AA-18, Application for Mother's/Father's and Child's Annuity

CURRENT

UNITED STATES OF AMERICA
RAILROAD RETIREMENT BOARD

FORM APPROVED
O.M.B. No. 3220-0030

DO NOT WRITE IN THIS SPACE
OFFICIALLY FILED
DAY
MONTH

Application
for Mother’s/Father’s
and Child’s Annuity

YEAR

OFFICE NUMBER

APPROVED

APPLICATION NUMBER

DATE CODED
MONTH

DAY

YEAR

CODED BY

Section 1

General Instructions

Before you complete this application, be sure to read booklet RB-17, Survivor Annuities, which explains information you will need
to answer many of the questions in this application. Also be sure to read the important notices at the end of the booklet.
Type or print legibly in ink. If you need more space than is provided to answer a question, use Section 10 for this purpose. If you
do not know the answer to a question, print “Unknown” in the space provided for the answer.
When entering dates, always use numbers. Also, be sure there is one number in each box. For example, you would enter
June 6, 2015, as:
MONTH

DAY

YEAR

0 6 0 6 2 0 1 5
Some items in this application will not apply to you so you will not need to answer them. Based on your answer to a question,
you may be told to skip to another item number, or even another section. Follow the instructions that tell you to “Go to” another
item. These are designed to save you time and help you move through the application form quickly, filling in only necessary
information. If no “Go to” instructions are given, answer the next item in order. Do not skip any items unless directed
to do so.
If you are completing this application 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

Applicant
Identification

1

EMPLOYEE’S NAME

2

EMPLOYEE’S SOCIAL SECURITY NUMBER

3

EMPLOYEE’S RAILROAD RETIREMENT CLAIM NUMBER

4

APPLICANT’S NAME

5

a

STREET ADDRESS

b

CITY AND STATE

c

ZIP CODE

d

COUNTY

6

DAYTIME TELEPHONE NUMBER
Form AA-18 (07-15) Destroy Prior Editions

Section 3

Information About The Employee

If a railroad retirement survivor benefit was previously received by someone, go to Section 4; otherwise go to Item 7.
Birth Date

7 Enter the employee’s date of birth.

Residence

8 Enter the state (or country if other than United States) which was the
employee’s permanent home at the time of death.

Day

Month

Year

If the employee was age 62 or older when he or she died, go to Item 10.
Disability

9 Enter an “X” in the appropriate box:
The employee was unable to work at the time of death because of an
illness or accident which occurred at least five months before death.

Military
Service

Please read the section “Credit for Employee’s Military Service” in Part V of the RB-17 booklet to find out
how active military service is determined.
10 Enter an “X” in the appropriate box:
The employee was in active military service after September 7, 1939.

 Yes
 No

 Yes
 No

Go to Note and Item 11
Go to Item 13

Note: If answered “Yes,” you will have to submit proof of the employee’s military
service. If you cannot submit proof show, in Section 10, the branch of the service
and the beginning and ending dates for each period of service.
11 Enter an “X” in the appropriate box:
The employee had voluntary military service during the
period June 15, 1948, through December 15, 1950.
12 Enter an “X” in the appropriate box:
The employee had non-railroad earnings after leaving the
military service and before returning to the railroad.

 Yes
 No

Go to Item 12
Go to Item 13

 Yes
 No

Recent
13 Regardless of whether the employee was retired at death, show the name and address of each railroad or
Employment
non-railroad employer for whom the employee performed any part-time or full-time work during the last 3

years he or she worked. Print the name and address of the most recent employer in 13a, the second in 13b,
and so on. Enter the date each job began and ended.
Name and Address of Employer
a Name
Began

Ended

Address
Month

Year

Month

Year

City, State, ZIP Code

b Name
Began

Ended

Address
Month

Year

Month

Year

City, State, ZIP Code

c Name
Began

Ended

Address
Month

Year

Month

City, State, ZIP Code
Self14 Enter an “X” in the appropriate box:
Employment
The employee was self-employed

during any of the last three calendar years.
15 Enter an “X” in the appropriate box:
The employee’s net earnings from self-employment were
more than $400 in any of the last three calendar years.
Form AA-18 (07-15)

Page 2

 Yes
 No

Go to Item 15
Go to Item 17

 Yes
 No

Go to Item 16
Go to Item 17

Year

Self16 Enter an “X” in the appropriate box(es):
Employment
Show the year or years in which the employee’s net
Con’t
earnings from self-employment were more than $400.
Railroad
Employment

 This year
 Last year
 Year before last

Answer Items 17 and 18 only if the employee was alive on October 1, 1981, and he or she had at least
25 years of railroad service; otherwise go to Item 19.
If the employee was alive on October 1, 1981, and had at least 25 years of railroad service, please read the
section “Requirements the Employee Must Have Met” in Part I of the RB-17 booklet to find out what special
conditions may apply.
Note: You may be requested to submit proof to verify the statements
made in Items 17 and 18.
17 Enter an “X” in the appropriate box:
The employee “involuntarily and without fault”:


stopped working for his or her last railroad
employer on or after October 1, 1975, or



was on furlough, leave of absence status, or
absent because of injury on October 1, 1975,
and was never called back to work for that
employer.

 Yes
 No

18 Enter an “X” in the appropriate box:
The employee declined an offer from a railroad employer to return
to a job in the same “class or craft” as his or her last railroad job.
Employee’s
Marriages

Go to Item 18
Go to Item 19

 Yes
 No

19 Enter the requested information for each of the employee’s marriages. Enter the most recent marriage in 19a,
the second most recent in 19b, and so on.
Answer if Marriage Ended for Reason
Other than Employee’s Death
Name of Employee’s Wife
or Husband
(if wife, include
maiden name)

a

b

c

City and State
Married
(country if other
than United States)

Date
Married
Month Day

Year

Month Day

Year

Month Day

Year

How Marriage
Ended
(check one)

Date Marriage
Ended

 Employee’s Death Month Day
 Spouse’s Death
 Divorce
 Annulment
 Employee’s Death
Month Day
 Spouse’s Death
 Divorce
 Annulment
 Employee’s Death Month Day
 Spouse’s Death
 Divorce

City and State
Marriage Ended
(country if other
than United States)

Year

Year

Year

 Annulment
Widow(er)

Answer Item 20 only if you and the employee were divorced.
Please read the marriage requirements in Part III of the RB-17 booklet to find out what categories of widow(er)s may be eligible for a railroad retirement annuity.
20 Enter an “X” in the appropriate box:
There is a widow(er) or remarried widow(er) who may be eligible
for a widow(er)’s annuity.
Page 3

 Yes
 No
Form AA-18 (07-15)

Parents

21 Enter an “X” in the appropriate box:
The employee was survived by a parent.
22 Enter an “X” in the appropriate box:
The parent was dependent on the employee
for one-half of his or her support.

 Yes
 No

Go to Item 22
Go to Section 4

 Yes
 No

Go to Item 23
Go to Section 4

23 Enter the requested information for each dependent parent of the employee.
Name of Parent

Date of Birth

a

Day

Month

Year

Address and Telephone Number
Address
Telephone Number (include area code)
(
)

b

Day

Month

Year

Address
Telephone Number (include area code)
(
)

Section 4

Information About The Applicant

Birth Date

24 Enter your date of birth.

Social
Security
Number

25 Enter your social security number.
(If none, enter “To be submitted.”)

Marriages

Month

26 Enter an “X” in the appropriate box:
I am now, or was previously, married to
someone other than the employee.

Day

 Yes
 No

Year

Go to Item 27
Go to Item 29

27 Enter the requested information for each of your marriages to someone other than the employee.
Enter the most recent marriage in 27a, the second most recent in 27b, and so on.

Your Husband’s or
Wife’s Name and
Social Security Number
(do not show employee)

a

Name

b

Name

c

Name

City and State
Married
(country if
other than
United States)

Date
Married
Month Day

Year

Month Day

Year

Month Day

Year

If Marriage Never Ended, Leave These Blank
How Marriage
Ended
(check one)

Date Marriage
Ended

 Spouse’s Death Month Day
 Divorce
 Annulment
 Spouse’s Death Month Day
 Divorce
 Annulment
 Spouse’s Death Month Day
 Divorce
 Annulment

City and State
Marriage Ended
(country if
other than
United States)

Year

Year

Year

28 Answer only if any of the social security numbers requested in Item 27 are unknown. If more than one social
security number is unknown, enter in Section 10, the information requested in this item for each additional
unknown number.
a Enter the name of the husband or wife
whose social security number is unknown.
Month

b Enter that husband’s or wife’s date of birth.
c Enter that husband’s or wife’s place of birth.
Item 28 continues on the next page.
Form AA-18 (07-15)

Page 4

Day

Year

Marriages
(cont.)

28 d Enter that husband’s or wife’s father’s name.
e Enter that husband’s or wife’s mother’s maiden name.

Support

If you and the employee were divorced, go to Item 35.
29 Enter an “X” in the appropriate box:
The employee and I were living together when the employee died.
If “Yes,” and you are male, go to Item 34. If “Yes,” and you are female,
go to Item 35.
30 Enter the date you and the employee stopped living together.

 Yes
 No
Month

Go to Item 30
Day

Year

31 Enter the reason you and the employee
stopped living together.
32 Enter an “X” in the appropriate box:
The employee was making regular contributions to my support when the
employee died. If “Yes,” and you are male, go to Item 34.
If “Yes,” and you are female, go to Item 35.
(Note: Consider the following as contributions to support:
money, food, clothes, paying bills, providing rent-free housing.)
33 Enter an “X” in the appropriate box:
The employee was under a court order to contribute to my
support.
(Note: Answer “Yes” if there was a court order, even if
the employee was not obeying it.)
One-Half
Support

 Yes
 No

Go to Item 33

 Yes

Go to Item 35

 No

Go to Item 35

Answer Item 34 only if you are working or have ever worked in the railroad industry, and Items 29 or 32 are answered “Yes.”
34 Enter an “X” in the appropriate box:
The employee’s contributions to me provided at least
one-half of the money needed to support me.

 Yes

Go to Note and Item 35

 No

Go to Item 35

Note: If answered “Yes,” complete and return to the RRB,
Form G-134, Statement Regarding Contributions and Support.
Criminal
Offense

35 Enter an “X” in the appropriate box:
Within the past 12 months, I have been imprisoned or given a
sentence of confinement due to a conviction for a criminal offense.
36 Enter the date of the conviction.
37 Enter the date of the sentence of confinement.
38 Enter the date that confinement began.

39 Enter an “X” in the appropriate box:
Has the confinement ended?

 Yes

Go to Item 36

 No

Go to Section 5

Month

Day

Year

Month

Day

Year

Month

Day

Year

 Yes

Go to Item 40

 No

Go to Section 5

Month

40 Enter the date confinement ended.
Page 5

Day

Year

Form AA-18 (07-15)

Section 5

Information About Children

Please read the section “Definition of a Child’s Annuity” in the RB-17 booklet to find out what categories of children may
be eligible for a railroad retirement annuity.
Children

41 Print the requested information for every child for whom you are filing this application who may be entitled
to a child’s annuity. Print the youngest child in a, the second youngest in b, and so on. Always complete f.
If a child does not have a social security number, enter “TO BE SUBMITTED.”
Child’s Full Name and
Social Security Number

a Name

b Name

c Name

d Name

e Name

f

Relationship to Employee
(Check One)






Natural
Adopted
Stepchild
Grandchild
Other







Natural
Adopted
Stepchild
Grandchild
Other







Natural
Adopted
Stepchild
Grandchild
Other







Natural
Adopted
Stepchild
Grandchild
Other







Natural
Adopted
Stepchild
Grandchild
Other

Enter an “X” in the
Appropriate Box: The
Child is Living with Me

Date of Birth
Month

Day

Year

 Yes
 No

Month

Day

Year

 Yes
 No

Month

Day

Year

 Yes
 No

Month

Day

Year

 Yes
 No

Month

Day

Year

 Yes
 No

Within the past 12 months, a child named in a through e above has been imprisoned, or
given a sentence of confinement due to a conviction for a criminal offense. If the answer is
“Yes,” a full explanation, including the name of the child, must be provided in Section 10.

 Yes
 No

If every child in Item 41 is living with you, go to Item 43.
Children
Not Living
With
Applicant

42 Print the requested information for every child in Item 41 who is not living with you. Print the youngest child in 42a.
If you need more space use Section 10.
First Name
of Child

Person with Whom Child now Lives
Child’s Address

Name

Relationship to Child

a

b

Legal
Guardian

43 Enter an “X” in the appropriate box:
A court has appointed a legal guardian for a child in Item 41.

Form AA-18 (07-15)

Page 6

 Yes
 No

Go to Item 44
Go to Item 45

Legal
Guardian
Con’t

44 Print the requested information for every child in Item 41 who has a court-appointed legal guardian.
Print the youngest child in 44a, etc.
Name and Address of Guardian

First Name of Child
a

b

Married
Children

45 Enter an “X” in the appropriate box:
One or more of the children in Item 41 is or
has been married.

 Yes
 No

Go to Item 46
Go to Item 47

46 Print the requested information for every child in Item 41 who has ever been married.
Print the youngest child in 46a, etc.
Child’s
Married Name

a

GrandChildren,
Other
Children

Date Married
Month

b

Enter an “X” in the
Appropriate Box:
The Child Is Still Married

Month

Day

Day

Year

Year



Yes



No



Yes



No

Date Marriage Ended
if Child Is Not
Still Married
Month

Day

Year

Month

Day

Year

If “Natural” or “Adopted” was checked for every child in Item 41, go to Item 49.
47 Enter an “X” in the appropriate box:
Every “Grandchild” or “Other Child” in Item 41 was living
with the employee at the time the employee died.

 Yes
 No

Go to Item 49
Go to Item 48

48 Print the requested information for every “Grandchild” or “Other Child” in Item 41 who was not living with the employee at the time the employee died. Print the youngest child in 48a, etc. If you need more space use Section 10.
First Name
of Child

Person with Whom Child Lived at the Time the Employee Died
Name

Relationship to Child

Address

a

b

Children
For Whom
You Are
Not Filing

49 Enter an “X” in the appropriate box:
There is a child for whom I am not filing this
application who may be entitled to a child’s annuity.

 Yes
 No

Go to Item 50
Go to Item 51

50 Print the requested information for every child for whom you are not filing an application who may be entitled
to a child’s annuity. Print the youngest child in 50a, the next youngest in 50b, and so on.
Reason for Not Filing

Child’s Full Name
a

b

c

Page 7

Form AA-18 (07-15)

Section 6
Public
Service
Pension

Information About Applicant’s Other Government Benefits

51 Enter an “X” in the appropriate box:
I am receiving or expect to receive a pension or I have
received or expect to receive a lump-sum payment
instead of a pension, based on my earnings, from an
agency of the Federal, state, or local government.

 Yes
 No

Go to Item 52
Go to Item 54

 Yes
 No

Go to Note and Item 54
Go to Item 53

(Answer “No” if your only government pension payments are social security, railroad retirement, veterans
affairs, worker’s compensation, or black-lung benefits.
Also, answer “No” if you received a lump-sum payment
that was just your contributions to the pension fund
plus interest.)
52 Enter an “X” in the appropriate box:
I am/was an employee of the Federal Government.

Note: If answered “Yes,” complete and return to the RRB, Form G-208,
Public Service Pension Questionnaire, and verification of your pension.
53 Enter an “X” in the appropriate box:
On my last day of employment, I was employed by a state or local
government or the military service, and social security (FICA)
taxes were being deducted from my public service earnings.

 Yes
 No

Go to Item 54
Go to Note and Item 54

Note: If answered “No,” complete and return to the RRB, Form G-208,
Public Service Pension Questionnaire, and verification of your pension.
Social
Security
BenefitsFiled For

54 Enter an “X” in the appropriate box:
An application has been filed for monthly social security
benefits for me or a child.

 Yes
 No

Go to Item 55
Go to Item 56

55 Enter the requested information for every family member for whom an application has been filed for
monthly social security benefits. Use as many lines as are needed beginning with 55a.
Family
Member

Person Whose
Record Was Filed On

Social Security Number
Filed On

a

b

c

Social
Security
BenefitsFuture
Filing

56 Enter an “X” in the appropriate box:
An application will be filed in the future for monthly
social security benefits for me or a child.
57 Enter the name of the person on
whose record you are filing.
58 Enter that person’s social security number.

Form AA-18 (07-15)

Page 8

 Yes
 No

Go to Item 57
Go to Item 59

Railroad
Retirement
Benefits

59 Enter an “X” in the appropriate box:
An application has been or will be filed within 90 days for
monthly railroad retirement benefits for me or a child based on the
record of someone other than the employee.

 Yes
 No

Go to Item 60
Go to Section 7

60 Enter an “X” in the appropriate box:
The application has been or will be filed based on the record of
someone other than myself.

 Yes
 No

Go to Item 61
Go to Section 7

61 Enter the name of the person on whose record the
application has been or will be filed.

Section 7

If only six numbers,
enter here

Prefix

62 Enter that person’s Railroad Retirement Board claim
number, including the letter prefix.

Information About Work And Earnings

Please read the section “How Earnings Affect An Annuity” in Part V of the RB-17 booklet to find out how work and earnings can affect your railroad retirement annuity or a child’s annuity. Also, please refer to Form G-77, How Earnings Affect
Payment of Survivor Annuities, for the exempt amounts to use when answering Items 63 through 68. When answering
Items 63 through 70, consider only yourself and the children listed in Item 41.
Earnings
Last Year
________
(Year)

Answer Items 63 and 64 only if the employee died before January 1 of this year.
63 Enter an “X” in the appropriate box:
My total earnings, or the total earnings of a child, for all
employment last year were more than the annual earnings
exempt amount shown on Form G-77.

 Yes
 No

Go to Item 64
Go to Item 65

64 Print the requested information for every family member whose total earnings for last year were more than the
annual earnings exempt amount shown on Form G-77. Use as many lines as needed beginning with 64a.
2 Total Earnings for Last Year
(Show Dollars Only)

a 1 Family Member

$
3 Enter an “X” in the appropriate box:
The family member earned more than the monthly earnings
exempt amount in employment for hire or performed substantial
services in self-employment in every month last year.
4 Enter an “X” next to each month last year in
which the family member did not earn more than
the monthly earnings exempt amount or perform
substantial services in self-employment.

 Yes
 No

JAN

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

NOV

DEC

2 Total Earnings for Last Year
(Show Dollars Only)

b 1 Family Member

$
3 Enter an “X” in the appropriate box:
The family member earned more than the monthly earnings
exempt amount in employment for hire or performed substantial
services in self-employment in every month last year.
4 Enter an “X” next to each month last year in
which the family member did not earn more than
the monthly earnings exempt amount or perform
substantial services in self-employment.
Page 9

 Yes
 No

JAN

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

NOV

DEC

Form AA-18 (07-15)

Earnings
Last Year
Con’t
_______
(Year)

2 Total Earnings for Last Year
(Show Dollars Only)

c 1 Family Member

$
3 Enter an “X” in the appropriate box:
The family member earned more than the monthly earnings
exempt amount in employment for hire or performed substantial
services in self-employment in every month last year.
4 Enter an “X” next to each month last year in
which the family member did not earn more than
the monthly earnings exempt amount or perform
substantial services in self-employment.

Earnings
This Year
________
(Year)

 Yes
 No

JAN

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

NOV

DEC

65 Enter an “X” in the appropriate box:
 Yes
Go to Item 66
I expect my total earnings, or the total earnings of a child
for all employment this year to be more than the annual
 No
Go to Item 67
earnings exempt amount.
66 Enter the requested information for every family member whose total earnings for this year are expected to
be more than the annual earnings exempt amount. Use as many lines as needed beginning with 66a.
a 1 Family Member

2 Total Expected Earnings for This Year
(Show Dollars Only)
$

3 Enter an “X” in the appropriate box:
The family member expects to earn more than the monthly earnings
exempt amount in employment for hire or to perform substantial
services in self-employment in every month this year.
4 Enter an “X” next to each month this year in which the
family member did not, or does not expect to, earn
more than the monthly earnings exempt amount or
perform substantial services in self-employment.

 Yes
 No

JAN

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

NOV

DEC

2 Total Earnings for This Year
(Show Dollars Only)

b 1 Family Member

$
3 Enter an “X” in the appropriate box:
The family member expects to earn more than the monthly earnings
exempt amount in employment for hire or to perform substantial
services in self-employment in every month this year.
4 Enter an “X” next to each month this year in which the
family member did not, or does not expect to, earn
more than the monthly earnings exempt amount or
perform substantial services in self-employment.

 Yes
 No

JAN

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

NOV

DEC

c 1 Family Member

2 Total Earnings for This Year
(Show Dollars Only)
$

3 Enter an “X” in the appropriate box:
The family member expects to earn more than the monthly earnings
exempt amount in employment for hire or to perform substantial
services in self-employment in every month this year.
4 Enter an “X” next to each month this year in which the
family member did not, or does not expect to, earn
more than the monthly earnings exempt amount or
perform substantial services in self-employment.

 Yes
 No

JAN

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

NOV

DEC

Note: If there are two or more children qualified to receive benefits and you are earning more than
the annual earnings exempt amount, please contact the RRB field office. Someone will be able to
help you decide whether it is better for you to file for yourself and the children, or whether you would
actually be better off to file for the children alone.
Form AA-18 (07-15)

Page 10

Earnings
Next Year
________
(Year)

67 Enter an “X” in the appropriate box:
I expect my total earnings, or the total earnings of
a child, from all employment next year to be more
than the annual earnings exempt amount.

 Yes
 No

Go to Item 68
Go to Item 69

68 Enter the requested information for every family member whose total earnings for next year are expected to be
more than the annual earnings exempt amount. Use as many blanks as are needed beginning with 68a.
Family
Member

a

Expected Earnings
for Next Year
(Show Dollars Only)

$

Family
Member

Expected Earnings
for Next Year
(Show Dollars Only)

$

b

$

c

69 Enter an “X” in the appropriate box:
I have worked, or a child has worked, for a railroad
or other employer in the railroad industry.
Railroad
Work

Expected Earnings
for Next Year
(Show Dollars Only)

Family
Member

 Yes
 No

Go to Item 70
Go to Section 8

70 Enter the requested information for every family member who has worked for a railroad or other employer
in the railroad industry. Use as many lines as needed beginning with 70a.
a 1 Family Member

2 Railroad Employer

3 Date Last Worked
Month

4 Enter an “X” next to each month in this year during
which the family member worked for an employer in
the railroad industry.
5 If you expect the annuity to begin before January 1
of this year, enter an “X” next to each month of last
year during which the family member worked for an
employer in the railroad industry.
b 1 Family Member

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

NOV

DEC

JAN

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

NOV

DEC

3 Date Last Worked
Month

5 If you expect the annuity to begin before January 1
of this year, enter an “X” next to each month of last
year during which the family member worked for an
employer in the railroad industry.
c 1 Family Member

Page 11

Year

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

NOV

DEC

JAN

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

NOV

DEC

3 Date Last Worked
Month

5 If you expect the annuity to begin before January 1
of this year, enter an “X” next to each month of last
year during which the family member worked for an
employer in the railroad industry.

Day

JAN

2 Railroad Employer

4 Enter an “X” next to each month in this year during
which the family member worked for an employer in
the railroad industry.

Year

JAN

2 Railroad Employer

4 Enter an “X” next to each month in this year during
which the family member worked for an employer in
the railroad industry.

Day

Day

Year

JAN

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

NOV

DEC

JAN

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

NOV

DEC

Form AA-18 (07-15)

Section 8
Filing
Protection

Filing Date

Answer only if you are age 62 or older, disabled, or otherwise eligible for social security old age, disability,
or survivor benefits and you have not filed an application for such benefits.
71 Enter an “X” in the appropriate box:
I also want this application used to protect my
filing date for social security benefits.

Section 9

 Yes
 No

Receiving Your Payments

All applicants filing for RRB benefits must choose to receive their annuity payments either:



By Direct Deposit to a bank, savings and loan, credit union or other financial institution; or
Into a Direct Express® Debit MasterCard® account.

Please read Part VII of the RB-17 booklet for an explanation of Direct Deposit and the Direct Express® Debit MasterCard®.
Payment
Options

Direct
Deposit

72 Enter an “X” in the appropriate box to indicate how you
want to receive your payments.



Direct Deposit - Go to Item 73



Direct Express® Debit MasterCard®
Go to Section 10



Neither Direct Deposit nor Direct Express®
Debit MasterCard® - Go to Section 10

To provide the information we need to correctly deposit your payments by Direct Deposit, either attach a voided
personal check and go to Section 10, or call your financial institution for the information you need to complete
Items 73 through 77 below.

73 Enter the name of your financial institution.
AREA CODE

TELEPHONE NUMBER

74 Enter the telephone number of your financial institution.

75 Enter the routing transit number of your financial institution.
76 Enter your account number.
77 Enter an “X” in the appropriate box:
Type of account for the above account number.

 Checking
 Savings
Go to Section 10

Section 10
Remarks

Remarks

78 This section is to be used for the continuation of answers to other items. Be sure to include the item number
at the beginning of the answer you wish to continue. You may also use this section to enter any additional
information that you feel may be important to include.

Form AA-18 (07-15)

Page 12

Section 11
Certification

Certification

79 Enter an “X” in the appropriate box:
I will have a guardian or other representative sign
this application on my behalf.

 Yes
 No

Go to Note and Item 80
Go to Item 80

Note: If answered “Yes,” your guardian or other representative
must sign this application. That person must also complete and
return Form AA-5, Application for Substitution of Payee.
80 I certify that the information I gave the Railroad Retirement Board (RRB) on this application is true to the best
of my knowledge. I know that if I make a false or fraudulent statement or withhold information in order to
receive benefits from the RRB, I am committing a crime under Federal law which may be punishable by fines,
imprisonment, or both. I have received and reviewed the booklets, RB-17, Survivor Annuities and RB-9s,
Events That Affect A Survivor Annuity. I understand that I am responsible for reporting events that would
affect my annuity as explained in the booklets.
I agree to immediately notify the RRB:
• If I marry;
• If I begin to receive a pension from an agency of the Federal, state, or local government, or if my present
payments change;
• If an application is filed for social security benefits for me or any child based on any person’s earnings record;
• If I or any child go to work for a railroad, railroad labor organization or work in any capacity in the railroad industry;
• If I or any child will earn more than the annual earnings exempt amount, and it was not reported on the
application;
• If I reported expected earnings for myself or any child and that earnings estimate changes;
• If my address changes;
• If my financial organization or the account number at my financial organization changes;

• If any child for whom I am receiving benefits dies, marries, or leaves my care;
• If I am, or any child is, confined in a jail, prison, penal institution, or correctional institution due to a conviction
for a criminal offense.
Signature
(First Name, Middle Initial,
Last Name)
Day

Month

Year

Date
81 If this certification is signed by mark (“X”) in Item 80, two witnesses who know the person signing must sign
below, giving their full addresses and daytime telephone numbers.
a. Signature of Witness
Address (Number and Street)
City, State, ZIP Code

Daytime Telephone Number (include area code)

Area Code

Telephone Number

Area Code

Telephone Number

b. Signature of Witness
Address (Number and Street)
City, State, ZIP Code

Daytime Telephone Number (include area code)
Page 13

Form AA-18 (07-15)

Section 12

How To Return Your Application

Before you return your application, 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 application.
 You have included all the needed proofs listed in the letter you received with this application.
When you received your application, you should also have received a pre-addressed return envelope. If you
do not have this envelope, you can use any envelope as long as it is addressed to the RRB office serving your
location. No matter which envelope you use, you must put the correct postage on the envelope. Be careful to
provide enough postage, because your application and the accompanying forms may weigh more than a standard letter. The U.S. Postal Service will not deliver your application unless it has the correct postage.
Make one final check before you seal the envelope to ensure that the following are enclosed:
 NEEDED PROOFS
 THE APPLICATION FORM ITSELF
 ADDITIONAL FORMS YOU WERE ASKED TO COMPLETE

Note: After the RRB receives your application, a receipt form with information about your claim will
be sent to you. When you receive it, you will know that the RRB has received your application and
has started the work needed to determine if you are entitled to benefits. If you do not receive the
receipt within two weeks after you have filed this application, please contact us so we can find out
what is causing the delay.

Form AA-18 (07-15)

Page 14