OMB control number
Medical Reports
OMB 3220-0038 ยท RRB.
OMB 3220-0038
The Railroad Retirement Act provides disability annuities for qualified railroad employees whose physical or mental condition renders them incapable of working in their regular occupation (occupational disability) or any occupation (total disability). The medical reports obtain information needed for determining the nature and severity of the impairment.
The latest form for Medical Reports expires 2027-01-31 and is listed under ICR 202312-3220-002.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form G-3EMP Medical Reports | Form and Instruction |
 Form G-197 Authorization to Disclose Information to the Railroad Retirement Board | Form and Instruction |
| Form RL-11D Medical Reports | Form and Instruction |
| 3220-0038 .docx | Supporting Statement A |
| SSA-4734-F4-SUP (08-85).pdf | Supplementary Document |
| SSA-827 (11-12).pdf | Supplementary Document |
 Medical Reports |
Form and Instruction |
| Authorization to Disclose Information to the Railroad Retirement Board |
Form and Instruction |
| Medical Reports |
Form and Instruction |
All Historical Document Collections
OMB Details
Medical Reports
Federal Enterprise Architecture: Income Security - General Retirement and Disability
| Form | Name | Electronic access | Type |
|---|---|---|---|
| Form G-250 | Medical Assessment | Paper Only | Form and instruction |
| Form RL-250 | Request for Medical Assessment | Paper Only | Form and instruction |
| Form RL-11B | Disclosure of Hospital Medical Records | Paper Only | Form and instruction |
| Form G-260 | Report of Seizure Disorder | Paper Only | Form and instruction |
| Form G-250A | Medical Assessment of Residual Functional Capacity | Paper Only | Form and instruction |
| Form G-3EMP | Report of Medical Condition by Employer | Paper Only | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.