Transmittal Letter for self-administered retirement applications

UNITED STATES OF AMERICA

RAILROAD RETIREMENT BOARD

CURRENT

E-MAIL:
OFFICE HOURS: 9:00 AM TO 3:30 PM
MONDAY THROUGH FRIDAY EXCEPT FEDERAL HOLIDAYS

TOLL-FREE NUMBER: 1-877-772-5772
FACSIMILE NUMBER: FAX NUMBER

In reply refer to

Enclosed are the forms and other material you will need to apply for your annuity under the
Railroad Retirement Act. The forms listed below in Group A have been designed so you can fill
them out yourself. You must complete and return the forms marked by an "X" to the district office
shown above. If you did not receive all the forms marked by an "X", contact the district office and
they will send you the missing form.
The booklets and pamphlets listed in Group B contain information you will need to complete the
form(s). You should keep the booklets and pamphlets you receive, even after you return your
form(s). Contact the district office shown above if you have not received all the material marked by
an "X".
GROUP A - FORMS TO BE COMPLETED AND RETURNED
AA-17
AA-17b
AA-18
AA-19
AA-19a
AA-21
G-273a
AA-20
AA-5
G-478
G-208

Application for Widow(er)'s Annuity
Application for Determination of Widow(er) Disability
Application for Mother's/Father's and Child's Annuity
Application for Child's Annuity
Application for Determination of Child Disability
Application for Lump-Sum Death Payment and Annuities
Unpaid at Death
Funeral Director's Statement of Burial Charges
Application for Parent's Annuity
Application for Substitution of Payee
Statement Regarding Patient’s Capability to Manage Benefits
Public Service Pension Questionnaire

RL-1S (04-07)

UNITED STATES RAILROAD RETIREMENT BOARD - 2
GROUP B - BOOKLETS AND PAMPHLETS YOU SHOULD KEEP
G-77
RB-3
RB-5
RB-9s
RB-17
RB-17b
RB-19a
RB-21
RB-23

How the Amount of Earnings Affect Payment of Survivor Annuities
Furnishing Evidence to Support Your Claim
Your Duties as Representative Payee - Representative Payee’s Record
Events that Affect a Survivor Annuity
Survivor’s Annuity
Widow(er)'s Disability Benefits
Child Disability Benefits
Lump-Sum Death Payment - Residual Lump-Sum - Annuities Unpaid at Death
Your Medicare Handbook

GROUP C - EVIDENCE YOU MUST SUBMIT
The booklet, RB-3 Furnishing Evidence to Support Your Claim, explains the various types of
documents that may be required and where you can locate them if you do not already have them.
Please furnish evidence only for the items marked by an "X" below.
Proof of Age
Proof of Death
Proof of Divorce
Proof of Legal Appointment
Proof of Marriage
Proof of Military Service
Proof of Payment of Burial Expenses
Proof of Relationship

If you have previously submitted any of these proofs to the Board, do not submit the proof again.
Instead, explain on a separate sheet of paper why you are not submitting the proof at this time. If
additional proof is needed, we will contact you.

Sincerely,

RL-1S (04-07)