G-131 Authorization of Payment and Release of All Claims to a

United States of America
Railroad Retirement Board

Form Approved
OMB No. 3220-0031

PROPOSED

AUTHORIZATION OF PAYMENT AND
RELEASE OF ALL CLAIMS TO A
DEATH BENEFIT OR
ACCRUED ANNUITY PAYMENT

Railroad Retirement Claim Number
Name of Deceased Individual

PAPERWORK REDUCTION ACT AND PRIVACY ACT NOTICES
The Railroad Retirement Board (RRB) is authorized to collect the information on this form under section 7(b)(6) of the Railroad
Retirement Act. The information asked for is needed to authorize payment of your share of an RRB benefit or unpaid annuity to
another eligible person. Although you are not required to furnish this information, your share of the RRB death benefit or unpaid
annuity cannot be paid to another person unless you complete and return the form.
A complete listing of the persons, organizations, and agencies to which the information you give us may be released is available
at any office of the RRB.
We estimate this form takes an average of 5 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, Illinois 60611-2092.
Completion Instructions: Check the information entered by the RRB in Item 1 for accuracy and make any needed
changes. You and a disinterested witness must then sign, date, and provide your full addresses in Items 2a and 2b,
respectively. Return the completed form to the RRB address shown at the top of the enclosed Form G-131a.
1. I, , have been informed that the approximate amount of my share of the benefit payable in this
case is <$Share Amount>, and it is my desire to waive my share of that benefit and have it paid to the person shown
below. Therefore, I hereby authorize the United States and its officers and agents, who are authorized by law to certify
and make such payments, to certify and pay my share under the provisions of the Railroad Retirement Act, to:
Name and Address:

Relationship to Deceased:
2. In consideration of such certification and payment, I hereby release the United States and its officers and agents from
any and all claims which I may have against them for such accrued annuity or lump-sum death benefit, or by reason of
their certification and payment thereof.
a. Signature of Person Authorizing this Release
Date

Full Address (City/Town, State, and ZIP Code)

b.

Signature of Disinterested Witness

Date

Full Address (City/Town, State, and ZIP Code)

G-131 (XX-XX) Destroy Prior Editions