AA-17rec; Receipt for Claim

Form AA-17rec (09-06)

United States of America
R a i l r o a d Retirement Board

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Application for Survivor Benefits Receipt for Claim
Applicant's Name and Address

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Employee's Name
Employee's RR Claim Number

Employee's Social Security Number
Application Filing Date
Your applicatio~ifor a (ENTER TYPE OF BENEFIT) has been released and will be processed as quickly as
possible. If you do not receive notification about your application by (ENTER DAYS FROM FILING DATE BASED ON
CUST S ERP LA N ) you should contact the field office show11below.
If you change your address, or if there is some other change that may affect your application, you
or your representative should report the change at once. If you have any questions, we will be glad
to help you. You can report changes either by telephone, mail, or in person, whichever you prefer.
Most Railroad Retirement Board offices are open to the public from 9:00 AM to 3:30 PM, Monday
through Friday.
The changes to be reported are listed below. Always give us your claim number when writing or
calling about your application.
Always Report These Changes to the RRB
Death - If the child dies. (Printed if application type is 5,6 or 7)
Marriage - If you remarry. (Printed if application type is 2,3,4,9)
Marriage - If YOU marry. (Printed if application type is 5, 6 or 7)
Social Security- If you file for social security benefits based on any person's earnings record.
Public Pension - If you begin to receive a pension or receive a lump sum payment based on
your earnings at an agency of the Federal, state or local government, or if your present
paymenf~change. (Printed if application type is 2,3 or 4)
Earnings - If your earnings change. On your application you told us you expected your total
earnings for
to be $
. (APPLICANT IS LESS THAN FULL RETIREMENT AGE.)
On your application you told us you expected your total earnings for
to be less than $

. (APPLICANT IS LESS THAN FULL RETIREMENT AGE.)
You are earning more than $
You are not earning more than $

a month. (APPLICANTIS LESS THAN FULL RETIREMENT AGE.)
a month. (APPLICANT IS LESS THAN FULL RETIREMENT AGE.)

Report at once if work pattern changes. (APPLICANT IS LESS THAN FULL RETIREMENT AGE.)

Work - If you go to work for a railroad or railroad labor organization.

Address - If your address changes.

Address - If yo~.~r

address changes, even if your payments are sent to a financial organization.

Bank Account - If your financial organization or the account number at your financial

organization changes.

Applicant is in Your Care - If any person for whom you are receiving an annuity dies or leaves

your care.

Criminal Offense - If you are confined to a jail, prison, penal institution or correctional

institution due to a conviction for a criminal offense.

school Attendance - If you stop attending school full-time. (PRINTED IF APPL~CAT~ON
TYPE IS 7.)
How to Report Changes
When a change occurs after you have begun receiving your annuity, you should report the change
at once. You or your representative can make tlie reports by telephone, mail or in person,
whichever your prefer.

In most cases, we calculate how
much to reduce your annuity because of your earnings based on either the earnings estimate you
gave us when you applied for benefits, or on reports submitted by employers to the Social Security
Adrninistra,tion. You do not have to report your earnings to us unless:

(PARAGRAPHWILLBE PRINTED IF NON DISABILITYAPPLICANT IS LESS THAN FULLRETIREMENTAGE.)

You stop working;

You start working and expect to earn more than the annual exempt amount;

Your employment is not covered under the Social Security Act
(i.e., FICA taxes are not

deducted from your pay);

You work for a railroad or railroad labor organization;

You
return to work for your last pre-retirement non-railroad employer; or

We ask for a report of your earnings.

To report any changes or ask questions, you should contact:
(Field Office Address and Telephone Number)

If for some reason you are unable to contact 'that office, you should contact:
US Railroad Retirement Board
844 N Rush Street
Chicago, Illinois 6061 1-2092
http://www.rrb.gov