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US Railroad Retirement Board
Form BA-11(xx.xx}

Form 13.4-11: Report of Gross Earliingl»

SA Number. 3259

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Form ApprCJliOO
OMB No. YlfJ1/nxJ.

US Railroad Retiremetlt Board
Form BM1(xx·xx)

SA Number: 3259

Vear: 2010

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Form 61'1-11: Rcp0i111f Gfi)s.~ Earnings

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BA Number. 3259

Tax Year: 2006

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Papenvork Reduction Act Notice
We estimate this form takes an average of 30 minutes per response to complete and that "'negative" reports (no employees, or
no employees with social security nmnbers ending with the digits "30') will take an average of 15 minutes per response to
complete. Responses include the time needed for reviewing the instructions, getting the needed data, and reviewing the
completed screens.
Federal agencies may not conduct or sponsor, and respondents are not required to respond to. a collection ofinfonnation
unless it displays a valid ONIB number.
'
If you wish, send comments regarding the acc~acy ofour estimate or any other aspect ofthis form, including suggestions for
reducing the completion time, to CHIEF OF INFOR..N1ATION RESOURCES MANAGEMENT, RAlLROAD
RETIREMENT BOARD, 844 N. RUSH STREET, CHICAGO, IL 60611-2092.