Page images

(13) Form AA-18, Application for (19) Form AA-22, Application for SubWidows and Child's Insurance An stitution of Payee for Survivor Annuities. This is the form of application nuitant. This form is to be used, in apfor insurance annuity benefits by the plying for payment of a survivor annuity widow on her own behalf and on behalf previously awarded, by either & legal of the children of a deceased employee; representative of a survivor annuitant or it may be considered as an application a person requesting to be recognized unalso for any insurance benefits payable der section 19(a) of the act as a subunder Title II of the Social Security Act stitute payee of the annuity of such as amended.

annuitant. (14) Form AA-19, Application on (20) Form AC-1, Appeal from Initial Behalf of Child for Child's Annuity. Decision of Bureau of Retirement Claims. This is the form of application for insur This is a form prescribed for filing of an ance annuity benefits on behalf of a appeal from an initial decision of the child; it may be considered as an appli Bureau of Retirement Claims with recation also for any insurance benefits spect to a determination made by that payable under Title II of the Social Bureau in connection with an application Security Act as amended.

for annuity or death benefits in accord(15) Form AA-19a, Supplement to ance with § 260.2 of this chapter. Application for Widow's and/or Child's (21) Form AC-2, Appeal from DeciInsurance Annuity. This form is to be sion of the Referee. This is the form used in providing information to permit prescribed for filing an appeal from a the Board to determine whether a child decision of the referee with respect to a age 18 or older, who is alleged to be dis determination made in connection with abled would meet the eligibility require an application for annuity or death ments for a child's insurance annuity, benefits in accordance with $ $ 260.3 and other than that of disability. A widow 260.4 of this chapter. caring for a disabled child age 18 or over, (22) Form G-19, Declaration of Perand claiming initial entitlement on that son Receiving Annuity Payments Under basis, or a widow claiming continued The Railroad Retirement Act. This form entitlement on the same basis, is to use is to be completed by beneficiaries in this form.

foreign countries to provide information (16) Form AA-20, Application for of work and earnings which might affect Parent's Insurance Annuity. This is the payment of benefits. It is released form to be used in applying for parent's through the Department of State to all insurance annuity benefits; it may be survivor annuitants, all retirement and considered as an application also for spouse annuitants whose annuities have any insurance benefits payable under been increased under the Social SecuTitle II of the Social Security Act as rity Act minimum provision of the Act, amended.

and all disability annuitants under age (17) Form AA-21. Application for 65, who reside outside of the United Lump-Sum Death Payment and An States. nuities Unpaid at Death. This is the (23) Form G-19a, Report to U.S. Railform of application for lump-sum death road Retirement Board of Earnings in payments due with respect to an em Prior Calendar Year and Estimate of ployee's death and for annuities due the Earnings for Current Calendar Year. employee but unpaid at his death and This form is to be completed by employee may be considered as an application also and survivor annuitant, with some few for any insurance benefits payable under exceptions, to provide information on Title II of the Social Security Act as work and earnings which might affect amended.

payment of benefits. The form is rea (18) Form AA-21a, Application for leased annually. Survivor Benefits Due Estate. This form (24) Form G-89, Authority for Change is to be used in applying for benefits of Effective Date. This is the form to due an estate when there is no formal be used by an applicant for a retirement administration or there is formal admin annuity to authorize a change in or istration but there are no known heirs or clarifying his annuity beginning date, or part of the funds would escheat. It may to set a beginning date upon reinstating also be considered as an application for a cancelled application. The form must any insurance benefits payable under be signed before and by two witnesses. Title II of the Social Security Act as (25) Form G-126, Election to Receive amended.

Residual Payment Instead of Future


Monthly Insurance Benefits Based on (31) Form G-661, Appeal From DeciService Under the Railroad Retirement sion Concerning Creditability of Service. Act. This form is to be used by a widow This form is prescribed for filing an apor parent to make an irrevocable elec peal from an initial decision of the Bution, under section 5(f) (2) of the Rail reau of Retirement Claims with respect road Retirement Act of 1937, as amended, to a determination by that bureau that to receive the lump sum payment pro service claimed in connection with an apvided by that section in lieu of future plication for annuity is not creditable bemonthly benefits which might otherwise cause the employer is not covered by the become payable.

Railroad Retirement Act. (26) Form G-129, Waiver of Annuity (32) Form CER-1, Employee Regisor Pension Under the Railroad Retire tration. This form must be executed by ment Act. This form is to be used by each individual entering, for the first annuitants or pensioners under the Rail time, employment covered by the Railroad Retirement Act who wish to waive road Retirement and Railroad Unempayment of all or part of their benefits ployment Insurance Acts and is to be in accordance with section 20 of the act forwarded to the Board through the emas amended.

ployer. The identifying information in(27) Form G-130, Waiver of All cluded on this form is for the purpose Claims Against the Estate of a Deceased. of enabling the Board to assign the inThis form is to be used by an individual dividual an account number and to esdesiring to waive a claim against an es tablish an individual account to which tate to permit the payment of benefits service and compensation under the Acts under the Railroad Retirement Act to may be credited. the estate without the requirements of (33) Form BA-6, Certificate of Service formal administration (see Part 236 of Months and Wages. This form, which this chapter). In executing the form the notifies employees of the retirement and individual waives all of his claim against unemployment insurance credits estabthe estate and releases and discharges lished in their accounts, is to be subthe United States and the Railroad Re mitted when filing for unemployment, tirement Board from any and all obliga sickness or maternity benefits. tions by reason of payment to the estate (34) Form G-70, Protest of Record of of the full amount due.

Service Months and Wages. This form (28) Form G-131, Authorization of is to be used by an employee in protestPayment and Release of All Claims to ing the Board's record of his service Death Benefits and Annuity Payments. months and wages, unless he is applying This form is to be used by an individual for benefits under the Railroad Unem. entitled to share in a benefit payable un ployment Insurance Act. This form der the Railroad Retirement Act to an provides for showing the employee's estate, to authorize payment to some claim of the amount of wages he earned person.

in each month of the year or years, the (29) Form G-339, Wife's Election to name of the employer from which they Have Her Wife's Annuity Reduced When were earned, and the place of employShe Becomes Eligible for Such Annuity ment. and Until Such Eligibility to Permit an (35) Form BA-3, Quarterly Report of Increase in Employee's Retirement An Creditable Compensation. This is to be nuity. This form is to be used by a wife used by employers in reporting the comwho, in order to increase the amount of pensation paid to each employee in each her husband's annuity to the amount month in a calendar quarter as required both would receive under the minimum to be submitted under $ 250.3 of this guarantee provisions of the act, elects to chapter. have her annuity reduced when she be

(36) Form BA-3a, Annual Report of comes eligible.

Creditable Compensation. This form is (30) Form G-340, Husband's State

to be used by employers authorized by ment in Connection with Wife's Election

the Board to report on an annual basis to to Have Her Wife's Annuity Reduced When She Becomes Eligible for Such An

report for each employee the service nuity. This form is to be used by the

months in which an individual worked, husband of the wife who submits Form the total service months earned, and the G-339 to show that he understands the total creditable compensation paid dureffect of his wife's election to have her ing the year as is required to be subannuity reduced.

mitted under $250.3 of this chapter.

(37) Form BA-4, Report of Creditable ered labor organizations of the service Compensation Adjustments. This form and compensation of its covered is to be prepared and submitted each employees. month by employers to report any ad (45) Form ES-1, Application for Emjustment in creditable compensation ployment Service. This form is to be which has been made by the employer used by unemployed persons in applying and which would affect the amount of for placement by the employment service. an employee's benefits under either the (46) Form S1-1a, Application for Railroad Retirement Act or the Railroad Sickness Benefits. This form is to be Unemployment Insurance Act.

used by an employee in applying for the (38) Form BA-5, Summary Report of form on which to claim sickness benefits. Compensation of Employees. Employ The completed form supplies informaers reporting creditable compensation tion necessary to determine if the appliare also required to prepare and submit cant is eligible to claim benefits and this form which is a quarterly summary

waives any existing "doctor-patient of all compensation paid and any ad privileges” for the purpose of supplying justments made during the quarter. medical information in support of his

(39) Form DC-1, Employer's Quarter claim. ly of Annual Report of Contributions (47) Form SI-16, Statement of SickUnder the Railroad Unemployment In ness. This form is a detachable part of surance Act. This is a form prescribed Form SI-la and is to be executed by an by $ 345.5 of this chapter to be filed by authorized person supplying medical inan ernployer under the Railroad Unem formation in connection with an employment Insurance Act to show the ployee's application for sickness benefits. amount of contributions being remitted (48) Form SI-1d, Pay Rate Report for the period covered.

and Employer's Corrected Report of Pay (40) Form DC-2, Employee Repre Rate. This form is to be used by a claimsentatives Report of Compensation. This

ant for sickness benefits to report the form is used by an individual serving as pay rates required to determine his daily an employee representative under the benefit rates under the Railroad UnemRailroad Retirement Act for reporting ployment Insurance Act. The pay rate employee representative service and report is then verified and, if necessary, compensation and is to be filed annually

corrected by the employer. or upon termination of employee repre

(49) Form SI-3, Claim for Sickness sentative service.

Benefits. This form is sent by the Board (41) Form DC-3, Claim for Abate

to claimants for sickness benefits to inment or Refund of Contributions, Inter

form the claimant of the registration est, or Penalty. This form is to be used period covered by the claim and to reby employers in claiming abatement or

quest information as to days of sickness refund of contributions, interest or

claimed, days worked, and earnings. The penalty under the Railroad Unemploy

form is to be returned to the office of ment Insurance Act.

the Board to which it is preaddressed.

(50) Form SI-62, Claim for Sickness (42) Form OE-1, Payroll Report

Benefits Due Employee But Not Paid at (Quarterly) for System Subordinate

Death. This is the form to be used in Units. The form is for quarter-annual

making claim for sickness benefits due reports by system subordinate units of

an employee but unpaid at his death. national-labor-organization “employers” (51) Form SI-101, Application for of earnings by employees and of em Maternity Benefits. This is the form to ployer “contributions" remitted pursuant be used by a female employee in applying to the Railroad Unemployment Insur

for a claim form on which to claim ance Act; it shows also amounts of taxes maternity benefits. The form provides paid pursuant to the Railroad Retire

for a statement by the employee of prior ment Tax Act.

employment and of the birth or expected

birth of a child; and also for a waiver (43) Form OE-2, Payroll Report

of any existing “doctor-patient privilege" (Monthly) for System Subordinate Units.

with respect to the maternity sickness This form is similar to Form OE-1 ex

for which the claim is made. This form cept that it is for monthly reports.

is to be mailed, together with completed (44) Form OE-5, Service and Com Form SI-104, to the Board. pensation Report by Labor Organiza (52) Form SI-103, Claim for Matertion. This requires a report from cov nity Benefits. This is the form to be

used in making claim for maternity benefits under the Railroad Unemployment Insurance Act.

(53) Form SI-104, Statement of Maternity Sickness This form is to be executed by a doctor of medicine in connection with an application for maternity benefits, and is to be furnished by the applicant to the Board, upon execution, together with completed Form SI101, Application for Maternity Benefits.

(54) Form UI-1, Application for Unemployment Benefits. This form is to be used by an employee in applying for unemployment benefits and provides for information in connection with employment service.

(55) Form UI-1a, Pay Rate Report and Employer's Corrected Report of Pay Rate. This form is given to a claimant for unemployment benefits to provide information of his employment and pay to be used in the determination of the claimant's daily benefit rate. The employer verifies and, if necessary, corrects the pay rate reported by the claimant.

(56) Form U1-3, Registration and Claim for Unemployment Benefits. This is a form for registering for days of unemployment and claiming unemployment insurance benefits, for providing notice to the claimant of requirements upon him, and for statement to be certified to by the claimant.

(57) Form U1-63, Application for ACcrued Benefits Due Under the Railroad Unemployment Insurance Act and Unpaid at Death. This application is used by a survivor or other person to claim benefits under the Railroad Unemployment Insurance Act due but unpaid to a claimant at the time of his death.

(58) Form U1-85, Appeal to the Board From Referee's Decision Under Railroad Unemployment Insurance Act. This form is used to appeal to the Board from a decision of a referee on a claim for benefits under the Railroad Unemployment Insurance Act.

(59) Form UI-86, Appeal from Initial Determination Under the Railroad Unemployment Insurance Act. This form is used to appeal from an initial decision denying benefits under the Railroad Unemployment Insurance Act. (Board Order 62–115, 27 F.R. 9254, Sept. 19, 1962, as amended at 35 F.R. 14543, Sept. 17, 1970]

$ 200.3 Availability of information to

public. (a) The following materials (more particularly described in paragraph (d) of this section), with identifying details deleted pursuant to paragraph (b) of this section, are available for public Inspection and copying:

(1) All final opinions (including concurring and dissenting opinions), and all orders made in the adjudication of cases, which have precedential effect;

(2) All statements of policy and interpretations which have been adopted by the Board, or by anyone under authority delegated by the Board, which have not been published in the FEDERAL REGISTER; and

(3) Administrative staff manuals and instructions to staff that affect any member of the public.

(b) The identifying details to be deleted shall include, but not be limuited to, names and identifying numbers of employees and other individuals as needed to comply with section 12 (d) and (n) of the Railroad Unemployment Insurance Act, section 10(b)6 of the Railroad Retirement Act, and 8 262.16 of this chapter, or to prevent a clearly unwarranted invasion of personal privacy.

(c) There shall be maintained in the Library, and made available for public inspection and copying, a current index of any of the materials referred to in paragraph (a) of this section which are issued, adopted, or promulgated after July 4, 1967. However, indexes in the material itself, and any index maintained in the offices of the Board for the use of the Board's employees which is made available for public inspection and copying, may be incorporated by reference.

(d) The materials and indexes thereto shall be kept, and made available to the public upon request, in the bureaus and offices of the Board which produce or utilize the materials. The following materials currently in use shall, as long as they are in effect as precedents and Instructions, be made available in offices of the Board at 844 Rush Street, Chicago:

(1) In the Bureau of Retirement Claims: The Retirement Claims Manual, RCM Circulars, Special Services Manual, Policy Decisions, Procedural Memoranda

containing information on the adjudication of claims not contained in the Retirement Claims Manual or in RCM Circulars, Instructions and Circular Letters to Employers, Field Operating Manual (Parts I and VI), FOM Circulars and Memoranda, and the Occupational Disability Rating Schedule.

(2) In the Bureau of Unemployment and Sickness Insurance: the Adjudication Instruction Manual, Regional Operating Manual (Part I), Field Operating Manual (Part II), FOM Circulars and memoranda, Bureau of Unemployment and Sickness Insurance Circulars, Memorandum Opinions, memorandum instructions on adjudication, and circular letters of instruction to railroad officials.

(3) In the Bureau of Data Processing and Accounts: the Instructions to Employers, and Circular Letters to Employers.

(4) In the Bureau of Law; Legal Opinions.

(5) In the Office of the Secretary of the Board: Decisions and rulings of the Board. Regional offices and field offices shall also make available to the extent practicable such of these materials and indexes as are furnished them in the ordinary course of business.

(e) The copies of manuals and instructions made available for public copying and inspection shall not include:

(1) Confidential statements, standards, and instructions, such as tolerance rules, assumptions, and guidelines, which cannot be disclosed to the public without adversely affecting the administration of the Acts, and

(2) Instructions not affecting the public (such as those relating solely to processing and procedure, to management, or to personnel) which it is feasible to separate from instructions that do affect the public.

(f) Except as to records relating to individuals (see § 262.16 of this chapter), records other than those made available under paragraphs (a), (c), and (d) of this section shall, upon receipt of a request identifying them, be made promptly available to the person requesting them unless they are exempted from disclosure by the provisions of 5 U.S.C. 552(b). A request may be made orally or in writing, without any special form. All written requests should be addressed to the Board, or to the head of the bureau or office having jurisdiction over the subject matter of the desired records, at 844 Rush Street, Chicago, Ill. 60611. Requests will be received and processed only during working hours of the Board, on days of business. When the retrieval of the record requested, or the furnishing of a copy, entails substantial and ascertainable additional expense to the Board, charge may be made in the amount of that cost, and shall be paid to the Director of Budget and Fiscal Operations.

(g) Any person whose request for materials or records under any paragraph of this section has been denied by a subordinate employee shall be entitled to have his request considered promptly by the head of the bureau or office having custody of such materials or records. (Board Order 6784, 32 F.R. 9651, Sept. 4, 1967]



PART 201-DEFINITIONS § 201.1 Words and phrases.

For the purposes of the regulations in this chapter, except where the language or context indicates otherwise:

(a) Act. The term “act,” or “1937 act" means the Railroad Retirement Act of 1937 (50 Stat. 307; 45 U.S.C. Chapter 9). The term “1935 act," means the Railroad Retirement Act of 1935 (49 Stat. 967; 45 U.S.C. Chapter 9).

(b) Employer. The term "employer" means an employer as defined in the act and Part 202 of this chapter.

(c) Employee. The term "employee" means an employee as defined in the act and Part 203 of this chapter.

(d) Service. The term "service" means service as defined in the act and Part 220 of this chapter.

(e) Compensation. The term “compensation" means compensation as defined in the act and Part 222 of this chapter.

(f) Board. The term "Board" means the Railroad Retirement Board.

(g) Company. The term “company" means a partnership, association, joint

« PreviousContinue »