TXL-26, Transmittal Letter for RRB-1001

UNITED STATES OF AMERICA

RAILROAD RETIREMENT BOARD

PROPOSED

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

Please complete the Form RRB-1001, Nonresident Questionnaire, shown below, so that we may
determine how United States income tax withholding applies to your monthly annuity payments.
Before completing the questionnaire be sure to read the Paperwork Reduction Act and Privacy Act
Notices contained in the enclosed Form TB-26, Completion Instructions for Form RRB-1001. The
questionnaire is needed because *ChooseOne*
[See next page for drop down choices.]
Be sure Items 1 through 9 are completed according to the TB-26 instructions. Return Form
RRB-1001 promptly in the envelope provided. If we do not receive it, we may be required to
withhold a higher rate of tax than would otherwise be necessary. NOTE: You do not have to
complete the form if you have completed one within the last 45 days and if no information has
changed.
If you have any questions about this letter or need additional information, contact the nearest RRB
field office, U.S. consulate, or U.S. embassy. You may also write to us at the address shown
above or visit our website at www.rrb.gov.

Enclosures
NONRESIDENT QUESTIONNAIRE
1. RRB Claim Number

2. Payee Code

3. Your United States Taxpayer
Identification Number
4. Name and Address

FORM APPROVED
OMB NO. 3220-0145

5. Claimed country of citizenship.
6. Claimed country of legal residence.
Note: If this is different than the country shown
In Item 4, you must submit proof of residency.
7. Do you claim exemption under any tax treaty in effect between
your country of legal residence and the United States?

Yes
Note: To receive an exemption, you must comply with certain
requirements. See Form TB-26 for more information about
No
claiming an exemption.
8. United States Passport Number only
Note: Passport cannot be expired.
9. I understand that making a false or fraudulent statement to the RRB is a crime
punishable by Federal law. I certify that the information provided on this
certificate is true, complete, and correct. I will notify the RRB within 30 days of
any change in this information.
Signature ________________________________
This certificate MUST BE SIGNED to be valid.

Date ________________
Form RRB-1001 (xx-xx)

Form TXL-26 (xx-xx)

UNITED STATES RAILROAD RETIREMENT BOARD - 2