AA-1 (Internet) Application for Employee Annuity

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Access Online Retirement Application

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U.S. Railroad Retirement Board

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.

it for processing. A partially completed application will be saved for 90 calendar days. After 90 days, if the
application has not been submitted, it will be deleted and you will need to start the application process again.

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Paperwork Reduction Act and Privacy Act Notices

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or not you are eligible to

government agencies. Information from these Matching programs can be used to establish or verify

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Informational Booklet RB-1, “Age and Service
Employee Annuity”

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Checklist

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Screen 5

Quick Access Bar (on all screens)

Private Pensions

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Screen 6

Step 1 – Employee Information

If your name was different at birth, enter that name

card?

See Screen 6a for "No" response

See Screen 6a for "Yes" response

See Screen 6b for dropdown choices

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Step 1 – Employee Information Input Values

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card?
card

Quebec
H3Z 2Y7
Canada

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Step 1 – Employee Information Input Values

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• States

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Step 2 – Information About Type of Annuity

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See Screen 7a
See Screen 7b

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Step 2 – Type of Annuity Input Values

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• “Full 60/30” or “Full Age” selected

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Screen 7b

Step 2 – Type of Annuity Input Values

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Step 3 – Employee’s Family Info

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Step 3 – Employee’s Family Input Values

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• Current Marital Status = “Married or Other”
(Answer "No" if your only

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Step 3 – Employee’s Family Input Values

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Step 3 – Add Family Member Input Values

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See Screens 8d and 8e
See Screens 8f and 8g
See Screen 8h
See Screen 8i. All "Child" screens except Screen 8j are the same.
child/Student

See Screen 8j.

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Step 3 – Female/Male Spouse

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See Screen 8e

See Screen 8e

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Step 3 – Male/Female Spouse Input Values

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Employee's Family Member Details

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Step 3 – Male/Female Spouse Input Values

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Employee's Family Member Details

State

Quebec
H3Z 2Y7
Canada

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Step 3 – Divorced Spouse

Screen 8g

See Screen 8h

See

en
Scre

8h

See Screen 8h

See Screen 8h
See Screen 8h

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Step 3 – Divorced Spouse Input Values

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Employee's Family Member Details
Marriage Began/Ended State

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Step 3 – Deceased Spouse

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Step 3 – Child

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Step 3 – Child

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Step 4 – Information About Your Railroad Work

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Row prefills once entire Screen
9a is completed.

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Step 4 – Railroad Employment Info Input

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this employer*

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Step 5 – Information About Your Nonrailroad Work

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."

See Screen 10a

-

See Screen 10b

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Step 5 – Nonrailroad Work Input Values

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ABD month.

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Screen 10b

Step 5 – Nonrailroad Work Input Values

See Screen 10c

Complete and return to the RRB, Form AA-4, Self-Employment and
Substantial Service Questionnaire.

-

See Screen 10c
See Screen 10c

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Step 5 – Nonrailroad Work Input Value

Screen 10c

See Screen 10d-f for all types

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Screen 10d

Step 5 – Nonrailroad Work Input Values

ZIP Code

See Screen 10e
See Screen 10e

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Step 5 – Nonrailroad Work Input Values

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Information About Your Nonrailroad Work

xxxxxxxxxxxxxxxxxxxxxxxx

Weekly
Bi-Weekly
Monthly
Yearly

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Step 5 – Nonrailroad Work – Self-Employment

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Company's State

ZIP Code

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Step 6 – Information About Your Earnings

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1, 2017?*

will be from only railroad employment before your date last worked, answer "No.") *

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Step 6 – Earnings for 2016 Input Values

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Information About Your Earnings

1, 2017?*

Prefills exempt amount.

that you did not earn more than the monthly earnings exempt amount from all

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Step 6 – Earnings for 2017 Input Values

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Information About Your Earnings

*

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Step 6 – Earnings for 2017 Input Values

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Information About Your Earnings

in 2017?
that you did not earn, or do not
expect to earn, more than the monthly earnings exempt amount.

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Step 6 – Earnings for 2018 Input Values

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Information About Your Earnings

will be from only
*

will be from only
*

that you expect to

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Step 7 – Information About Your Pay for Time Lost
and Sick Pay

*

Sick Pay

Screen 12

See Screen 12a

See Screen 12b

Did you receive or do you expect to receive sick pay under a railroad wage continuation plan (other
after the actual date you last worked for the

*

See Screen 12b

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Step 7 – Pay For Time Lost Input Values

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*
,"

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Step 7 Railroad Sick Pay Input Values

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Sick Pay

do you expect to receive sick pay under a railroad wage continuation plan (other
after the actual day you last worked for the

*

• Lawsuit Input Values
Sick Pay

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Step 8 Information About Garnishment, Criminal
Offense, and Deemed Current Connection

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See Screen 13a
? (NOTE: Reference to pension rights may be

See Screen 13b

on this application nonrailroad employment that could break your current connection?*

See Screen 13c

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Step 8 – Garnishment or Property Settlement
Input Values

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? (NOTE: Reference to

applies?

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Step 8 – Criminal Offense Input Values

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Step 8 Deemed Current Connection

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on this application nonrailroad employment that could break your current connection?*

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Step 9 – Information About Your Military Service

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See Screen 14a

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Step 9 – Military Service Input Values

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,

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Step 10 – Information About Your Social Security
Benefits

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See Screen 15a.
See Screen 15a.

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Step 10 –Social Security Benefits Input Values

benefits are based

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on whose earnings your social security

social security benefits are based

on whose earnings your

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Step 11 – Information About Your Noncovered Service
Pension

noncovered service pensions.

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Step 11 – Noncovered Service Pension Input Values

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Employer Infiormation About Your Noncovered Service Pension (NCSP)

Line prefills once all
questions in Step
11 are completed.

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Step 11 – Noncovered Service Pension Input Values

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See Screens 16c-e
See Screens 16f-g
See Screen 16h

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Step 11 – Lump-Sum Input

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See Screen 16d

-

-

lump-sum paid

See Screen 16e

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Step 11 – Lump-Sum Payment Input Values

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Employer Infiormation About Your Noncovered Service Pension (NCSP)

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Step 11 – Lump-Sum Payment Input Values

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Employer Infiormation About Your Noncovered Service Pension (NCSP)

lump sum paid

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Screen 16f

Step 11 – Recurring Payment Input

See Screen 16g1

See Screen 16g2

See Screen 16g3

See Screen 16g4 and 16g5 if "Yes" is selected

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Step 11 – Recurring Payment Input Values

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Employer Information About Your Noncovered Service Pension (NSCP)

2

1

3

4

5

rate 1

rate 2

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Step 11 – Recurring and Lump-Sum Input

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Step 11 – Recurring and Lump-Sum Input

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Employer Information About Your Noncovered Service Pension (NCSP)

Lump sum covers
period from

Lump sum covers
period to

lump sum

date the lump
sum

-

lump sum paid

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Step 12 – Information About Other Railroad
Retirement Annuity

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See Screen 17a

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Step 12 – Other Railroad Retirement Annuity Input
Values

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Railroad Retirement Claim Number

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Step 13 – Information About Private Pensions

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Private Pensions

Are you receiving or do you expect to receive a
recurring pension or lump-sum pension payment
from one or more railroad employers? *
*

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Step 13 – Private Pension Input Values

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Information About Private Pensions
Are you receiving or do you expect to receive a
recurring pension or lump-sum pension payment
from one or more railroad employers? *

See Screen 18b

private pension details

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Step 13 – Private Pension Input Values

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Private Pension Info

Select the correct option that
-

sum

-

See Screen 18c
See Screen 18d
See Screen 18e

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Step 13 – Private Pension Input Values

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Private Pension Info

Select the correct option that
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Is this pension based on a collective
bargaining (union) agreement? *

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Step 13 – Private Pension Input Values

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Private Pension Info

Select the correct option that

-

Is this pension based on a collective
bargaining (union) agreement? *

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Step 13 – Private Pension Input Values

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Private Pension Info

Select the correct option that
-

See Screen 18f

See Screen 18f
See Screen 18f
Is this pension based on a
collective bargaining (union)
agreement?

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Step 13 – Private Pension Input Values

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Private Pension Info
Select the correct option that
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Is this pension based on a
collective bargaining (union)
agreement?

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Step 14 – Information About Medicare – Under
Age 65

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Based on your date of birth you have not met the 64 years and 5 months of age requirement.
You can skip this step and proceed to the next step.

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Step 14 – Information About Medicare – Age 65 or
Over

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Based on your date of birth you meet the 64 years and 5 months of age requirement.
Please read Part VI of the RB-1 booklet for an explanation of the Medicare program.

See Screen 19b

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Step 14 – Information About Medicare Input Values

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Step 14 – Information About Medicare Input Values

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See Screen 19d for "Yes"
Note: You understand that by selecting "No" you are electing not to enroll in Part B and that the
premium rate may be higher if you do enroll later in Part B.

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Step 14 – Information About Medicare Input Values

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Note: You understand that by selecting "No" you are electing not to enroll in Part B and that the
premium rate may be higher if you do enroll later in Part B.

Note: You understand that by selecting "No" you are electing not to enroll in Part B and that the
premium rate may be higher if you do enroll later in Part B.

See Screen 19e for "Yes"

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Step 14 – Information About Medicare Input Values

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Information About Medicare
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

a Special Enrollment Period?

See Screen 19f

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Step 14 – Information About Medicare Input Values

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a Special Enrollment Period?

a Special Enrollment Period?

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Step 15 – Receiving your Payments

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See Screen 20a

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Step 15 – Payments Input Values

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Step 16 – Summary

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Step 16 – Summary, continued

Private Pensions

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Certification

,"

See Attachment 22A

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Attachment 22A
I understand that my application will be signed electronically when I select the “Submit” box. I also understand that my electronic signature means that I intend to file for an annuity and
have provided accurate information. The information I provided will be used to process my application.
I certify that the information I have given to the Railroad Retirement Board (RRB) in relation to this application is true to the best of my knowledge. I know that if I make a false or
fraudulent 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 reviewed the booklets RB-1, Age and Service Employee Annuity, and RB-9, Employee and Spouse Annuities - Events that Must be Reported. I understand that I am
responsible for reporting events that would affect my annuity as explained in the booklets. Failure to report any of the events listed below or other events that may affect my annuity
may result in a penalty deduction from my annuity, as well as criminal and/or civil prosecution.
I agree to immediately notify the RRB, if

Railroad Work – I return to work for a railroad or railroad labor organization or return to work in any capacity in the railroad industry.

Railroad Work – I change the date I will cease working for current railroad employer.

Social Security – I file for social security benefits based on any person’s earnings record.

Social Security – Benefits I receive directly from the Social Security Administration are adjusted for a reason other than normal cost-of-living increases.

Public Pension – I receive a lump-sum payment or begin to receive a pension based on earnings not covered by the Social Security Administration or the Railroad Retirement
Board.

Pension – I receive a lump-sum payment or begin to receive a monthly pension from my railroad employer.

Other Benefits – I begin to receive worker’s compensation or a public disability benefit.

Settlement – I receive a settlement with credit for railroad service as “pay-for-time-lost” for months after the last day I worked for a railroad employer.

Employment – There is a change in my status with my last nonrailroad employer.

Employment – I perform work, including self-employment, for a family owned, controlled or managed business, including a business operated, managed or owned by me, a
family member, friend or close associate, whether for pay or not, and without regard to how the business is organized (e.g., sole proprietorship, partnership, corporation, LLC,
etc.).

Employment – I become a corporate officer of, own or operate a corporation (including a corporation owned by a family member or friend), whether for pay or not.

Employment – I receive anything of value in lieu of salary or wages for any work that I performed.

Earnings – I work for any employer or perform any self-employment work.

Earnings – My earnings for this year change.

Address – My address changes, even if my payments are sent to a financial organization.

Bank Account – My financial organization or the account number at my financial organization changes.

Criminal Offense – I am confined in a jail, prison, penal institution, or correctional facility due to a conviction for a criminal offense.

Spouse – My spouse who is receiving a benefit dies or our marriage ends in divorce or annulment.

Child – A qualifying child marries or leaves my custody or residence.
If you are not 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:






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.

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. You can contact our local office at 877-772-5772. Most Railroad
Retirement Board offices are open to the public from 9:00 AM to 3:30 PM, Monday, Tuesday, Thursday, Friday and 9:00 AM to 12:00 PM Wednesday.
When you select “Submit”, you will be sending this completed application electronically to the Railroad Retirement Board. Please make sure that everything is correct. You will not
be able to change the information once the application is submitted.

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Confirmation and Printing

application?

application?

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