ES-2 (proposed) Supplemental Information for Central Register

Form Approved
OMB No. 3220-005

Central Register Notification
Your name currently appears on a central register o f separated and furloughed railroad
employees who are available for employment
Information 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
from the register
- - if you do not return this letter within 30 days.
Check one of the following:
(1)

Continue t o include my name on the central register.

12)

Remove my name from the central register.'

.

.

-

-

If item (21 is checked because you have obtained employment, please complete the following:
Name o f Employer
Address
Date Work Began
Signature

Date

P<

Paperwork Reductio Privacy Act ~ o t i c @

vl

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 to 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 ya!id OMB number. If you wish, send
.
comments regarding the accuracy of our estimate or any other aspecs of this form. including suggestions for reducing
completion time, to Chief of Information Management, Railroad Retirement Board. 844 N Rush St. Chicago, IL 6061 1-2092.

A

RRB Form ES-2

($-#I