G-251 (Proposed) Vocational Report

PROPOSED

United States of America
Railroad Retirement Board

Form Approved
OMB No. 3220-0141

Vocational Report
Section 1

General Instructions

Be sure to read the Important Notice at the bottom of page 8.
Type or print legibly in ink. If you need more space than is provided to answer a question, attach a separate sheet of
paper. If you do not know the answer to a question, print "Unknown" in the space provided for the answer. Additional
forms may be obtained from the RRB office shown on page 9.
If you are completing this form 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

1 Employee's Name
2 Employee's Social Security Number
3 Employee's Railroad Retirement Claim
Number, if different from Item 2

Applicant
Identification

4 Applicant's Name
5 Applicant’s Address (Include Street
Address, City, State/Province,
ZIP Code and Country)
6 Daytime Telephone Number:

Section 3
Work History

Regular
Occupation

Alternate Telephone Number:

Information About Your Work History
7 List all railroad and nonrailroad jobs you have had in the last 15 years before you stopped working and
enter
an “X” in the appropriate box to indicate whether the work was railroad or nonrailroad. If you have
th
a 6 grade education or less and performed only heavy unskilled labor for 35 years or more, list all of
the jobs you have had since you began to work. NOTE 1: If you list only one job in Item 7, do not
complete pages 4 through 7. If you have more than 3 jobs to list, continue on another Form G-251.
NOTE 2: Enter the appropriate job title(s) from Item 7a, b, and c, below, at the top of pages 2, 4, and 6.
Dates Worked
Hours
Type and Name of Business
Job Title
per
From
To
(Railroad or Nonrailroad)
MO
YR
MO
YR
Week
a.

Railroad

Nonrailroad

b.

Railroad

Nonrailroad

c.

Railroad

Nonrailroad

8 Enter an "X" in the appropriate box:
Are you applying for an employee occupational disability annuity?

Yes - Go to Item 9
No - Go to Item 12

9 Enter the title of your usual railroad job in the last 5 years.
10

Enter the title of your usual railroad job in the last 15 years.

11

Enter an "X" in the appropriate box:
Which job did you claim as your regular occupation?

1

Job in Item 9
Job in Item 10

Form G-251 (xx-xx)

Only complete this page to provide a description of a job listed in Item 7a, ________________________________.
Description of
Job in Item

7a

12 Describe the essential duties of the position or occupation named in Item 7a. In that description
include technical knowledge or skills involved; any handwritten or typed reports to be completed; any
manipulative (manual dexterity) skills used; any driving and/or operating of machinery; and any
supervisory responsibilities.

13 Describe the environmental conditions that the position described above exposes you to (i.e., walking
on uneven terrain; heights; dangerous machinery; exposure to electric shock or high voltage;
proximity to electromagnetic fields; temperature/humidity extremes; fumes; noxious gases; dust;
excessive noise or vibration).

14

Indicate below the kind and amount of physical activity this job involved during a typical 8-hour
workday. (The total hours shown should equal 8 hours or the exact number of hours worked daily.)
a. Check the number of hours a day spent:
0 1 2 3  4  5  6 7  8
(1) Standing/walking
(2) Sitting
0 1 2 3  4  5  6 7  8

Constantly

Frequently
(1/3 to 2/3)

2

Descriptive Comments

1

Never

Action

Occasionally
(Up to 1/3)

b. Indicate in the chart below, the amount of time and a description of the physical action or activity
involved during a typical 8-hour workday. If an action listed below does not apply to the position,
enter “N.A.” in the Descriptive Comments column.
Amount of Time

(1) Balancing (With or without
equipment in all weather
conditions and on any surface,
including uneven terrain)

   

(2) Bending

   

(3) Twisting/Turning

   

(4) Crouching/Squatting/Stooping

   

(5) Kneeling

   

(6) Reaching above should level

   

1Occasionally means occurring from very little up to one-third (approx. 2-1/2 hours) of an 8-hour workday; cumulative, not
continuous.
2Frequently means occurring one-third (approx. 2-1/2 hours) to two-thirds (approx. 5 hours) of an 8-hour workday; cumulative, not
continuous.

2

Form G-251 (xx-xx)

Description of
Job in Item

Constantly

Frequently
(1/3 to 2/3)

Descriptive Comments

1

Action

2

Never

7a (cont.)

Occasionally
(Up to 1/3)

Amount of Time

14 b. (7)

Climbing (Indicate what is
climbed such as stairs, ladder,
etc.)

   

(8)

Pushing/Pulling (Indicate what
and how you pushed or pulled)

   

(9)

Crawling under equipment to
view, inspect, or repair

   
   

(10) Gripping/Holding
(11) Foot Control (Shifting of feet
when using pedals, brakes,
clutch, etc.)
(12) Fine manipulation (Fingering;
keypunch; keyboard; pressing
buttons; picking/pinching/
turning knobs; etc.)

   
   
   

(13) Lifting/lowering/carrying
a. Indicate the objects you
lift/lower/carry

Heaviest Weight Lifted
10 lbs 20 lbs 50 lbs 100 lbs Over 100 lbs
Weight Most Often Lifted/Carried
Up to 10 lbs Up to 25 lbs Up to 50 lbs Over 50 lbs

b. Check the weight of the
objects you lift/lower/carry
15

a. Has your employer made permanent adjustments to this
job to accommodate you?

Yes – Go to Item 15b
No – Go to Item 16

b. Describe any permanent accommodation(s) given (e.g., job duties, hours of work, hours of
overtime, attendance, etc.) and the start and end dates for each accommodation. If there is not an
end date for the accommodation, enter “N/A.”
From
To
Yes No
Month
Year
Month
Year
Job Duties



Hours of Work



Hours of Overtime



Attendance



Other



1Occasionally means occurring from very little up to one-third (approx. 2-1/2 hours) of an 8-hour workday; cumulative, not
continuous.
2Frequently means occurring one-third (approx. 2-1/2 hours) to two-thirds (approx. 5 hours) of an 8-hour workday; cumulative, not
continuous.

3

Form G-251 (xx-xx)

Only complete this page to provide a description of a job listed in Item 7b, ________________________________.
Otherwise, go to page 8.
Description of 16 Describe the essential duties of the position or occupation named in Item 7b. In that description
Job in Item
include technical knowledge or skills involved; any handwritten or typed reports to be completed; any
7b
manipulative (manual dexterity) skills used; any driving and/or operating of machinery; and any
supervisory responsibilities.

17 Describe the environmental conditions that the position described above exposes you to (i.e., walking
on uneven terrain; heights; dangerous machinery; exposure to electric shock or high voltage;
proximity to electromagnetic fields; temperature/humidity extremes; fumes; noxious gases; dust;
excessive noise or vibration).

18

Indicate below the kind and amount of physical activity this job involved during a typical 8-hour
workday. (The total hours shown should equal 8 hours or the exact number of hours worked daily.)
a. Check the number of hours a day spent:
0 1 2 3  4  5  6 7  8
(3) Standing/walking
(4) Sitting
0 1 2 3  4  5  6 7  8

Constantly

Frequently
(1/3 to 2/3)

2

Descriptive Comments

1

Never

Action

Occasionally
(Up to 1/3)

b. Indicate in the chart below, the amount of time and a description of the physical action or activity
involved during a typical 8-hour workday. If an action listed below does not apply to the position,
enter “N.A.” in the Descriptive Comments column.
Amount of Time

(1) Balancing (With or without
equipment in all weather
conditions and on any surface,
including uneven terrain)

   

(2) Bending

   

(3) Twisting/Turning

   

(4) Crouching/Squatting/Stooping

   

(5) Kneeling

   

(6) Reaching above shoulder level

   

1Occasionally means occurring from very little up to one-third (approx. 2-1/2 hours) of an 8-hour workday; cumulative, not
continuous.
2Frequently means occurring one-third (approx. 2-1/2 hours) to two-thirds (approx. 5 hours) of an 8-hour workday; cumulative, not
continuous.

4

Form G-251 (xx-xx)

Description of
Job in Item

Constantly

Frequently
(1/3 to 2/3)

Descriptive Comments

1

Action

2

Never

7b (cont.)

Occasionally
(Up to 1/3)

Amount of Time

18 b. (7)

Climbing (Indicate what is
climbed such as stairs, ladder,
etc.)

   

(8)

Pushing/Pulling (Indicate what
and how you pushed or pulled)

   

(9)

Crawling under equipment to
view, inspect, or repair

   
   

(10) Gripping/Holding
(11) Foot Control (Shifting of feet
when using pedals, brakes,
clutch, etc.)
(12) Fine manipulation (Fingering;
keypunch; keyboard; pressing
buttons; picking/pinching/
turning knobs; etc.)

   
   
   

(13) Lifting/lowering/carrying
a. Indicate the objects you
lift/lower/carry

Heaviest Weight Lifted
10 lbs 20 lbs 50 lbs 100 lbs Over 100 lbs
Weight Most Often Lifted/Carried
Up to 10 lbs Up to 25 lbs Up to 50 lbs Over 50 lbs

b. Check the weight of the
objects you lift/lower/carry
19

a. Has your employer made permanent adjustments to this
job to accommodate you?

Yes – Go to Item 19b
No – Go to Item 20

b. Describe any permanent accommodation(s) given (e.g., job duties, hours of work, hours of
overtime, attendance, etc.) and the start and end dates for each accommodation. If there is not an
end date for the accommodation, enter “N/A.”
From
To
Yes No
Month
Year
Month
Year
Job Duties



Hours of Work



Hours of Overtime



Attendance



Other



1Occasionally means occurring from very little up to one-third (approx. 2-1/2 hours) of an 8-hour workday; cumulative, not
continuous.
2Frequently means occurring one-third (approx. 2-1/2 hours) to two-thirds (approx. 5 hours) of an 8-hour workday; cumulative, not
continuous.

5

Form G-251 (xx-xx)

Only complete this page to provide a description of a job listed in Item 7c, ________________________________.
Otherwise, go to page 8.
Description of 20 Describe the essential duties of the position or occupation named in Item 7c. In that description
Job in Item
include technical knowledge or skills involved; any handwritten or typed reports to be completed; any
7c
manipulative (manual dexterity) skills used; any driving and/or operating of machinery; and any
supervisory responsibilities.

21 Describe the environmental conditions that the position described above exposes you to (i.e., walking
on uneven terrain; heights; dangerous machinery; exposure to electric shock or high voltage;
proximity to electromagnetic fields; temperature/humidity extremes; fumes; noxious gases; dust;
excessive noise or vibration).

22

Indicate below the kind and amount of physical activity this job involved during a typical 8-hour
workday. (The total hours shown should equal 8 hours or the exact number of hours worked daily.)
a. Check the number of hours a day spent:
0 1 2 3  4  5  6 7  8
(5) Standing/walking
(6) Sitting
0 1 2 3  4  5  6 7  8

Constantly

Frequently
(1/3 to 2/3)

2

Descriptive Comments

1

Never

Action

Occasionally
(Up to 1/3)

b. Indicate in the chart below, the amount of time and a description of the physical action or activity
involved during a typical 8-hour workday. If an action listed below does not apply to the position,
enter “N.A.” in the Descriptive Comments column.
Amount of Time

(1) Balancing (With or without
equipment in all weather
conditions and on any surface,
including uneven terrain)

   

(2) Bending

   

(3) Twisting/Turning

   

(4) Crouching/Squatting/Stooping

   

(5) Kneeling

   

(6) Reaching above shoulder level

   

1Occasionally means occurring from very little up to one-third (approx. 2-1/2 hours) of an 8-hour workday; cumulative, not
continuous.
2Frequently means occurring one-third (approx. 2-1/2 hours) to two-thirds (approx. 5 hours) of an 8-hour workday; cumulative, not
continuous.

6

Form G-251 (xx-xx)

Description of
Job in Item

Constantly

Frequently
(1/3 to 2/3)

Descriptive Comments

1

Action

2

Never

7c (cont.)

Occasionally
(Up to 1/3)

Amount of Time

22 b. (7)

Climbing (Indicate what is
climbed such as stairs, ladder,
etc.)

   

(8)

Pushing/Pulling (Indicate what
and how you pushed or pulled)

   

(9)

Crawling under equipment to
view, inspect, or repair

   
   

(10) Gripping/Holding
(11) Foot Control (Shifting of feet
when using pedals, brakes,
clutch, etc.)
(12) Fine manipulation (Fingering;
keypunch; keyboard; pressing
buttons; picking/pinching/
turning knobs; etc.)

   
   
   

(13) Lifting/lowering/carrying
a. Indicate the objects you
lift/lower/carry

Heaviest Weight Lifted
10 lbs 20 lbs 50 lbs 100 lbs Over 100 lbs
Weight Most Often Lifted/Carried
Up to 10 lbs Up to 25 lbs Up to 50 lbs Over 50 lbs

b. Check the weight of the
objects you lift/lower/carry
23

a. Has your employer made permanent adjustments to this
job to accommodate you?

Yes – Go to Item 23b
No – Go to Item 24

b. Describe any permanent accommodation(s) given (e.g., job duties, hours of work, hours of
overtime, attendance, etc.) and the start and end dates for each accommodation. If there is not an
end date for the accommodation, enter “N/A.”
From
To
Yes No
Month
Year
Month
Year
Job Duties



Hours of Work



Hours of Overtime



Attendance



Other



1Occasionally means occurring from very little up to one-third (approx. 2-1/2 hours) of an 8-hour workday; cumulative, not
continuous.
2Frequently means occurring one-third (approx. 2-1/2 hours) to two-thirds (approx. 5 hours) of an 8-hour workday; cumulative, not
continuous.

7

Form G-251 (xx-xx)

Section 4
Certification

Certification
24 Enter an "X" in the appropriate box:
I will have a guardian or other representative sign this report on
my behalf.

Yes – Go to Note and Item 25
No – Go to Item 25

Note: If answered "Yes," the guardian or other representative of the
applicant must sign this report.
25 I know that civil and criminal penalties may be imposed on me for false or fraudulent statements, or for
withholding information to misrepresent a fact material to determining a right to a payment under the
Railroad Retirement Act. I affirm that to the best of my knowledge, the information I have given
represents the complete truth.
Signature
(First Name, Middle Initial,
Last Name)
Month

Day

Year

Date
26 If this certification is signed by mark ("X") in Item 25, two witnesses who know the person signing must
sign below, giving their full addresses.
a. Signature of Witness

Address (Number and Street)

City, State, ZIP Code

b. Signature of Witness

Address (Number and Street)

City, State, ZIP Code

PAPERWORK REDUCTION ACT AND PRIVACY ACT NOTICES
The Railroad Retirement Board is authorized to collect the information on this form under Section 7(b)(6) of the Railroad
Retirement Act. While you are not required to respond, your cooperation is needed to provide information necessary to
complete processing of the claim. If you fail to provide us with the requested information, we may be unable to pay you
any benefits (as explained in Section 2(a) of the Railroad Retirement Act).
We estimate this form takes an average of 40 to 50 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, IL 60611-1275.

8

Form G-251 (xx-xx)

Section 5

How to Return Your Report

Before you return your report, 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 report.
● You have included all the needed proofs listed in the letter you received with this report.
When you received your report, you should have also received a pre-addressed envelope.
If you do not have this envelope, you can use any envelope as long as it is addressed to the
RRB office shown below. No matter which envelope you use, you must put the correct
postage on the envelope. Be careful to provide enough postage because your report may
weigh more than a standard letter. The U.S. Postal Service will not deliver your report
unless it has the correct postage.
If you need information or assistance, contact:
U.S. Railroad Retirement Board

 Telephone Number:

If for some reason you cannot contact that office, you should contact:

U.S. RAILROAD RETIREMENT BOARD
844 NORTH RUSH STREET
CHICAGO, ILLINOIS 60611-1275

9

Form G-251 (xx-xx)