BA-6a (Internet) ( BA-6a, BA-6 Address Report (Internet Equivalent)

United States of America
Railroad Retirement Board

Form Approved
OMB NO. 3220-0005

Form BA-6a, BA-6 Address Report

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Employer BA Number:
Social Security Number:

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Employee Last Name:

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Employee First Name:

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Employee Middle Initial:

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Street Address Line 2:

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State:

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Effective Date:

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( (This is the date you recorded the employee's address. If the date
is not known, leave this item blank.)

The information contained in this report is required by law under Section 7(b) 6 of the Railroad
Retirement Act (RRA) and Section 209.12 of the Code of Federal Regulations. I a f f m that to the best
of my knowledge, the information I have given is true, and correct. I understand that failure to report or
the making of a false or fraudulent report can result in criminal prosecution or civil penalties, or both.

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Pa~erworkReduction Act Notice

Display of Paperwork Reduction Act Notice
(For ERS Forms BA-4 and BA-6a)

PAPERWORK REDUCTION ACT NOTICE

We estimate this form takes an average of 20 minutes to
complete, including the time for reviewing the instructions,
getting the needed data, and reviewing the completed form.
Federal agencies may not conduct or sponsor, and
respondents are not required to respond to, a collection of
information unless it displays a valid OMB number. If you
wish, send comments regarding accuracy of our estimate or
any other aspect of this form, including suggestions for
reducing completion time, to CHIEF OF INFORMATION
RESOURCES
MANAGEMENT,
RAILROAD
RETIREMENT BOARD, 844 N RUSH STREET,
CliUCAGO, IL 60611-2092.