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UNITED STATES OF AMERICA
RAILROAD RETIREMENT BOARD
FORM APPROVED
O.M.B. No. 3220-0030
OFFICIALLY FILED
MONTH
APPLICATION FOR
DETERMINATION OF
CHILD’S DISABILITY
DO NOT WRITE IN THIS SPACE
DAY
OFFICE NUMBER
YEAR
APPROVED
APPLICATION NUMBER
DATE CODED
MONTH
DAY
YEAR
CODED BY
Section 1
General Instructions
Before you complete this application, be sure to read Part 1 of booklet RB-19a, Child’s Disability Benefits, which
explains information you will need to answer many of the questions in this application. Please read “Important Notices” on
page 14 of this application.
Print legibly in ink. If you need more space than is provided to answer a question, use Section 9, Remarks, for this purpose.
If you do not know the answer to a question, print “unknown” in the space provided for the answer.
When entering dates, always use numbers. Also, be sure there is one number in each box. For example, you would enter
December 13, 2021 as:
MONTH
DAY
YEAR
1 2 1 3 2 0 2 1
Some items in this application will not apply to you, so you will not need to answer them. Based on your answer to a
question, you may be told to skip to another item number, or even another section. Follow the instructions that tell you to
“Go to” another item. These are designed to save you time and help you move through the application form quickly, filling
in only necessary information. If no “Go to” instructions are given, answer the next item in order. Do not skip any
items unless directed to do so.
If you are completing this application on behalf of someone else, you must answer each question as it applies to
the applicant.
Section 2
Identifying Information
Check the information entered by Railroad Retirement Board (RRB) for Items 1 through 9 for accuracy.
X If the information is correct, go to Section 3.
X If the information is not correct, enter the correct information.
X If the information is missing, fill it in.
Employee
Identification 1
Applicant
Identification
EMPLOYEE’S NAME
2
EMPLOYEE’S SOCIAL SECURITY NUMBER
3
EMPLOYEE’S RAILROAD RETIREMENT CLAIM NUMBER
4
APPLICANT’S
NAME
5
a STREET ADDRESS
b CITY AND STATE
c ZIP CODE
d COUNTRY
6
a DAYTIME TELEPHONE NUMBER
b ALTERNATE TELEPHONE NUMBER
7
APPLICANT’S SOCIAL SECURITY NUMBER
8
APPLICANT’S DATE OF BIRTH
9
APPLICANT’S GENDER
q FEMALE
q MALE
Form AA-19a (06-19) Destroy Prior Editions
Information About Your Medical Condition
Section 3
Medical
Condition
Describe the medical condition(s) causing you to file. Enter the exact primary diagnosis if known and any
additional condition(s). Also enter if no medical records are being forwarded for each condition described.
Primary Condition
Medical Attached
q Yes
q No
10
Additional Condition(s)
When
Condition
Began
When
Condition
Became
Severe
How
Condition
Affects
Work
Current
Work
Status
Medical Attached
11 Enter the date the condition began to affect your ability
to work
12
Enter the date the condition began to severely interfere with your
activities.
13
Enter an “X” in the appropriate box:
Has the condition kept you from working?
14
Describe how your condition(s) prevent you from working.
15
Enter an “X” in the appropriate box:
Does this condition prevent you
from working now?
No
Month
Day
Year
Month
Day
Year
Go to Item 14
q Yes
q No
Go to Item 17
Go to Item 15
Go to Item 16
Day
Month
Year
Information About Your Medical Care
Section 4
Medical
17
Care or
Examination
Enter an “X” in the appropriate box:
Have you received any medical care, or been examined for
your condition since the date in Item 12?
Medical
Care
Before 22
Enter information about each doctor or medical facility from whom you received treatment or
care before age 22.
18
q
q Yes
q No
Enter the date this condition no longer
prevented work.
16
q Yes
a
NAME OF FACILITY
q Yes
q No
Go to Item 18
Go to Section 5
ADDRESS of Facility (Street Address, City,
State/Province, and Zip Code)
ATTENDING PHYSICIAN’S NAME
Enter an “X” in the appropriate box:
INPATIENT
q
OUTPATIENT
q
Area Code
PATIENT NUMBER
DATES TREATED
OR TESTED
Form AA-19a (06-19)
DESCRIBE TYPE OF TREATMENT OR TESTING
Page 2
Telephone Number
Medical
Care
Before 22
(Cont.)
18 b
NAME OF FACILITY
ADDRESS of Facility (Street Address, City,
State/Province, and Zip Code)
ATTENDING PHYSICIAN’S NAME
Enter an “X” in the appropriate box:
INPATIENT
q
OUTPATIENT
q
Area Code
PATIENT NUMBER
DATES TREATED
OR TESTED
Telephone Number
DESCRIBE TYPE OF TREATMENT OR TESTING
c NAME OF FACILITY
ADDRESS of Facility (Street Address, City,
State/Province, and Zip Code)
ATTENDING PHYSICIAN’S NAME
Enter an “X” in the appropriate box:
INPATIENT
q
OUTPATIENT
q
Area Code
PATIENT NUMBER
DATES TREATED
OR TESTED
Telephone Number
DESCRIBE TYPE OF TREATMENT OR TESTING
Note: If you received more medical care before age 22, use Section 9
to discuss additional treatment or care. Include the dates for each period of care.
Other
Medical
Care
19
Enter information about any other doctor or medical facility from whom you have received treatment or
care since the date in Item 12.
a NAME OF FACILITY
ADDRESS of Facility (Street Address, City,
State/Province, and Zip Code)
ATTENDING PHYSICIAN’S NAME
Enter an “X” in the appropriate box:
INPATIENT
q
OUTPATIENT
q
Area Code
PATIENT NUMBER
DATES TREATED
OR TESTED
Telephone Number
DESCRIBE TYPE OF TREATMENT OR TESTING
Page 3
Form AA-19a (06-19)
Other
Medical
Care
(Cont.)
19 b
ADDRESS of Facility (Street Address, City,
State/Province, and Zip Code)
NAME OF FACILITY
ATTENDING PHYSICIAN’S NAME
Enter an “X” in the appropriate box:
INPATIENT
q
OUTPATIENT
q
Area Code
PATIENT NUMBER
Telephone Number
DESCRIBE TYPE OF TREATMENT OR TESTING
DATES TREATED
OR TESTED
c NAME OF FACILITY
ADDRESS of Facility (Street Address, City,
State/Province, and Zip Code)
ATTENDING PHYSICIAN’S NAME
Enter an “X” in the appropriate box:
INPATIENT
q
OUTPATIENT
q
Area Code
PATIENT NUMBER
DATES TREATED
OR TESTED
Telephone Number
DESCRIBE TYPE OF TREATMENT OR TESTING
Note: If you received more medical care before age 22, use Section 9
to discuss additional treatment or care. Include the dates for each period of care.
Activity
Restriction
20
21
Enter an “X” in the appropriate box:
Has a medical doctor restricted your daily
activities since the date in Item 12?
q Yes
q No
Go to Item 21
Go to Item 24
Enter the name of the medical doctor who imposed the restriction. Also enter the medical doctor’s address if it
has not been previously entered in Item 18 or 19
ADDRESS of Medical Doctor
(Street Address, City, State/Province, and Zip Code)
NAME OF Medical Doctor
Month
22
Enter the date the restriction began.
23
List and Describe the condition(s) and how your daily activites were restricted by the condition(s).
Form AA-19a (06-19)
Page 4
Year
Medications 24
Enter an “X” in the appropriate box:
Are you currently taking prescribed medication(s)?
q Yes
q No
Go to Item 25
Go to Section 5
25 Enter from the prescription label the following information for all medications prescribed for you:
Name or type of medication, dosage, and frequency. For (example, Penincillin, 1.5 gram tablet, 3 times a day)
Name/Type
Section 5
Activities
26
27
Dosage ( Grams, Number of Pills, Etc.)
Frequency
Information About The Child’s Daily Activities
q Yes
q No
Enter an “X” in the appropriate box:
Do you attend a health or socialization center daily?
Enter the name, address, and
daytime telephone number of
the center.
Go to Item 28
NAME OF FACILITY (STREET, ADDRESS, CITY AND
STATE/PROVINCE, ZIP CODE)
Area Code
28
Go to Item 27
Telephone Number
Check the box after each activity listed below that best describes your ability to do that activity.
• EASY — I can easily do the activity.
• DIFFICULT - I can do the activity with difficulty.
• HARD — I can only do the activity with assistance.
• NOT AT ALL — I cannot do the activity without assistance.
• N.A. - Not applicable.
ACTIVITY
Difficult
q
q
q
q
q
q
q
q
q
q
q
q
q
q
q
q
q
q
q
q
q
q
q
q
q
Dressing (Tying Shoes,
Combing Hair, Etc.)
q
q
q q
q
Other Bodily Needs
q
q
q q
q
Indoor Chores (Meal
Preparation, Laundry,
Cleaning, Etc.)
q
q
q q
q
Outdoor Chores (Shopping,
Yardwork, Etc.)
q
q
q q
q
q
q
q
q
q q
q q
q
q
Conducting Personal
Business (Talking to and
Dealing with Other People)
q
q
q q
q
Reading English (For
example, newspapers
and magazines)
q
q
q q
q
Writing English (For example,
notes and letters)
q
q
q q
q
Sitting
Standing
Walking
Eating
Bathing
Driving a Motor Vehicle
Using Public Transportation
Hard
Not at
all
Easy
Page 5
N.A.
Explain each” DIFFICULT,” “HARD”
and “NOT AT ALL” answer
Form AA-19a (06-19)
Daily
Activities
(Cont.)
29 Describe your daily activities during a normal day (i.e. a typical day from the time you get up until you go to bed).
30 a
b
Enter an “X” in the appropriate box:
Do you perform any volunteer work?
(Volunteer work is any work performed without pay.)
d
31 a
b
d
Form AA-19a (06-19)
Go to Item 31
Average Hours Per Week
Enter an “X” in the appropriate box:
Does your condition(s) restrict your ability to perform
volunteer work?
q Yes
q No
Go to Item 30d
q Yes
q No
Go to Item 31b
Go to Item 31
Describe the changes.
Enter an “X” in the appropriate box:
Do you participate in social or recreational activities?
For example, clubs, traveling, exercise, indoor/outdoor
sports,hobbies/crafts, ect.
Go to Section 6
Describe the social or recreational activities that you participate in and enter the number of average hours
you participate per week.
Average Hours Per Week.
Activity
c
Go to Item 30b
Describe the volunteer work that you perform and enter the number of average hours you participate per
week.
Volunteer Work
c
q Yes
q No
Enter an “X” in the appropriate box:
Does your condition(s) restrict your participation in the
activities listed above?
Describe the changes.
Page 6
q Yes
q No
Go to Item 31d
Go to Section 6
Section 6
Schooling
and
Training
32
First School
33
Attended
Information About Your Education And Training
Enter an “X” in the appropriate box:
Have you ever attended any type of school (including
online) or received some type of special training?
q Yes
q No
Go to Item 33
Go to Section 7
NAME
Enter the name and address of the first
school you attended
STREET ADDRESS
CITY AND STATE/PROVINCE
ZIP CODE
Second
School
Attended
34
Describe the type of school or training.
35
Enter the dates you attended school or training.
If you are still in attendance at this school, draw a
line in the “To” boxes
36
Enter the highest level you achieved.
37
Enter the name and address
of the second school you
attended. If none, enter
“NONE” and go to Item 45.
From
Month
Year
To
Month
Year
To
Month
Year
SCHOOL’S NAME
STREET ADDRESS
CITY AND STATE/PROVINCE
ZIP CODE
38
Third
School
Attended
Describe the type of school or training.
39
Enter the dates you attended school or training.
If you are still in attendance at this school, draw a
line in the “To” boxes
40
Enter the highest level you achieved.
41
Enter the name and address of the third
school you attended. If none, enter
“NONE” and go to Item 45.
From
Month
Year
SCHOOL’S NAME
STREET ADDRESS
CITY AND STATE/PROVINCE
ZIP CODE
Page 7
Form AA-19a (06-19)
Third
School
Attended
(Cont.)
42
Describe the type of school or training.
43
Enter the dates you attended school or training.
If you are still in attendance at this school, draw a line
in the to “To” boxes
44
Enter the highest level you achieved
From
Month
To
Month
Year
Year
Note: If you attended more than three schools, complete Item 45 and
use Section 9 to discuss the other schools.
Problems
in School
45
Describe any special accommodations or assistance you received.
Section 7
Any Work
Most
Recent
Job
Information About Your Work Activities
46 Enter an “X” in the appropriate box:
Have you ever worked?
q Yes
q No
47 Enter the title of your most
recent job.
48 a Enter the employer’s name and address.
Go to Item 47
Go to Section 8
EMPLOYER’S NAME
b Describe the type of business.
STREET ADDRESS
CITY AND STATE/PROVINCE
c Is this a sheltered employment?
q Yes
q No
ZIP CODE
From
To
49
Enter the dates you worked at this job.
If you are still working at this job, draw a line
in the “To” boxes.
50
Enter the number of hours worked each week.
51
Describe your basic duties and responsibilities for the job. Include any difficulties you had
or have, performing the full range of duties.
52
Enter an “X” in the appropriate box:
Did your duties differ from those of other
workers with the same job title?
Month
Year
q Yes
q No
53
Describe how your duties differed from those of other worked with the same job title.
54
Describe the amount of supervision and assistance you received.
Form AA-19a (06-19)
Page 8
Month
Go to Item 53
Go to Item 54
Year
Most
Recent
Job
(Cont.)
55
Explain why you stopped working at this job. If you are still working, go to Item 56
Second
Most
Recent
Job
56
Enter the title of your second most recent job.
If none, enter “NONE” and go to Item 65
57
a
Enter the employer’s name and address.
b
Describe the type of business.
EMPLOYER’S NAME
STREET ADDRESS
CITY AND STATE/PROVINCE
c
Is this a sheltered employment?
q No
ZIP CODE
q Yes
From
Month
To
Month
58
Enter the dates you worked
at this job.
59
Enter the number of hours worked each week.
60
Describe your basic duties and responsibilities for the job. Include any difficulties you had or
have performing the full range of duties.
61
Enter an “X” in the appropriate box:
Did your duties differ from those of other
workers with the same job title?
Year
q Yes
q No
62
Describe how your duties differed from those of other workers with the same job title.
63
Describe the amount of supervision and assistance you received.
64
Explain why you stopped working at this job.
Year
Go to Item 62
Go to Item 63
Note: If you had more than two jobs, use Section 9 to discuss the other jobs.
Page 9
Form AA-19a (06-19)
Work for
an
Employer
65
This
Calendar
Year
66
Last
Calendar
Year
67
Self68
employment
Enter an “X” in the appropriate box:
Have you worked for pay for an employer
in the last 12 months?
(Do not include any “self-employment”.)
q Yes
q No
Go to Item 66
Go to Item 68
Enter your earnings, before any deductions, for each month you have already worked this year.
Then, starting with the current month, enter your expected gross earnings for that month and each
remaining month this year.
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
Enter your earnings, before any deduction, for each month last year.
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
Enter an “X” in the appropriate box:
Have you been self-employed in the last 12 months?
q Yes
q No
Go to Note and Item 69
Go to Item 71
Note: If answered “Yes,” also complete and return to the RRB
Form AA-4,Self Employment Questionnaire.
This
Calendar
Year
Last
Calendar
Year
69 Enter your earnings, before any deduction, this month and for each month you worked this year.
Then starting with the current month, enter your expected earnings for that month and each remaining
month this year.
70
71
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
Enter your earnings, before any deduction for each month last year.
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
Enter an “X” in the appropriate box:
Are you a corporate officer or owner/operator of a
corporation?
q Yes
q No
Go to Note and Item 72
Go to Item 72
Note: If answered “Yes,” also complete and return to the RRB Form G-252, Self-Employment/
Corporate Officer Work and Earnings Monitoring.
Work Next
12 Months
72 Enter an “X” in the appropriate box:
Do you expect to work during the next 12 months?
Include self-employment, if any.)
Form AA-19a (06-19)
Page 10
q Yes
q No
Go to Item 73
Go to Section 8
Work Next
12 Months
(Cont.)
73
Enter the name and address of the person or
company for whom you expect to work.
(If self-employed enter “Self”)
74 Enter the dates you expect to work.
(For example, “June and July,” “Indefinitely
Starting, ect.)
75 Enter the gross amount you expect to
earn. (If self-employed, enter the net
amount.)
Section 8 General Information
Filing AA-3,
AA-18, or
AA-19
76
Guardianship 77
Enter an “X” in the appropriate box:
Are you filing Form AA-3, Form AA-18,
or Form AA-19 at this time?
Enter an “X” in the appropriate box:
Has the court appointed a legal guardian for you?
78 Enter the name, address, and
daytime telephone number of
the court-appointed guardian.
q Yes
q No
Go to Item 87
q Yes
q No
Go to Item 78
Go to item 77
Go to item 80
EMPLOYER’S NAME
STREET ADDRESS
CITY AND STATE/PROVINCE
ZIP CODE
Area Code
Telephone Number
79 Enter the guardian’s relationship
to you.
Child’s
Marital
Status
Social
Security
Benefits
Criminal
Offense
80 Enter an “X” in the appropriate box:
Are you now, or were you previously,
married?
81 Enter the date you were married.
q Yes
q No
82 Enter an “X” in the appropriate box:
Are you still married?
q Yes
q No
83 Enter the date your marriage ended.
Month
84 Enter an “X” in the appropriate box:
Was your marriage annulled?
q
q
q
q
Month
85 Enter an “X” in the appropriate box:
Have you filed, or do you expect to file, for
monthly Social Security disability benefits or SSI?
86 Enter the Social Security claim number and suffix
under which you have filed or will file.
Go to Item 85
Day
Year
Go to Item 85
Go to Item 83
Day
Year
Yes
No
Yes
Go to Item 86
No
Go to Item 87
Suffix
87 Enter an “X” in the appropriate box:
Within the last 12 months, have you been imprisoned or given a
sentence of confinement due to a conviction for criminal offense?
q Yes
q No
88 Enter the date of the conviction.
Month
89 Enter an “X” in the appropriate box:
Is your disability related to the
commission of the criminal offense?
q Yes
q No
90 Enter the date of the sentence of
confinement.
Month
Page 11
Go to Item 81
Go to Item 88
Go to Item 96
Day
Year
Day
Year
Form AA-19a (06-19)
Criminal
Offense
Cont.
Month
91 Enter the date that confinement began.
92 Enter an “X” in the appropriate box:
Is your disability related to the confinement?
q Yes
q No
q Yes
q No
94 Enter an “X” in the appropriate box:
Has the confinement ended?
Month
95 Enter the date confinement ended.
Remarks
Year
q Yes
q No
93 Enter an “X” in the appropriate box:
During the confinement are you participating in a rehabilitation
program which is expected to result in the ability to engage in
gainful work within a reasonable time after release?
Section 9
Day
Go to Item 95
Go to Section 9
Day
Year
Remarks
96 This section is to be used for the continuation of answers to other items. Be sure to include the item number
at the beginning of the answer you wish to continue. You may also use this space to enter any additional
information that you feel may be important to include.
Form AA-19a (06-19)
Page 12
Certification
Section 10
Did you complete this application with the assistance of
an attorney or non-family member (RRB staff excluded)?
97 a
q Yes
q No
b
Enter the name and address of the attorney or non-family
member who assisted with completing this application.
c
Did you pay a fee to the attorney or non-family member
who assisted with completing of this application?
q Yes
q No
Enter an “X” in the appropriate box:
Will you have a guardian or other representive sign
this application on your behalf?
q Yes
q No
98
Go to Item 97b
Go to Item 98
Go to Note and Item 99
Go to Item 99
Note: If answered “Yes,” the guardian or other representative of the applicant must sign this application.
That person must also complete and return Form AA-5, Application for Substitution of Payee.
99
I Certify that the information I gave the Railroad Retirement Board (RRB) on this application is true to the
best of my knowledge. I know that if I make a false statement or withhold information in order to receive
benefits from the RRB, I am committing a crime under Federal law which may be punishable by fines,
imprisonment, or both. I have received and reviewed the booklet, RB-19a, Child’s Disability Benefits. I
understand that I am responsible for reporting events that would affect my annuity as explained in the booklet.
I agree to immediately notify the RRB:
• If I work for any employer, railroad or nonrailroad, or perform any self-employment work;
• If my condition improves;
• If I am confined in a jail, prison, penal institution, or correctional facility due to a conviction for a
criminal offense;
• If my address changes;
• If I marry;
• If an application is filed for social security benefits for me based on any person’s earning records;
• If my reported estimated earning amount changes;
I know that if I am receiving a disability annuity and fail to report work and earnings promptly, I am
committing a crime punishable by Federal law that may result in criminal prosecution and/or
penalty deductions in my annuity payments.
Signature
(First Name, Middle Initial,
Last Name)
Month
Day
Year
Date
100
If this certification is signed by mark (X) in Item 99, two witnesses who know the person signing must sign
below, giving their full address and daytime telephone number.
a. Signature of Witness
b. Signature of Witness
Address (Number and Street)
Address (Number and Street)
City, State/Province, and Zip Code
City, State/Province, and Zip Code
Daytime Telephone Number (include area code)
Daytime Telephone Number (include area code)
(
)
(
Page 13
)
Form AA-19a (06-19)
Section 11
How To Return Your Application
Before you return your application, check to make sure that:
X
Every question that applies to you has been answered.
X
You have entered “unknown” in any answer space for which you were unable to answer a question.
X
You have signed and dated the application.
X
You have included all the needed proofs listed in the letter you received with this application.
When you received your application, you should also have received a pre-addressed return envelope. If you do not
have this envelope, you can use any envelope as long as it is addressed to the RRB office shown on page 15 of this
application. No matter which envelope you use, you must put the correct postage on the envelope. Be careful to provide enough postage, because your application and the accompanying forms may weigh more than a standard letter.
The U.S. Postal Service will not deliver your application unless it has the correct postage.
Make one final check before you seal the envelope to ensure that the following are enclosed:
X
NEEDED PROOFS
X
THE APPLICATION FORM ITSELF
X
ADDITIONAL FORMS YOU WERE ASKED TO COMPLETE
Note: Make no entries on page 15, which is the receipt for your claim. After the RRB receives your application,
they will complete the blanks on the receipt and send it back to you. When it is returned to you, you will know
that the RRB has received your application and has started the work needed to determine if you are entitled to
benefits. If you do not receive the receipt within two weeks after you filed this application, please contact us so
we can find out what is causing the delay.
Important Notices
PAPERWORK REDUCTION ACT AND PRIVACY ACT NOTICES
The information asked for in this form is needed to determine your entitlement to benefits under the Railroad
Retirement Act. The RRB’s authority for requesting this information is Section 7(b)(6) of the Railroad Retirement Act.
We estimate that this form takes and average of 40 to 50 minutes per response to complete, including the time for
reviewing the instructions, getting the needed data, and reviewing the completed form. Federal agencies may not
conduct or sponsor, and respondents are not required to respond to, a collection of information unless it displays a
valid OMB number. If you wish send comments regarding the accuracy of our estimate or any other aspect of this
form, including suggestions for reducing the completion time, to: the Associate Chief Information Officer for Policy
and Compliance, Railroad Retirement Board, 844 North Rush Street, Chicago, IL 60611-1275.
COMPUTER MATCHING AND PRIVACY PROTECTION ACT NOTICE
The Computer Matching and Privacy Protection Act of 1988 requires the RRB to advise you that information you
have provided may be used, without your consent, in automated matching programs. These matching programs are
a computer comparison of RRB records with records kept by other Federal, state, or local governmental agencies.
Information from these matching programs can be used to establish or verify a person’s eligibility for federally funded
or administered benefit programs and for repayment of payments or delinquent debts under these programs.
Form AA-19a (06-19)
Page 14
Receipt For Your Claim
Employee’s Name
Applicant’s Name
Railroad Retirement Board Claim Number
Date Claim Received
Your application for railroad retirement disability benefits 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 claim, you or your representative should
report the change. The changes to be reported are listed below. Always give us your claim number when writing or calling
about your claim. If you have any questions about your claim we will be glad to help you. If you need to personally visit one
of our field offices, please call for an appointment. You will not be refused service if you do not have an appointment, but
our staff can serve you better when an appointment is made. Most offices are open to the public from 9:00 a.m. to 3:30
p.m., Monday, Tuesday, Thursday. and Friday and from 9:00 a.m. to 12:00 p.m. on Wednesday.
Always Report These Changes To The RRB
l
Work–If you perform work for any employer,
railroad or nonrailroad, or perform any selfemployment work.
l Social Security–If an application is filed for
social security benefits for you based on any
person’s earnings record.
l
Earnings–if you reported estimated earnings
and the amount changes.
l Address–If your address changes.
l
Improvement in your Condition–If your
condition improves and a doctor advises
you are able to work.
l
Marriage–If you marry.
l Criminal Offense–If you are confined in a jail,
prison, penal institution, or correctional facility
due to a conviction for a criminal offense.
How To Report Changes
When a change occurs after you become entitled to disability annuity, it should reported at once. You
or your representative can make the reports by telephone, mail, or in person, whichever you prefer.
To report any of the above changes, contact:
u
(
Telephone Number:
If for some reason you cannot contact that office, you should contact:
u
Form AA-19a (06-19)
U S RAILROAD RETIREMENT BOARD
844 N RUSH ST
CHICAGO IL 60611-1275
Page 15
| File Type | application/pdf |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |