouse must submit proof that the marriage to the
employee lasted a t least ten consecutive years before
the date of the final divorce decree.

Best Proofs of a
Ceremonial Marriage

Where to Secure
Personal records

Adoption

The original certdicate of
marriage

When the relationship involves a legally adopted child
or the parent of a legally adopted child, submit a
certified copy of the decree or order of adoption. If the
record of adoption cannot be obtained, submit one of
the following documents:

A copy of a public record of
the marriage certi6ed by
the custodian of the record

Clerk of the Court in the
city or county where
marriage license was
obtained
or
Bureau of Vital Statistics
of the State in which you
were married

A copy of a religious record

Church were marriage
took place

The official notice received by the adopting parents
stating that the adoption has been completed; or

A birth certificate issued a s a result of the adoption
proceeding.
If you are unable to furnish any of the documents
described above or if t h e adoption proceedings
have been completed, contact t h e n e a r e s t field
office of the RRB. The people there will be glad to
assist you.

of the marriage certi6ed by
the custohan of the record

NOTE: A marriage license is not a n acceptable
proof of marriage. If none of the proofs listed above
can be found or if no marriage ceremony took place,
contact the nearest field office o f the RRB. The
people there will be glad to assist you.
Proof of Termination of a Remarriage
If you are claiming benefits a s the divorced spouse
a n d have remarried since your divorce from t h e
employee, you m u s t furnish proof t h a t t h e l a t e r
marriage or marriages have terminated.
If you a r e c l a i m i n g b e n e f i t s a s t h e r e m a r r i e d
widowlwidower, or surviving divorced spouse, you
m u s t f u r n i s h proof t h a t t h e l a t e r m a r r i a g e or
marriages have terminated, unless you remarried
after attainment of age 60 or after attainment of age
50 if previously eligible for a disabled widow(er)'s or
s u r v i v i n g divorced s p o u s e s a n n u i t y before t h e
marriage occurred.
Refer t o Chapter 5 for a discussion of acceptable
proofs of divorce or annulment and Chapter 7 for a
discussion of acceptable proofs of death.

Part 5
Proof of Divorce

Part 6
Proof of Military Service

Proof of divorce is required when benefits are claimed
a s t h e divorced wife or husband or t h e surviving
divorced spouse of a former railroad employee. A
person filing a s a divorced spouse or surviving
divorced spouse must prove that the divorce took place
after a t least ten consecutive years of marriage to the
employee. A divorced spouse or surviving divorced
spouse claiming exemption from the public service
pension offset based on entitlement as a divorced wife
under social security eligibility requirements in effect
in J a n u a r y 1977 must prove t h a t the divorce took
place after a t least 20 consecutive years of marriage to
the employee. See Chapter 4 for circumstances when
the later marriage does not have to be terminated.

In some cases, credit may be given for the former
railroad employee's military service. If credit for
military service is claimed, proof must be furnished.
Both the beginning date and the ending date of the
military service must be proven.

Proof of Divorce

Where t o Secure

The original decree of
final or absolute divorce
or divorce a vinculo
matrimonii

Personal records

A copy of the divorce
certified by the
custodian of the record

Clerk of the Court in city
or county where divorce
was obtained
or
Bureau of Vital
Statistics of State in
which you were divorced

A certified photocopy of
one of the documents
shown above

If you a r e unable to obtain any of the documents
listed above or if the decree is not for a final, absolute
or divorce a vinculo matrimonii, contact the nearest
field office of the RRB. The people there will be glad
to assist you.

Annulment
C h a p t e r 4 of t h i s booklet d e s c r i b e s w h e n i t i s
n e c e s s a r y t o file proof of t e r m i n a t i o n of a
remarriage. When a marriage or remarriage ends
with a n annulment, submit a certified copy of the
decree of annulment.

Best Proof of Military
Service

Where t o Secure

Original certificate of
discharge or release to
inactive duty from a
branch of the Armed
Forces that shows the
beginning and ending
date of the active
military service

Personal records

Copy of a certificate
made by the State,
county or municipal
agency or department in
which the original record
was recorded

County Recorder or
County Clerk for county
of residence when
discharged

Certification from a
branch of the Armed
Forces that shows the
beginning and ending
dates of employee's
military service

National Personnel
Records Center (Military
Personnel Records), 9700
Page Boulevard, St.
Louis, Missouri 63 1325100. If the employee
was discharged from the
Army during 1912-1959
or the Air Force during
1947-1963, see the
"Other Proofs of
Military Service"
section.

A certified photocopy of
one of the documents
shown above.

Other Proofs of Military Service
Some military service records stored in the Personnel
Records Center in St. Louis were damaged by a fire in
1973. The military service records were involved in
the fire if the former railroad employee was either:
Discharged from the Army during the years from
1912 to 1959, or
Discharged from the Air Force during the period
from September 1947 through December 1963 and
the last name comes after Hubbard in the alphabet.

If your military service records were destroyed either
in the fire in the National Records Center a t St. Louis
in 1973, or in some other way, you may request a new
military service record with Form SF-180, Request
Pertaining to Military Records. This form is available
from the RRB or your branch of service. If no other
record can be obtained, a w r i t t e n s t a t e m e n t of
military service from one of the agencies listed below
can be used as proof of military service. Only request
information from a n agency if t h e condition in the
"If" column applies to the employee.

Part 7
Proof of Death
Proof of the death of a former railroad employee is
required with all claims for survivor benefits.

Death occurred inside the United States
Types of Proof

Where to Secure

Where to Secure Proof

Certified copy of the
public record of death
(Death Certificate)

Bureau of Vital
Statistics or
Department of Health
for city, county or State

The employee ever filed
a claim for
unemployment
compensation based
upon the military service

State unemployment
compensation office

Coroner's report of death

Coroner or medical
examiner
Coroner or medical
examiner

The employee was
paid a bonus

State Bonus Office

Verdict of the coroner's
jury of the State or
community where death
occurred.

The employee retired
from Federal
employment

Office of Personnel
Management. Bureau of
Retirement and
Insurance Employee
Service and Records
Center, Boyers, PA
16017

Funeral home

The employee ever
furnished the military
service record to a n
employer

Federal, State, local or
private employer to
whom a record of
military service was
furnished

The employee ever filed
a claim for Veteran's
benefits of any kind

Nearest Veteran's
Affairs Regional Office

A signed statement of
death by funeral director
on a n acceptable RRB or
SSA form (RRB Form G273a Statement of
Burial Expenses or
SSA's Form SSA-721
Statement of Death by
Funeral Director or SSA2872 Statement of Death
by Funeral Director).
NOTE: This is not a n
acceptable proof o f death
if the applicant is a
funeral director or a
representative o f a
funeral home

The employee ever
performed any service in
the National Guard

State Adjutant General

If

The employee ever filed
Social Security
a claim for Social
Administration
Security Act benefits and
the military service
involved was after
September 6, 1939.

I f you are unable to locate any of the documents listed
above, contact the nearest field office of the RRB. The
people there will be glad to assist you.

A certified photocopy of
any of the documents
described above

Death occurred outside the United States
Types of Proof

Where to Secure

A report of death by a
United States consul, or
other agent of the State
Department, bearing the
signature and official seal

United States consulate or
embassy

A certified copy of the
public record of death
(Death Certificate)

Bureau of Vital Statistics
or Department of Health

Funeral home
A signed statement of
death by a funeral director

Part 8
Proof of Payment
of Burial Expenses
To prove the payment of all or any part of the burial
expenses, you m u s t e i t h e r s u b m i t Railroad
Retirement Board Form G-273a or a n itemized,
receipted statement or bill from the funeral director
and other persons furnishing goods or services. The
receipt must identify the deceased person, be signed
by t h e funeral director or other person to whom
payment was made a n d give all of t h e following
information:
Total amount of all burial expenses
Name of each person who paid toward the burial
expenses
Amount and date of each payment
Amount of unpaid burial expenses
If more than one funeral home is involved, proof of
payment of burial expenses must be furnished by
each one. If Form G-273a cannot be completed or an
itemized bill cannot be given, contact the nearest field
office of the RRB.

Part 9
Proof of Appointment
as Legal Representative
Evidence of appointment a s legal representative is
required of anyone filing a n application for benefits
in this official capacity. A legal representative can
be the guardian, trustee, committee or conservator
of a n individual or t h e administrator or executor of
a n estate.
Proof of Court Appointment
Certified copy of letters of appointment
"Short" certificate
Certified copy of the order of appointment
Any official document issued by the clerk or other
proper official of the appointing court
The document submitted must bear the court seal or
the signature of the court clerk. If the court papers of
appointment were made more t h a n one year before
the application is filed, the certification must show
that they are still in full force and effect.

If you are unable to furnish any of the documents
listed or if you have not been appointed by the court,
contact the nearest field office of the RRB. The people
there will be glad to assist you.

Part 10
Proof of Citizenship
and Residence
Citizenship is a m a t e r i a l factor in applying t a x
provisions. Generally, RRB accepts a claim t h a t a n
individual is a citizen of the country of birth unless
there is information or evidence to the contrary.

Conclusive Evidence of U.S. Citizenship
Any of t h e following d o c u m e n t s is generally
conclusive evidence of U.S. citizenship for the person
to whom the document is issued regardless of where
the person was born.
Birth certificate showing birth in the U.S.
U.S. passport
Certificate of C i t i z e n s h i p or Certificate of
Naturalization
Report of Birth Abroad of a Citizen of the United
States (Form FS-240).
Certificate of Birth (Form FS-545)
United S t a t e s Citizen Identification Card (INS
Form 1-197)

Evidence of Citizenship in other Countries
Documents s i m i l a r to those listed above may be
submitted as evidence to prove citizenship in another
country, such as:
Birth certificate showing birth in that country
Passport issued by the country
Certificates of citizenship, naturalization, or citizen
identification cards issued by the country.
U.S. citizens or residents should complete Form
RRB-1001, "Non-resident Questionnaire," on leaving
the United States to take up permanent or temporary
residence in a foreign country. The Internal Revenue
Service r e q u i r e s t h a t r e s i d e n t s of t a x - t r e a t y
countries claim their exemption every three years by
completing a n RRB-1001. The form may be secured
from RRB field offices or requested by mail from the
Bureau of Taxation, U.S. Railroad Retirement Board,
844 North Rush Street, Chicago, Illinois 60611-2092,
U.S.A.

Proof of residence i s required when a n individual
claims residence on the RRB-1001 in a country that is
not the country in the mailing address. Acceptable
proofs of residence must be valid for the period of time
for which residence i s to be verified; t h e date of
issuance must be within one year of the period of
residence to be established. Acceptable proofs of
residence are:

In the United States

Proof of filing a declaration of intent to become a
U.S. citizen under naturalization laws.
O t h e r evidence showing t h e individual h a s a
current attachment to the U.S., and intends to
return to make the U.S. hislher home.

In other Countries

A Valid Alien Registration Receipt Card ("Green
Card), Form 1-151 or 1-551.
Reentry Permit (Form 1-132). Whether first-issued
or renewed, the permit is valid for one year.
U.S. Federal income tax return for the most recent
tax year (this may be a photocopy and need not be
certified by IRS).
Refugee travel document issued by t h e United
States.
Application to Retain U.S. Residence (INS Form
N-470). A photocopy is acceptable.

I

Notice of Approval of Application to Preserve
Residence (INS Form N-472).

Acceptable Proofs of Residence are:
Identification or voter's registration card issued by
the government of the foreign country.
Record or current eligibility for government health
or welfare programs.
Tax record for the prior year.
Current passport.
Recent bill for public utilities.
Library card with a n address in the country.

Fraud and Abuse Hot Line
Call the toll-free Fraud and Abuse Hot Line if you have any reason to believe that someone
is receiving railroad retirement or unemployment-sickness benefits to which he or she is not
entitled; t h a t persons responsible for t h e financial affairs of minors or incompetent
beneficiaries are misappropriating benefits; or that a doctor, hospital, or other provider of
health care services is performing unnecessary or inappropriate services or is billing
Medicare for services not received. You may also use the Hot Line to report any suspected
misconduct by a Railroad Retirement Board (RRB) employee. The Hot Line h a s been
installed by the RRB's Inspector General to receive any evidence of fraud or abuse of the
RRB's benefit programs.
Call (toll-free) 1-800-772-4258. Or you may send your complaints in writing to:
Railroad Retirement Board
OIG, Hot Line Officer
844 North Rush Street
Chicago, Illinois 60611-2092
Please do not call the Hot Line with questions about eligibility requirements, delayed claims,
or similar problems. Such matters should be directed to the nearest RRB field office.

Nondiscrimination on the Basis of Disability
Under Section 504 of the Rehabilitation Act of 1973 and Railroad Retirement Board (RRB)
regulations, no qualified person may be discriminated against on the basis of disability. RRB
programs and activities must be accessible to all qualified applicants and beneficiaries,
including those who are vision- or hearing-impaired. Disabled persons needing assistance
(including auxiliary aids or program information in accessible formats) should contact the
nearest RRB office. Complaints of alleged discrimination by t h e RRB on t h e basis of
disability must be filed within 90 days in writing with the
Director of Administration
Railroad Retirement Board
844 North Rush Street
Chicago, Illinois 6061 1-2092.
Questions about individual rights under this regulation may be directed to t h e RRB's
Director of Equal Opportunity a t the same address shown above.

Field Office Assistance
If you need assistance and wish to personally visit one of our field offices, you are urged to call
for an appointment. You will not be refused service if you do not have a n appointment, but
Railroad Retirement Board representatives can serve you better when an appointment is made.
Most Railroad Retirement Board offices are open to the public from 9:00 a.m. to 3:30 p.m.,
Monday through Friday.

p4s
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