AA-3rec, Receipt for Claim

United States of America
Railroad Retirement Board

CURRENT

Form AA-3rec (04-13)

Application for (Application Type) - Receipt for Claim
Applicant’s Name and Address
LINE-2
LINE-3
LINE-4
LINE-5
Employee’s Name
Application Filing Date
(Printed if application type is spouse or spouse with child.)
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
(Customer service standard added to application filing date) you should contact the
field office shown below.
(Printed if application type is Medicare only.)
Your application for Medicare has been received and will be processed as quickly as
possible.
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 through Friday.
The changes to be reported are listed below.
Always Report These Changes to the RRB
 Marriage – If you remarry.
 Marriage – If your marriage to the employee ends by death or divorce.
 Social Security – If you file for social security benefits based on any person’s
earnings record.
 Public Pension – If you receive a lump-sum payment or begin to receive a
monthly pension based on your earnings at an agency of the Federal, state or local
government.
 Public Pension – If your present payments change.

United States of America
Railroad Retirement Board

Form AA-3rec (04-13)

 Earnings – If your earnings change.
 On your application you told us you expect your total earnings for (current year)
to be $ ________.
 On your application you told us you expect your total earnings for (current year)
to be less than $ ________.
 You are earning more than $ ______
 You are not earning more than $ _____
 Railroad Work – If you go to work for a railroad or railroad labor organization or
work in any capacity in the railroad industry. (Print on all receipts.)
 Employment – If you return to work for ______________________________ .
 Employment – If you change the date of last nonrailroad employment. On your
application you said your last day of employment with _________ would be
________________.
 Employment – If you cease working for ______________________________.
 Settlement – If you receive a settlement with credit for railroad service as “pay-fortime-lost” for months after _______________.
 Address – If your address changes, even if your payments are sent to a financial
organization.
 Address – If your address changes. (Print if application type is Medicare Only.)
 Bank Account – If your financial organization or the account number at your
financial organization changes.
 Criminal Offense – If you are confined in a jail, prison, penal institution, or
correctional institution due to a conviction for a criminal offense.
 Children in Your Care – If a child on whose basis you are entitled to an annuity
marries, dies or leaves your care and custody.
 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.
(Print if applicant is applying for a spouse benefit and is under FRA.)
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:

United States of America
Railroad Retirement Board

Form AA-3rec (04-13)

 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 nonrailroad employer.
To report any changes or ask questions, you should contact:
(Field Office Address and Toll-Free Telephone Number)

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 60611-2092
http://www.rrb.gov