Form G-251 (05-10) G-251 (05-10) Vocational Report

United States of America
Railroad Retirement Board

Form Approved
OMB No. 3220-0141

CURRENT

Vocational Report
Section 1

General Instructions

Be sure to read the Important Notice at the bottom of page 5.
Type or print legibly in ink. If you need more space than is provided to answer a question, attach a separate sheet of
paper. If you do not know the answer to a question, print "Unknown" in the space provided for the answer. Additional
forms may be obtained from the RRB office shown on page 6.
If you are completing this form on behalf of someone else, you must answer each question as it applies to the applicant.

Section 2

Identifying Information

Check the information entered by the Railroad Retirement Board (RRB) for Items 1 through 6 for accuracy.
If the information is correct, go to Section 3.
If the information is not correct, cross out the incorrect information and enter the correct information above it.
If the information is missing, fill it in.
Employee
Identification

1 Employee's Name
2 Employee's Social Security Number
3 Employee's Railroad Retirement Claim
Number, if different from Item 2

Applicant
Identification

4 Applicant's Name
5 Applicant’s Address (Include Street
Address, City, State, ZIP Code and
County)
6 Daytime Telephone Number

Section 3
Work History

Regular
Occupation

Information About Your Work History
7 List all railroad and nonrailroad jobs you have had in the last 15 years before you stopped working and
enter
an “X” in the appropriate box to indicate whether the work was railroad or nonrailroad. If you have
th
a 6 grade education or less and performed only heavy unskilled labor for 35 years or more, list all of
the jobs you have had since you began to work. NOTE: If you list only one job in Item 7, do not
complete pages 3 and 4. If you have more than 3 jobs to list, continue on another Form G-251.
Dates Worked
Hours
Type and Name of Business
Job Title
per
From
To
(Railroad or Nonrailroad)
MO
YR
MO
YR
Week
a.

Railroad

Nonrailroad

b.

Railroad

Nonrailroad

c.

Railroad

Nonrailroad

8 Enter an "X" in the appropriate box:
Are you applying for an employee occupational disability annuity?

Yes - Go to Item 9
No - Go to Item 12

9 Enter the title of your usual railroad job in the last 5 years.
10

Enter the title of your usual railroad job in the last 15 years.

11

Enter an "X" in the appropriate box:
Which job did you claim as your regular occupation?

1

Job in Item 9
Job in Item 10

Form G-251 (05-10)

Only complete this page to provide a description of a job listed in Item 7a.
Description of 12 a. In the job described in Item 7a, did you: (circle all that apply)
Job in Item

7a

1 Use machines,
tools or equipment
of any kind?

2 Use technical
knowledge or
skills?

3 Do any writing,
complete reports, or
perform similar duties?

4 Use manipulative
skills, i.e., manual
dexterity?

5 Have
supervisory
responsibilities?

b. Describe your basic duties (explain what you did and how you did it) below. Also, explain all circled
answers in Item 12a by giving a full description of: the type of machines, tools, or equipment you
used and the exact operation you performed; the technical knowledge or skills involved; the type of
writing you did, and the nature of any reports; the manipulative skills used; and the number of
people you supervised and the extent of your supervision. If more space is needed attach a sheet
of paper.

13 a. Environmental Hazards (circle the hazards you were exposed to)
1 Walking on
Uneven Terrain

2 Heights

3 Dangerous 4 Extremes of
Machinery
Temperature

5 Fumes or
6 Dust
Noxious Gases

7 Excessive
Noise or Vibration

b. If you circled any of the hazards in Item 13a, briefly explain your exposure.

14 Indicate below the kind and amount of physical activity this job involved during a typical 8-hour
workday. (The total hours shown should equal 8 hours or the exact number of hours worked daily.)
a. Circle the number of hours a day spent:
0
1
2
3
4
5
6
7
8
(1) Standing/walking
(2) Sitting
0
1
2
3
4
5
6
7
8
b. Circle how often a day you had to:
Bend .................................................
Crouch/Squat ...................................
Kneel ................................................
Reach above shoulder level .............
Climb ................................................
● Circle what you climbed ..............

Never
Never
Never
Never
Never
Stairs

Occasionally1
Occasionally
Occasionally
Occasionally
Occasionally
Vertical ladder

Frequently2
Frequently
Frequently
Frequently
Frequently
Step ladder

Constantly
Constantly
Constantly
Constantly
Constantly

(6) Push/Pull ..........................................
● Briefly explain what and how you
pushed and pulled

Never

Occasionally

Frequently

Constantly

Never

Occasionally

Frequently

Constantly

(1)
(2)
(3)
(4)
(5)

c. (1) Name the objects you lift and carry
(2) Circle how often a day you lift and
carry
(3) Circle the weight of the objects you
lift and carry

Heaviest Weight Lifted
10 lbs
20 lbs
50 lbs
100 lbs
Over 100 lbs
Weight Most Often Lifted/Carried
Up to 10 lbs Up to 25 lbs
Up to 50 lbs Over 50 lbs

1Occasionally means occurring from very little up to one-third (approx. 2-1/2 hours) of an 8-hour workday; cumulative, not
continuous.
2Frequently means occurring one-third (approx. 2-1/2 hours) to two-thirds (approx. 5 hours) of an 8-hour workday; cumulative, not
continuous.

2

Form G-251 (05-10)

Only complete this page to provide a description of a job listed in Item 7b. Otherwise go to page 5.
Description of 15 a. In the job described in Item 7b did you: (circle all that apply)
Job in Item

7b

1 Use machines,
tools or equipment
of any kind?

2 Use technical
knowledge or
skills?

3 Do any writing,
complete reports, or
perform similar duties?

4 Use manipulative
skills, i.e., manual
dexterity?

5 Have
supervisory
responsibilities?

b. Describe your basic duties (explain what you did and how you did it) below. Also, explain all circled
answers in Item 15a by giving a full description of: the type of machines, tools, or equipment you
used and the exact operation you performed; the technical knowledge or skills involved; the type of
writing you did, and the nature of any reports; the manipulative skills used; and the number of
people you supervised and the extent of your supervision. If more space is needed attach a sheet
of paper.

16 a. Environmental Hazards (circle the hazards you were exposed to)
1 Walking on
Uneven Terrain

2 Heights

3 Dangerous 4 Extremes of
Machinery
Temperature

5 Fumes or
Noxious Gases

6 Dust

7 Excessive
Noise or Vibration

b. If you circled any of the hazards in Item 16a, briefly explain your exposure.

17 Indicate below the kind and amount of physical activity this job involved during a typical 8-hour
workday. (The total hours shown should equal 8 hours or the exact number of hours worked daily.)
a. Circle the number of hours a day spent:
0
1
2
3
4
5
6
7
8
(1) Standing/walking
0

(2) Sitting

1

2

3

4

5

6

7

8

b. Circle how often a day you had to:
Bend .................................................
Crouch/Squat ...................................
Kneel ................................................
Reach above shoulder level .............
Climb ................................................
● Circle what you climbed ..............

Never
Never
Never
Never
Never
Stairs

Occasionally1
Occasionally
Occasionally
Occasionally
Occasionally
Vertical ladder

Frequently2
Frequently
Frequently
Frequently
Frequently
Step ladder

Constantly
Constantly
Constantly
Constantly
Constantly

(6) Push/Pull ..........................................
● Briefly explain what and how you
pushed and pulled

Never

Occasionally

Frequently

Constantly

Never

Occasionally

Frequently

Constantly

(1)
(2)
(3)
(4)
(5)

c. (1) Name the objects you lift and carry
(2) Circle how often a day you lift and
carry
(3) Circle the weight of the objects you
lift and carry

Heaviest Weight Lifted
10 lbs
20 lbs
50 lbs
100 lbs
Over 100 lbs
Weight Most Often Lifted/Carried
Up to 10 lbs Up to 25 lbs
Up to 50 lbs Over 50 lbs

1Occasionally means occurring from very little up to one-third (approx. 2-1/2 hours) of an 8-hour workday; cumulative, not
continuous.
2Frequently means occurring one-third (approx. 2-1/2 hours) to two-thirds (approx. 5 hours) of an 8-hour workday; cumulative, not
continuous.

3

Form G-251 (05-10)

Only complete this page to provide a description of a job listed in Item 7c. Otherwise go to page 5.
Description of 18 a. In the job described in Item 7c, did you: (circle all that apply)
Job in Item

7c

1 Use machines,
tools or equipment
of any kind?

2 Use technical
knowledge or
skills?

3 Do any writing,
complete reports, or
perform similar duties?

4 Use manipulative
skills, i.e., manual
dexterity?

5 Have
supervisory
responsibilities?

b. Describe your basic duties (explain what you did and how you did it) below. Also, explain all circled
answers in Item 18a by giving a full description of: the type of machines, tools, or equipment you
used and the exact operation you performed; the technical knowledge or skills involved; the type of
writing you did, and the nature of any reports; the manipulative skills used; and the number of
people you supervised and the extent of your supervision. If more space is needed attach a sheet
of paper.

19 a. Environmental Hazards (circle the hazards you were exposed to)
1 Walking on
Uneven Terrain

2 Heights

3 Dangerous 4 Extremes of
Machinery
Temperature

5 Fumes or
Noxious Gases

6 Dust

7 Excessive
Noise or Vibration

b. If you circled any of the hazards in Item 19a, briefly explain your exposure.

20 Indicate below the kind and amount of physical activity this job involved during a typical 8-hour
workday. (The total hours shown should equal 8 hours or the exact number of hours worked daily.)
a. Circle the number of hours a day spent:
0
1
2
3
4
5
6
7
8
(1) Standing/walking
(2) Sitting
0
1
2
3
4
5
6
7
8
b. Circle how often a day you had to:
Bend ..................................................
Crouch/Squat ....................................
Kneel .................................................
Reach above shoulder level ..............
Climb .................................................
● Circle what you climbed ...............

Never
Never
Never
Never
Never
Stairs

Occasionally1
Occasionally
Occasionally
Occasionally
Occasionally
Vertical ladder

Frequently2
Frequently
Frequently
Frequently
Frequently
Step ladder

Constantly
Constantly
Constantly
Constantly
Constantly

(6) Push/Pull ...........................................
● Briefly explain what and how you
pushed and pulled

Never

Occasionally

Frequently

Constantly

Never

Occasionally

Frequently

Constantly

(1)
(2)
(3)
(4)
(5)

c. (1) Name the objects you lift and carry
(2) Circle how often a day you lift and
carry
(3) Circle the weight of the objects you
lift and carry

Heaviest Weight Lifted
10 lbs
20 lbs
50 lbs
100 lbs
Over 100 lbs
Weight Most Often Lifted/Carried
Up to 10 lbs Up to 25 lbs
Up to 50 lbs Over 50 lbs

1Occasionally means occurring from very little up to one-third (approx. 2-1/2 hours) of an 8-hour workday; cumulative, not
continuous.
2Frequently means occurring one-third (approx. 2-1/2 hours) to two-thirds (approx. 5 hours) of an 8-hour workday; cumulative, not
continuous.

4

Form G-251 (05-10)

Section 4
Certification

Certification
21 Enter an "X" in the appropriate box:
I will have a guardian or other representative sign this report on
my behalf.

Yes – Go to Note and Item 22
No – Go to Item 22

Note: If answ ered " Yes," the guardian or other representative of the
applicant must sign this report.
22 I know that civil and criminal penalties may be imposed on me for false or fraudulent statements, or for
withholding information to misrepresent a fact material to determining a right to a payment under the
Railroad Retirement Act. I affirm that to the best of my knowledge, the information I have given
represents the complete truth.
Signature
(First Name, Middle Initial,
Last Name)
Month

Day

Year

Date
23 If this certification is signed by mark ("X") in Item 22, two witnesses who know the person signing must
sign below, giving their full addresses.
a. Signature of Witness

Address (Number and Street)

City, State, ZIP Code

b. Signature of Witness

Address (Number and Street)

City, State, ZIP Code

PAPERWORK REDUCTION ACT AND PRIVACY ACT NOTICE
The Railroad Retirement Board is authorized to collect the information on this form under Section 7(b)(6) of the Railroad
Retirement Act. While you are not required to respond, your cooperation is needed to provide information necessary to
complete processing of the claim. If you fail to provide us with the requested information, we may be unable to pay you
any benefits (as explained in Section 2(a) of the Railroad Retirement Act).
We estimate this form takes an average of 30 to 40 minutes per response 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 the 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 North Rush Street, Chicago, IL 60611-2092.

5

Form G-251 (05-10)

Section 5

How to Return Your Report

Before you return your report, check to make sure that:
● Every question that applies to you has been answered.
● You have entered "unknown" in any answer space for which you were unable to answer a
question.
● You have signed and dated the report.
● You have included all the needed proofs listed in the letter you received with this report.
When you received your report, you should have also received a pre-addressed envelope.
If you do not have this envelope, you can use any envelope as long as it is addressed to the
RRB office shown below. No matter which envelope you use, you must put the correct
postage on the envelope. Be careful to provide enough postage because your report may
weigh more than a standard letter. The U.S. Postal Service will not deliver your report
unless it has the correct postage.
If you need information or assistance, contact:
U.S. RAILROAD RETIREMENT BOARD

 TELEPHONE NUMBER: 1-877-772-5772

If for some reason you cannot contact that office, you should contact:

U.S. RAILROAD RETIREMENT BOARD
844 NORTH RUSH STREET
CHICAGO, ILLINOIS 60611-2092

6

Form G-251 (05-10)