RL-1S, Transmittal Letter for Self-administered Retirement Applications

UNITED STATES OF AMERICA

RAILROAD RETIREMENT BOARD

CURRENT

844 NORTH RUSH STREET

CHICAGO, IL 60611-1275
WWW.RRB.GOV
OFFICE HOURS: M-T-TH-F 9:00 AM TO 3:30 PM
WEDS. 9:00 AM TO 12:00 PM - CLOSED FEDERAL HOLIDAYS

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

,
In reply refer to

Enclosed are the forms and other material you will need to apply for your annuity under the
Railroad Retirement Act. If you want a formal determination of your eligibility for benefits, you must
complete an official application within 90 days. If you return the completed application within 90
days of the date of this letter, we will use the date you contacted us as the filing date of your
application. If you do not file within 90 days, you may lose benefits.
GROUP A - FORMS TO BE COMPLETED AND RETURNED
The forms listed below 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(s).
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 (08-18)

UNITED STATES RAILROAD RETIREMENT BOARD - 2
GROUP B - BOOKLETS AND PAMPHLETS YOU SHOULD KEEP
The booklets and pamphlets listed below contain information you will need to complete your
application(s). You should keep the booklets and pamphlets you receive, even after you return
your applications(s). Contact the district office shown above if you have not received all the
material marked by an "X".
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 Railroad Retirement 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 (08-18)