G-88a2 (10-10) - Notice Of Retirement And Request For Service Needed For Eligibility
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1United States of America
Form Approved
Railroad Retirement Board
OMB No. 3220-0005
Section 1 – Identifying Information
Notice of Retirement and
1.
Social Security No.
Request for
Service Needed for Eligibility
2.
Name of Employee
3.
4.
5.
6.
Railroad Name and Address
BA No.
Payroll Number
Job Title
7.
8.
9.
Work Location
Dept. or Div.
RRB Filing Date
10.
11.
Date Last Worked or
Date Rights
12.
Date Released
Paid for Time Lost
Relinquished
(If applicable)
Facsimile Number:
Paperwork Reduction Act Notice
The Railroad Retirement Board's (RRB) authority for requesting this information is Section 7(b)(6) of the Railroad Retirement Act
(RRA) (45 U.S.C. 231f(b)(6)). The information requested is used by the RRB to determine your employee’s eligibility for a retirement
annuity under Section 2 of the RRA (45 U.S.C. Sec. 231a.)
We estimate this form takes an average of 5 minutes per response, 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 any comments regarding the
accuracy of our estimates or any other aspect of this form, including suggestions for reducing the completion time, to the Chief of
Information Resources Management, Railroad Retirement Board, 844 North Rush Street, Chicago, IL 60611-2092.
Section 2 - Employer Instructions
This employee filed an application for an annuity and has informed the RRB that (s)he relinquished employment rights (if applicable)
and stopped working on the date shown in Item 10.
• Complete Item 13 below only if the date in Item 10 differs from the date on your records.
• Always complete Items 14 and 16.
• Fax this form to (312) 751-7192 or mail it to the U.S. Railroad Retirement Board, Retirement Benefits Division, 844 North Rush
Street, Chicago IL 60611-2092, within 10 days of the date released by the RRB. The employee cannot be awarded an
annuity until we receive this information.
IMPORTANT NOTE: This employee’s service months and compensation must also be included on your Form BA-3, Annual Report
of Creditable Compensation. If you have any questions, refer to the “Reporting Instructions to Employers” or telephone the Quality
Reporting Service Center at (312) 751-4992.
Month
Day
Year
13. Date Last Worked or Paid for Time Lost on Your Records
14. Indicate with an “X,” months the employee had service. The “Current Year” refers to the year shown in Item 10. “Prior Year” is
the year before. If this form will be submitted before your annual report for the prior year, complete items about the prior year
as well. Do not report service months after the date in Item 11.
J
F
M
A
M
J
J
A
S
O
N
D
TOTAL MONTHS
Current Year
Prior Year
15. REMARKS
Section 3 - Employer Certification
16. I understand that civil and criminal penalties can be imposed against me for false or fraudulent statements or for withholding
information to misrepresent a fact material to determining a right to payment under the Railroad Retirement Act. I certify that,
to the best of my knowledge, the information which I have given is true, complete, and correct.
Signature of Certifying Officer
Date
Title of Certifying Officer
Telephone No.
(
)
Facsimile No.
E-Mail Address
(
)
NOTE: IF EMPLOYEE RETURNS TO COMPENSATED SERVICE NOTIFY THE RRB IMMEDIATELY.
G-88A2 (10-10)
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