Form ES-2 (07-01) ES-2 (07-01) Supplemental Information for Central Register

Form Approved
OMB No. 3220-005

In Reply Refer To
SS No
'

Central Register Notification
Your name currently appears on a central register o f separated and furloughed railroad
employees who are available f o r employment
lnformation is needed t o update the register, Please complete the items below and return this
letter within 30 days t o the address shown above. Your name will automatically be deleted
f r o m the register
- - if. you do not return this letter within 30 days.
- Check one o f the following:

1 Continue t o include my name on the central register.

(I)

Remove my name from the central register.

(21
--

-

--

-

If item (2) is checked because you have obtained employment, please complete the following:
Name o f Employer
Address
Date Work Began
Signature

Date

Paperwork ReductionlPrivacy A c t Notice
The RRB's authority for requesting this information is section 5(b) of the Railroad Unemployment Insurance A c t
Although you are not required t o provide this information, failure t o do so will result in your name being removed
from the central register.
W e estimate this form takes less than 1 minute to complete, including the time for reviewing the instructions,
getting the needed data, and reviewing the completed f o r m Federal agencies may not conduct or sponsor, and respondents
are not required t o respond to, a collection of information unless it displays a yalid OMB number. If you wish, send
comments regarding the accuracy of our estimate or any other aspects of this form, including suggestions f o r reducing
completion time, t o Chief o f Information Management, Railroad Retirement Board. 844 N Rush St, Chicago, IL 6061 1-2092.

RRB Form ES-2 (7-01)