Transmittal Letter for RRB Form G-319

CURRENT

In reply refer to

The enclosed forms will be used by the Railroad Retirement Board to determine if the railroad
employee's **Chooseone** can be included in the Special Guaranty Computation under the
Railroad Retirement Act.

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GROUP A FORMS TO BE COMPLETED AND RETURNED
Please complete and return the forms marked by an "X" below.
G-319 - Statement Regarding Family and Earnings for Special Guaranty Computation
AA-19a - Application for Determination of Child's Disability
G-139 - Statement Regarding Contributions and Support of Children (stepchild or grandchild
dependency)
G-208 - Public Service Pension Questionnaire
G-320 - Student Questionnaire for Special Guaranty Computation

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GROUP B EVIDENCE YOU MUST SUBMIT
The enclosed booklet, Form RB-3, Furnishing Evidence to Support Your Claim, explains the
various types of documents that provide evidence to support your claim. Please furnish evidence
for the items marked by an "X" below.
Proof of age of each child to be included in the family group
Proof of relationship of each child to be included in the family group
Proof of dependency of any stepchild or grandchild included in the family group (Form G-139)
Medical evidence for any disabled child over age 18 to be included in the family group
Proof of marriage
Proof of age ofyour spouse

Form RL-3 19 (01-06)

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.
If you have any questions about this letter or need additional information, contact our office as
soon as possible.
Sincerely,

Enclosures
Form G-77a
Form G-179