Drl-145 (12-17)

CURRENT
UNITED STATES OF AMERICA
RAILROAD RETIREMENT BOARD
DEBT RECOVERY DIVISION
844 NORTH RUSH STREET

CHICAGO, IL 60611-1275
WWW.RRB.GOV
OFFICE HOURS: 9:00 AM TO 3:30 PM
MONDAY THROUGH FRIDAY EXCEPT FEDERAL HOLI DAYS

Name
Address Line 1
Address Line 2
City, State, ZIP Code

In reply refer to:
Bill Doc ID: B-<#>
Payee Name:
Amount Due:
Dear

:

We have reviewed your record and found that you were paid more in railroad retirement
annuities than you were entitled to receive.
Code Paragraphs are Inserted Here
A Payment Summary is enclosed showing the annuities due and annuities paid. All rates shown
on this summary include Part B, C and D premiums if they were being deducted from your
railroad retirement annuity.
Please read the enclosed Form , "Your Rights to Review and/or
Waiver," which explains your rights concerning this overpayment and the amount of time
you have to request your rights.
If you wish to request your rights, complete the enclosed Form G-66BA, "Rights Request Form,"
and return it in the enclosed envelope.
If you do not wish to request your rights, you must refund the overpaid annuities.
If you do not request your rights or remit full payment within 60 days from the date of this letter,
interest shall accrue on the unpaid portion of this debt. In addition, penalty and administrative
charges shall accrue on any amounts unpaid after 120 days.
Payment may be made by check, money order, or debit card and should reference the above
Billing Document ID. If you pay by check or money order, complete the enclosed
Form DR-422B, "Response to Debt Notice," and return it with your payment. Checks and money
orders must be drawn on a U.S. bank, in U.S. dollars. If you choose to pay by debit card,
complete the enclosed Forms DR-422B and G-421F, "Repayment by Debit Card Form."

Form DRL-145 (12-17)

UNITED STATES RAILROAD RETIREMENT BOARD – 2

If you are unable to make repayment in one lump sum and would like to request installment
payments, complete the appropriate section of Form DR-422B. The RRB will consider any
reasonable offer, but keep in mind that repayment by installments should satisfy the debt within
a reasonable amount of time. If you enter into an installment plan and payments are made in a
timely manner, penalty and administrative charges will not be added. However, interest
charges would be assessed to the unpaid balance of your debt.
To ensure proper and timely handling, your payment or completed Form G-66BA, should be
mailed using the enclosed envelope addressed to the Railroad Retirement Board, Retirement
Survivor Debt Collections, P.O. Box 979018, St. Louis, Missouri 63197-9000.
You may also pay this debt online at: https://secure.rrb.gov/onlinebillpayment.
If you have any questions regarding this letter, please contact any Debt Recovery Specialist at
(312) 751-4630.

Debt Recovery Division
Enclosures
Envelope

G-66BA
G-421F
DR-422B
Payment Summary

Form DRL-145 (12-17)