UNITED STATES OF AMERICA
FORM APPROVED
RAILROAD RETIREMENT BOARD
OMB NO. 3220-0008
ANNUAL REPORT OF CREDITABLE COMPENSATION
(SEE INSTRUCTIONS FOR COMPLETING AND MAILING THIS FORM ON REVERSE SIDE)
The information contained in this report, which is required by law under Section 9 of the Railroad Retirement Act (RRA) and Section 6 of the Railroad Unemployment Insurance Act (RUIA), is needed to pay RRA and RUIA benefits.
Failure to report or the making of a false or fraudulent report can result in criminal prosecution or civil penalties, or both
This report is due at the Railroad Retirement Board by no later than the last day of February.
.
FORM G-440, REPORT SPECIFICATIONS SHEET, MUST ACCOMPANY THIS FORM.
1. YEAR
2. EMPLOYER BA NO.
3. PAYROLL NO.
4. PAGE NO.
5a. CORPORATE NAME OF EMPLOYER
5b. OTHER NAME, IF ANY
6.
7.
8.
9.
10.
11.
12.
EMPLOYEE
RUIA COMPENSATION
CREDITABLE SERVICE MONTHS
RRA COMPENSATION
EMPLOYEE
LAST
NAME
a.
b.
a.
b.
c.
d.
SOCIAL
TOTAL
DAILY
MAXIMUM
J
F
M
A
M
J
J
A
S
O
N
D
(Last Name;
CREDITABLE
SECURITY
SM
PAY
BENEFIT
A
E
A
P
A
U
U
U
E
C
O
E
TIER I
TIER II
MISCELLANEOUS
SICK PAY
First Name; and
AMOUNT
NUMBER
N
B
R
R
Y
N
L
G
P
RATE
AMOUNT
T
V
C
Middle Initial)
For RRB
21-29
30-65
66-72
75-81
84-95
96-97
98-105
108-115
125-132
135-142
118-122
Use Only
13. RECORD
14. Enter the compensation total amounts below. Include a decimal point and two digits representing cents ($$$$$$.¢¢).
COUNT
8a
RUIA C
reditable Amount
8b
RUIA Ma
ximum Benefit Amount
11a RRA Tier I
11b
RRA
Tier II
11c RRA Miscellaneous
11d
RRA Si
ck Pay
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Form BA-3 (01-08)