Form G-88A.2 (10-10) G-88A.2 (10-10) Notice of Retirement and Request for Service Needed for

Form Approved

United States of America
Railroad Retirement Board

Notice of Retirement and
Request for
Service Needed for Eligibility
3. Railroad Name and Address

Facsimile Number:

OMB No. 3220-0005
1. Social Security No.

2. Name of Employee
4. BANo.

5. Payroll Number

6. Job Title

7. Work Location

8.

9. RRB Filing Date

Dept. or Div.

12. Date Released

The
requesting this
(RRA)
requested is used by
annuity u
Section
RRA (45 U.S.C. Sec. 231a.)
We estimate this form takes an average of 5 minutes per response, 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 any comments regarding the
accuracy of our estimates or any other aspect of this form, including suggestions for red
the completion time, to the Chief of
Information Resources
Railroad Retirement
844 North Rush
IL 60611-2092.
employee
an application
an
and has
and stopped working on the date shown in Itl;lm 10.
• Complete Item 13 below only if the date in Item 10 differs from the date on your records.
• Always complete Items 14 and 16.
• Fax this form to (312) 751-7192 or mail it to the U.S. Railroad Retirement Board, Retirement Benefits Division, 844 North Rush
Street, Chicago IL 60611-2092, within 10 days of the date released by the RRB. The employee cannot be awarded an
annuity until we receive this information.
IMPORTANT NOTE: This employee's service months and compensation must also be included on your Form BA-3, Annual Report
of Creditable Compensation. If
have any questions, refer to the "Reporting Instructions to Employers" or telephone the Quality
R""r'lt'lr1tinn Service Center at
-4992.
13.

Date Last Worked or Paid for Time Lost on Your Records

-+

14.

Title of Certifying Officer

Telephone No.

(
Facsimile No.

(

)

E-Mail Address

)

G-88A2 (10-10)