RRB Form RL-1 (04-07)

In reply refer to

Enclosed are the forms and other materials you will need to apply for your annuity under the
Railroad Retirement Act.
GROUP A - FORMS TO BE COMPLETED AND RETURNED

The application forms listed below have been designed so you can fill them out yourself.
You must complete and return the forms marked by an " X to the district office shown above. If
you did not receive all of the forms marked by an "X," contact the district office and they will send
you the missing forms.

- Application for Employee Annuity
- Application for Determination of Employee Disability
- Application for SpouselDivorced Spouse Annuity
- Self-Employment and Substantial Service Questionnaire
- Application for Substitution of Payee
- Employee's Statement of Service Performed Before January 1, 1937, To
Employers Under the Railroad Retirement Act
- Application for Determination of Child's Disability
- Verification of Worker's Compensation/Public Disability Benefit Information
- Public Service Pension Questionnaire
- Employee Non-Covered Service Pension Questionnaire
- Vocational Report
- Employee's Certification
- Statement Regarding Patient's Capability to Manage Benefits
- Tax Withholding Election

GROUP B - BOOKLETS AND PAMPHLETS YOU SHOULD KEEP
The booklets and pamphlets listed below contain information you will need to complete your
application(s). You should keep the booklets and pamphlets you receive, even after you file your
application. Contact the district office shown above if you have not received all the material that
was marked by an "X."

-

How Earnings Affect Payment of Retirement Annuities
General Information about Non-Railroad Employment after Retirement
Age and Service Employee Annuity
- Employee Disability Benefits
- Furnishing Evidence to Support Your Claim
- Your Duties as Representative Payee - Representative Payee's Record
- Employee and Spouse Annuities - Events That Must Be Reported
- Child's Disability ~enefits
- SpouselDivorced Spouse Annuity

-

GROUP C EVIDENCE YOU MUST SUBMIT
The booklet, Form RB-3, Furnishing Evidence To Support Your Claim, explains the various types
of documents that may be required and where you can locate them if you do not already have
them. Please furnish evidence only for the items marked by an " X below.

[7

Proof of Age
Proof of Relationship
Proof of Marriage
Proof of Military Service
Proof of Death
Proof of Divorce

If you have previously submitted any of these proofs to the Railroad Retirement Board, do not
submit the proof again. Instead, explain on a separate sheet of paper why you are not submitting
the proof at this time. If additional proof is needed, we will contact you.
Sincerely,