Form ES-2 (11-07) ES-2 (11-07) Supplemental Information for Central Register

OMB No. 3220-0057

U.S. RAILROAD RETIREMENT BOARD

408 ATLANTIC AVE ROOM
POBOX 52126

BOSTON MA 02205

In reply refer to
SS No

Central Register Notification
Your name currently appears on a central register of separated and furloughed railroad
employees who are available for employment
Information is' needed to update the register. Please complete the items below and return this
letter within 30 days to the address shown above. Your name will automatically be deleted
from the register if you do not return this letter within 30 days.
Check one of the following:
(1)

0

Continue to include my name on the central register.

(2)0

Remove my name from the central register.

If item (2) is checked because you have obtained employment, please complete the following:

Name of Employer

Address

Date Work Began _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Signature

Date

Paperwork Reduction Act/Privacy Act Notices
The RRB's authority for requesting this information is section 5 b) of the Railroad Unemployment Insurance Act
Although you are not required to provide this information. failure to do so will result in your name being removed
from the central register.
We estimate this form takes less than 1 minute 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. B44 N Rush St. Chicago. IL
60611- 2092.

RRB Form ES-2 (11-07)