AA-17rec; Receipt for Claim

United States of America
Railroad Retirement Board

CURRENT

Form AA-17rec (01-19)

Application for Survivor Benefits - Receipt for Claim
Applicant’s Name and Address
LINE-2
LINE-3
LINE-4
LINE-5
Employee’s Name
Application Filing Date

Your application for a (Application Type) has been released and will be processed as
quickly as possible. If you do not receive notification about your application by (Days from
filing date based on Customer Service Plan) you should contact the field office shown
below.
If you change your address or if there is some other change that may affect your
application, you or your representative should report the change at once. If you have any
questions, we will be glad to help you. You can report changes either by telephone, mail,
or in person, whichever you prefer. Most Railroad Retirement Board offices are open to
the public from 9:00 AM to 3:30 PM, Monday, Tuesday, Thursday, Friday and 9:00 AM to
12:00 PM Wednesday.
The changes to be reported are listed below.
Always Report These Changes to the RRB
Death – If the child dies. (Printed if application type is 5, 6 or 7.)
Marriage – If you remarry. (Printed if application type is 2, 3, 4, 9.)
Marriage – If you marry. (Printed if application type is 5, 6 or 7.)
Social Security – If you file for social security benefits based on any person’s
earnings record.
Public Pension – If you begin to receive a pension or receive a lump-sum payment
based on your earnings at an agency of the Federal, state or local government, or if
your present payments change. (Printed if application type is 2, 3 or 4.)
Earnings – If your earnings change.
On your application you told us you expect your total earnings for (current year) to
be $
. (Printed if applicant is less than full retirement age.)
On your application you told us you expected your total earnings for (current year)
to be less than $
. (Printed if applicant is less than full retirement age.)

United States of America
Railroad Retirement Board

Form AA-17rec (01-19)

You are earning more than $
a month. (Printed if applicant is less than full
retirement age.)
You are not earning more than $
a month. (Printed if applicant is less than
full retirement age.)
Railroad Work – If you go to work for a railroad or railroad labor organization or work
in any capacity in the railroad industry.
Address – If your address changes.
Address – If your address changes, even if your payments are sent to a financial
organization.
Bank Account – If your financial organization or the account number at your financial
organization changes.
Applicant is in Your Care – If any person for whom you are receiving an annuity dies
or leaves your care.
Criminal Offense – If you are confined in a jail, prison, penal institution or correctional
institution due to a conviction for a criminal offense.
School Attendance – If you stop attending school full-time. (Printed if application type
is 7.)
Death or Disability – Your representative should notify the RRB immediately if you die
or become unable to handle your own benefits.
How to Report Changes
When a change occurs after you have begun receiving your annuity, you should report the
change at once. You or your representative can make the reports by telephone, mail or in
person, whichever you prefer.
(Paragraph will be printed if non disability applicant is less than full retirement age.)
In most cases, we calculate how much to reduce your annuity because of your earnings
based on either the earnings estimate you gave us when you applied for benefits, or on
reports submitted by employers to the Social Security Administration. As a reminder, you
should report your earnings (1) when we ask for a report of your earnings or (2) if any of
the following happens:
You stop working;
You start working and expect to earn more than the annual exempt amount;
Your employment is not covered under the Social Security Act (i.e., FICA taxes are
not deducted from your pay);
You work for a railroad or railroad labor organization; or
You return to work for your last pre-retirement non-railroad employer.
To report any changes or ask questions, you should contact:
(Field Office Address and Toll-Free Telephone Number)

Form AA-17rec (01-19)

United States of America
Railroad Retirement Board

If for some reason you are unable to contact that office, you should contact:
U.S. Railroad Retirement Board
844 N Rush Street
Chicago, Illinois 60611-1275
http://www.rrb.gov