AA-17rec; Receipt for Claim

United States of America
Railroad Retirement Board

Form AA-17rec (11-08)

-

Application for Survivor Benefits Receipt for Claim

Applicant's Name and Address
LINE-2
LINE-3
LINE-4
I-INE-5

Employee's Name

A p p l i c a t i o ~Filing
i
Date

Your application for 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 (ENTERDAYS FROM FILING DATE BASED ON
CUSTSER PLAN) you should contact the field office shown below.
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, wl-~icheveryou prefer.
Most Railroad Retirement Board offices are open to ,the public from 9:00 A M to 3:30 PM, Monday
through Friday.
The changes to be reported are listed below.
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
. (APPLICANTIS LESS THAN FULL RETIREMENT AGE.)
earnings for
to be $
On your application you told us you expected your total earnings for
to be less than $
. (APPLICANTIS LESS THAN FULL RET~REMENTAGE.)
You are earning more than $
a month. (APPLICANTIS LESS THAN FULL RETIREMENT AGE.)
You are not earning more than $
a month. (APPLICANTIS LESS THAN FULL RETIREMENT AGE.)
Report at once if work pattern changes. (APPLICANTIS LESS THAN FULL RETIREMENTAGE.)
Work - If you go to work for a railroad or railroad labor organization.
Address - If your address changes.

Address - If your address changes, even if your payments are sent to a financial organization.
Bank Account - If your financial organization or the account nurr~berat your financial
organization changes.
Applicant is in Your Care - If any person for whom you are receiving an arlnuity 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. (PRINTEDIF APPLICATION 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 the reports by telephone, mail or in person,
whichever yol.lr prefer.

In most cases, we caIcl.llate 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 tlie Social Security
Administration. You do not have to report your earnings to us unless:
(PARAGRAPH
WILL BE PRINTED IF NON DISABILITYAPPLICANT IS LESS THAN FULL RETIREMENTAGE.)

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