from a railroad employer, a railway labor organization, or any Board office. An application for sickness benefits (Form SI-1a) and the required statement of sickness (Form SI-1b) may be mailed to any office of the Board (see Part 335 of this chapter). It is important that a statement of sickness be filed promptly, for no day can be considered as a day of sickness unless a statement of sickness with respect to such day is filed at an office of the Board within ten days. The application and statement of sickness are forwarded to a regional office where they are examined. If it appears that the employee is entitled to benefits, the regional office will send him a 1 claim form covering a 14-day registration period, and a pay rate report (Form SI-1d). The employee completes the forms, indicating on the claim form the days during the period he claims as days of sickness and returns both forms to the regional office I to which the claim form is pread

dressed. When additional medical in1formation is needed, a form for supplemental doctor's statement is sent to the employee. This should be filled out by a doctor and returned to the Board.

(5) Maternity benefits must be applied for on a form prescribed by the Board. A statement of maternity sickness, executed by a person authorized to execute statements of sickness (see Part 335 of this chapter), is required also. The necessary forms may be obtained from a railroad employer, a railway labor organization, or any Board office. An application for maternity benefits (Form SI-101) and the statement of maternity sickness (Form SI-104) may be filed in person or by mail with any Board office. It is important that the statement of maternity sickness be filed promptly since no day can be considered as a day of sickness in a maternity period unless a statement of maternity sickness with respect to the day is filed at an office of the Board within ten days. As in the case of claims for sickness benefits, the forms are forwarded to a regional office. Claim forms are mailed to the claimant and are pre-addressed for return to the regional office.

(6) Whether benefits are payable to a claimant and, if so, the amount, of benefits payable, is determined with respect to claims for unemployment, sickness, and maternity benefits, by the regional office. The names and addresses of claimants to whom benefits are found payable, and the amounts payable to them, are certified to the local disbursing office of the Treasury Department which mails the benefit checks to the claimants. If a claim is denied in whole or in part, an explanation is given to the claimant by letter.

(7) The rate at which benefits are payable is determined from the claimant's railroad wages earned in a base year period or from his daily pay rate for his last railroad employment in the base year period, whichever will result in the higher benefit rate. His daily benefit rate will be at least 60 per centum of his daily pay rate for his last railroad employment in the base year period, but not exceeding $10.20.

(8) Any qualified employee whose claim for benefits under the Railroad Unemployment Insurance Act has been denied in whole or in part may, within one year from the date such denial is communicated to him, appeal from the initial determination, and such appeal will be heard before an impartial referee. An unsuccessful claimant in an appeal before such referee may appeal to the Board. (For further details of appeals procedure by claimants for benefits and for appeals procedure by employers, see Parts 319 and 320 of this chapter.)

Any claimant, or any railway labor organization organized in accordance with the provisions of the Railway Labor Act, of which the claimant is a member, or any other party aggrieved by a final decision pursuant to the Railroad Unemployment Insurance Act, may, only after ail administrative remedies within the Board will have been availed of and exhausted, obtain a review of such final decision of the Board by filing a petition for review within 90 days after the mailing of notice of such decision to the claimant or other party, or within such further time as the Board may allow, in the United States court of appeals for the circuit in which the claimant or other party resides or will have had his prin

cipal place of business or principal executive office, or in the United States Court of Appeals for the Seventh Circuit, or in the United States Court of Appeals for the District of Columbia Circuit.

(c) Current compensation and service records. Current compensation and service records are maintained by the Bureau of Data Processing and Accounts. These records are obtained from reports made periodically on either a quarterly or annual basis by employers and employee representatives. General instructions in this regard may be found in Part 250 of this chapter. Special instructions to employers and employee representatives are issued from time to time by the Director of Data Processing and Accounts.

(d) Collection of contributions. The Office of Budget and Fiscal Operations acts as the collecting agency of the Board in receiving contributions due under the Railroad Unemployment Insurance Act. Contributions are, with some few exceptions, due quarterly and with the payment, the employer must file a report, Form DC1, Employers Quarterly or Annual Report of Contributions under the Railroad Unemployment Insurance Act. (For further details see Part 345 of this chapter.)

(e) Employment service. Employers needing workers may avail themselves of the Board's employment service by making requests of any field office for referrals, in writing, on forms provided by the Board, or by telephone.

[15 FR 6752, Oct. 6, 1950, as amended at 21 FR 4808, June 29, 1956; Board Order 62-115, 27 FR 9254, Sept. 19, 1962; Board Order 6767, 32 FR 9064, June 27, 1967; 41 FR 22557, June 4, 1976]

§ 200.2 Designation of forms and instructions.

(a) Following are the forms to be used by applicants, employers and others, together with a description of each form and instructions for each. Subparagraphs (1) through (31) of this paragraph describe the basic forms to be used in filing applications for benefits under the retirement act, the report forms required of beneficiaries, and the related appellate forms.

Paragraphs (a)(32) through (34) of this section describe the forms used in registration of railroad employees and the crediting of service months and wages to their accounts. Paragraphs (a)(35) through (44) of this section describe the compensation and contribution report forms to be used by railroad employers and national-labor organization "employers." Paragraphs (a)(45) through (59) of this section describe the basic application, claim and report forms to be used in applying for benefits under the unemployment insurance act, and related appellate forms. Forms may be secured upon application in person or by mail at any of the Board's offices.

(1) Form AA-1, Application for Employee (Age and Service) Annuity Under The Railroad Retirement Act. This form must be executed by each individual who wishes to file claim for an employee annuity under the Railroad Retirement Act on a basis other than disability. Information to be included on the form consists of data required to identify the employee on the records of the Board and on the employer's payroll or other records; a statement as to whether or not credit for military service is claimed; statements as to his marital status and whether he has children under age 18 or disabled; and the date on which the individual wishes to have the annuity begin. Form AA-1 must be signed by the individual in accordance with § 210.4 of this chapter.

(2) Form AA-1a, Request for Supplemental Information When Annuitant or Pensioner Attains Age 65. This form is used when supplemental information is requested. Information requested includes the claimant's social security account number, his marital status in some detail, and whether he has children who are under age 18 or disabled.

(3) Form AA-1b, Application for Recomputation of Employee Annuity Under the Railroad Retirement Act. This form is for use of annuitants who wish to apply for a recomputation of an annuity to include service rendered after the annuity beginning date.

(4) Form AA-1d, Application for Employee (Disability) Annuity Under the Railroad Retirement Act. This form

must be executed by each individual who wishes to file claim for an employee annuity under the Railroad Retirement Act on the basis of disability. Information to be included on the form consists of data required to identify the employee on Board and employer records; his work history; answers to questions about his disabilities; statements as to his marital status and children under age 18 or disabled; and the date on which the individual wishes to have the annuity begin. This form is also an application to establish a period of disability under the guaranty provisions.

(5) Form AA-1ƒ, Application to Establish Period of Disability. This form is to be executed by an individual whose claim for a period of disability was denied when he filed Form AA-1d, Application for Employee (Disability) Annuity. Should his physical condition retrogress to the point where he could be considered disabled under the | Social Security Act, he may file this form to secure a new decision on his claim for a period of disability to increase employee, spouse, or insurance annuities under the guaranty provisions.

(6) Form AA-3, Application of Wife for Spouse's Annuity. This form must be executed by the wife of an annuitant in filing claim for a spouse's annuity under the Railroad Retirement Act. The form requires information 1 needed to determine a wife's eligibility for a spouse's annuity.

(7) Form AA-3a, Supplement to Application for Wife's Annuity. This form is to be completed by a wife, who has filed a claim for a spouse's annuity, to provide supplemental information to enable the Board to determine if the wife may have eligibility on the basis of having in her care a disabled child who is 18 years of age or older.

(8) Form AA-4, Application of Husband for Spouse's Annuity. This form must be executed by the husband of a female annuitant in filing claim for a spouse's annuity under the Railroad Retirement Act. This form requires information required by the Board to determine a husband's eligibility for a spouse's annuity.

(9) Form AA-5, Application for Substitution of Payee for Employee or

Spouse Annuitant. This form is to be used where a guardian or other legal representative is appointed, or a substitute payee under section 19(a) of the Railroad Retirement Act is requested, for an employee or a spouse after the award of an annuity to him or her. The form requires information needed to show the authority of the legal representative, or the basis for recognizing the substitute payee to receive payment on behalf of the employee or the spouse and requires the signature of the person applying. The form also lists the conditions under which an annuity is not payable and includes a form of agreement concerning the payment of the annuity and for the reporting of events which would affect such payment.

(10) Form AA-11a, Designation or Change of Beneficiary. This is a form prescribed in accordance with subsection (f)(2) of section 5 of the Railroad Retirement Act, as amended, on which an individual who was an employee after December 31, 1936, may designate the person or persons whom he wishes to receive any death benefits payable under such paragraph. The form is also to be used to change a designation of beneficiary made on a Form AA-11a previously filed with the Board. It must be signed by the individual and witnessed by two persons who are not designated on the form as beneficiaries.

(11) Form AA-17, Application for Widow's or Widower's Insurance Annuity. This is the form of application for insurance annuity and lump-sum benefits by the widow or widower of a deceased employee; it may be considere l as an application also for any insurance benefits payable under Title II of the Social Security Act as amended.

(12) Form AA-17a, Application for Widow's or Widower's Insurance Annuity. This form is to be used where an applicant for widow's or widower's insurance annuity has previously filed an application for a lump-sum death payment, a widow's current insurance annuity, or a spouse's annuity; it may be considered as an application also for any insurance benefits payable under Title II of the Social Security Act as amended. Where the applicant

has not previously filed an application for a spouse's annuity, lump-sum death payment, or widow's current insurance annuity, Form AA-17 is to be filed.

(13) Form AA-18, Application for Widow's and Child's Insurance Annuities. This is the form of application for insurance annuity benefits by the widow on her own behalf and on behalf of the children of a deceased employee; it may be considered as an application also for any insurance benefits payable under Title II of the Social Security Act as amended.

(14) Form AA-19, Application on Behalf of Child for Child's Annuity. This is the form of application for insurance annuity benefits on behalf of a child; it may be considered as an application also for any insurance benefits payable under Title II of the Social Security Act as amended.

(15) Form AA-19a, Supplement to Application for Widow's and/or Child's Insurance Annuity. This form is to be used in providing information to permit the Board to determine whether a child age 18 or older, who is alleged to be disabled would meet the eligibility requirements for a child's insurance annuity, other than that of disability. A widow caring for a disabled child age 18 or over, and claiming initial entitlement on that basis, or a widow claiming continued entitlement on the same basis, is to use this form.

(16) Form AA-20, Application for Parent's Insurance Annuity. This is the form to be used in applying for parent's insurance annuity benefits; it may be considered as an application also for any insurance benefits payable under Title II of the Social Security Act as amended.

(17) Form AA-21, Application for Lump-Sum Death Payment and Annuities Unpaid at Death. This is the form of application for lump-sum death payments due with respect to an employee's death and for annuities due the employee but unpaid at his death and may be considered as an application also for any insurance benefits payable under Title II of the Social Security Act as amended.

(18) Form AA-21a, Application for Survivor Benefits Due Estate. This

form is to be used in applying for benefits due an estate when there is no formal administration or there is formal administration but there are no known heirs or part of the funds would escheat. It may also be considered as an application for any insurance benefits payable under Title II of the Social Security Act as amended.

(19) Form AA-22, Application for Substitution of Payee for Survivor Annuitant. This form is to be used, in applying for payment of a survivor annuity previously awarded, by either a legal representative of a survivor annuitant or a person requesting to be recognized under section 19(a) of the act as a substitute payee of the annuity of such annuitant.

(20) Form AC-1, Appeal from Initial Decision of Bureau of Retirement Claims. This is a form prescribed for filing of an appeal from an initial decision of the Bureau of Retirement Claims with respect to a determination made by that Bureau in connection with an application for annuity or death benefits in accordance with § 260.2 of this chapter.

(21) Form AC-2, Appeal from Decision of the Referee. This is the form prescribed for filing an appeal from a decision of the referee with respect to a determination made in connection with an application for annuity or death benefits in accordance with §§ 260.3 and 260.4 of this chapter.

(22) Form G-19, Declaration of Person Receiving Annuity Payments Under The Railroad Retirement Act. This form is to be completed by beneficiaries in foreign countries to provide information of work and earnings which might affect payment of benefits. It is released through the Department of State to all survivor annuitants, all retirement and spouse annuitants whose annuities have been increased under the Social Security Act minimum provision of the Act, and all disability annuitants under age 65, who reside outside of the United States.

(23) Form G-19a, Report to U.S. Railroad Retirement Board of Earnings in Prior Calendar Year and Estimate of Earnings for Current Calendar Year. This form is to be completed by employee and survivor annuitant, with

some few exceptions, to provide information on work and earnings which might affect payment of benefits. The form is released annually.

(24) Form G-89, Authority for Change of Effective Date. This is the form to be used by an applicant for a retirement annuity to authorize a change in or clarifying his annuity beginning date, or to set a beginning date upon reinstating a cancelled application. The form must be signed before and by two witnesses.

(25) Form G-126, Election to Receive a Residual Payment Instead of Future Monthly Insurance Benefits Based on Service Under the Railroad Retirement Act. This form is to be used by a widow or parent to make an irrevocable election, under section 5(f)(2) of the Railroad Retirement Act of 1937, as amended, to receive the lump sum payment provided by that section in lieu of future monthly benefits which might otherwise become payable.

(26) Form G-129, Waiver of Annuity or Pension Under the Railroad Retirement Act. This form is to be used by annuitants or pensioners under the Railroad Retirement Act who wish to waive payment of all or part of their benefits in accordance with section 20 of the act as amended.

(27) Form G-130, Waiver of All Claims Against the Estate of a Deceased. This form is to be used by an individual desiring to waive a claim against an estate to permit the payment of benefits under the Railroad Retirement Act to the estate without the requirements of formal administration (see Part 236 of this chapter). In executing the form the individual waives all of his claim against the estate and releases and discharges the United States and the Railroad Retirement Board from any and all obligations by reason of payment to the estate of the full amount due.

(28) Form G-131, Authorization of Payment and Release of All Claims to Death Benefits and Annuity Payments. This form is to be used by an individual entitled to share in a benefit payable under the Railroad Retirement Act to an estate, to authorize payment to some person.

(29) Form G-339, Wife's Election to Have Her Wife's Annuity Reduced

When She Becomes Eligible for Such Annuity and Until Such Eligibility to Permit an Increase in Employee's Retirement Annuity. This form is to be used by a wife who, in order to increase the amount of her husband's annuity to the amount both would receive under the minimum guarantee provisions of the act, elects to have her annuity reduced when she becomes eligible.

(30) Form G-340, Husband's Statement in Connection with Wife's Election to Have Her Wife's Annuity Reduced When She Becomes Eligible for Such Annuity. This form is to be used by the husband of the wife who submits Form C-339 to show that he understands the effect of his wife's election to have her annuity reduced.

(31) Form G-661, Appeal From Decision Concerning Creditability of Service. This form is prescribed for filing an appeal from an initial decision of the Bureau of Retirement Claims with respect to a determination by that bureau that service claimed in connection with an application for annuity is not creditable because the employer is not covered by the Railroad Retirement Act.

(32) Form CER-1, Employee Registration. This form must be executed by each individual entering, for the first time, employment covered by the Railroad Retirement and Railroad Unemployment Insurance Acts and is to be forwarded to the Board through the employer. The identifying information included on this form is for the purpose of enabling the Board to assign the individual an account number and to establish an individual account to which service and compensation under the Acts may be credited.

(33) Form BA-6, Certificate of Service Months and Wages. This form, which notifies employees of the retirement and unemployment insurance credits established in their accounts, is to be submitted when filing for unemployment, sickness or maternity benefits.

(34) Form G-70, Protest of Record of Service Months and Wages. This form is to be used by an employee in protesting the Board's record of his service months and wages, unless he is applying for benefits under the Railroad