BA-3 (Internet) pr Annual Report of Creditable Compensation

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Screen 2

Form Approved

US Railroad RetiremMt Board

Form 6A-3(xx-xx)

OMS /IkI. XXXX-XYJCX

SA Number; 28G1
SElECT REPORT YEAR

120101

Screen 3

US Railroad R.mreme.nt Board
Form BA-3{xx-xx)
Foml BA.3: Annual Report of Cleditabfo Compensation

SA Number. 2861
Year. 2010
Please select one of tile foDowIngactiom;
f) Pfe-fill GCti1en$ with employee SSNe.. Names, and Psyrol11Ds
(j Pmiide blank

scraens with no pre.fills

C Fikl azero EJA.3 !1pOlt. Ihave no empl~8 to report
C Upload Ii completed BA-J report file

Screen 4

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US Railroad IGtimment Bollld

Form AppI'owd
OMBNo,~

FOfIll BA-3(xx"xxJ

Form SA·),: Armual Report of Creditable Compensation
SA Humbel: 2861
Tax: Y&ar. 2010

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MICHAEL

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JOHN

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R

CHARlES

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TODD

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J

DANJEL

xxxxx

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1 UHlIU

ITotal EE

I Retord
Count
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38

Total RUlA1

Total RUIA2

Oualifiing
Maximum
Amount Benefit Amount
0

0

Total RRA Tier 1
Compensation

Total RAA li91l2

Amount

Amount

0

0

Compensation

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TotalMisc
Total SIck
Pay .
Compensation
Amount
i Amount
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Screen 5
Form ApproYed
OMS No. 3220-0008

US Railroad Rstiremetll Board
Form BA-3(9!t-99)

Form 81\·3: AnnUill Hepod {If Creditable Compe"!Hltioll
Yaar.
Socia! Security Number:

xxx-xx-xxxx

LaetName:

XXXXXXXXXXX

2010

Einplc.yar:
PaytOlIlD Numb«:
FiIlilName:

Ii Not U.S. SSN?
RICHARD

Middle Initial:

Click on the -All Months Worked" Box if reporting 31112 months as wolked.

Enter a "1' mr each month being reported as WOl'ked.

or
Entar gptionjIJ codas 8 Of 9 for montlts fiOl vrorked, if employee's status is knewn far all not \!ll!fIq!d,

(8. ;; employee had If relationship fur a~or part of month; 9'" employ_ bad no rela!ionship for any part of month)

Dr

fiB
JUN

1111
JUL

[ijiI
AUG

OIhetwl59

Enter reported compensation amount earned for reptlrnngyear
RUIA l

RUIA II

RRA Tier I

RRA Tlee II

RRA Ulse Comp

Qualif;don Maximum
RUiAI

RUiAll

RRA Tiel' I

RRA TlerlJ

15960,00

20616,00

106600,00

79200,00

DAILY PAY RATE

10·00

optional: 100 Railroad RaliremanlBoatd cumlnUy dcas nCl hsYII' an address en file for this employee. Reporting an
address for this employee is optional at this tima. Your 8A3 report mil be processed Without an addrass.
Street Adckass Une 1:
Street Adckass Una 2:

City:

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I

StatEY.

Zip Code:

"EffeCliYB Date(MMlDOJYYYY):

n... .............._ _ ......l....portl1l._ _ Iu"'", _ _ _ 9 ....,.. RtAct~~

_ _ CioflhltR.akirng of.

~ . . 01" ~ nport IOar1l re-ault in orimiINJ.

po..eoutioo: or oivil

Screen 6

.. us Railroad ROOf8fl'lent Board

Form ApprOYllil
OMB No. x.'OCX.xxxx

Form 8A-3(lOI-xx)
Form 8A,:\: Anilual Report of Creditable Compensation

Employer Upload Semen
SA Hwnber: 2861
Tax Year. 2011

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EJa6'~ a ivmmut

i/BA-4 SUmmary

ElBA-4 Detail
!ilID-41

Approver Use.- Name:

Usernam85 of all who updated ~

R8port Type:

Appro..,et email address:

Date of proCtiSIng:

Screen 9

Paperwork ReduetiOD Act Notiee
We estimate this fmm takes an average of46.25 minutes penesponse rocomplete and that ''negative'" reports (00
~es) will take an ~ of 1S mimtes per response to complete. Responses include the 1im.e neededfor reviewing
the instmdiom, getling the needed data, and reviewing the completed screens.
Federal agacies may not cood!iJet or sponsOI't and t~ ate not required to respond to. aoolledion ofiofomwion
llIIless it displays avalid OMS DIJm.ber.

If you wish. send comments regarding the acancy of OM estimate or any otlwr aspect oftbis fonn. includiag suggestions for
~ the oompletion time, to CHIEF OF INFORMATION RESOURCES MANAGE.lVlENT. RAILROAD

RBllRBMBNT BOARD. S44 N. RUSH STREET. CHICAGO.lL 60611·2092.