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STANDARDS - OPENNESS - ACCESSIBILITY - ACCOUNTABILITY
Form RB-17 (7-04): For Use With Survivor Annuity Applications
Paperwork Reduction and Privacy Act Notice
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Introduction

Part I - Applying For Your Annuity

Part II - Types Of Annuities

Part III - Requirements For An Annuity

Part IV - Furnishing Proof To Support Your Application

Part V - General Information

Part VI - After You Apply For Your Annuity

Part VII - How Your Annuity Is Computed

Part VIII - Medicare Benefits

Part IX - Federal Income Tax And Your Benefits

Paperwork Reduction & Privacy Act Notice


Fraud and Abuse Hot Line

Glossary

Nondiscrimination on the
Basis of Disability

Publications Index

This notice is given under the Paperwork Reduction Act of 1995 and the Privacy Act of 1974. The Privacy Act requires that the Railroad Retirement Board (RRB) tell you the following whenever we ask you for information.
  1. The law which allows us to ask for the information;
  2. whether that law requires you to give us that information and what, if anything, might happen to you if you do not give it to us;
  3. the reason why the information is requested; and
  4. the persons, organizations, and agencies to which we may release the information without your permission.

The RRB’s authority for requesting this information is Section 7(b) of the Railroad Retirement Act of 1974. Providing us with this information is voluntary on your part. However, if you fail to provide us with the requested information we may be unable to pay you any benefits. The RRB needs this information to determine whether you are eligible to receive such benefits and, if so, the amount you are entitled to receive. If your annuity application is approved and we begin to pay you benefits, information that we may request from you in the future will be used to determine whether you are entitled to continue to receive such benefits.

Although the information we request is almost never used for any purpose other than the payment of benefits under the Railroad Retirement Act, the RRB does have the authority to release information to the indicated individuals, organizations, and/or agencies listed below without your approval:

  1. An attorney, the Office of the President, a Congressional office, a labor union or the Department of State’s embassy or consular offices if they allege to be representing you at your request.
  2. Other people who are receiving benefits based on the same railroad retirement account as you are if the information affects their payments from the RRB.
  3. A person who will receive benefits on your behalf if the RRB decided that some medical condition keeps you from receiving your own benefits; such information may also be released in determining whether such a medical condition exists and who is suitable to receive such benefits for you.
  4. To people or organizations who are working for the RRB; such information may include medical records.
  5. The U.S. Treasury Department or U.S. Postal Service to issue payments and to investigate lost, forged, or stolen checks.
  6. Your last employer to make sure that you are eligible to receive railroad retirement benefits and you continue to receive any available medical benefits, and to any railroad industry employer (or to its insurance company) to make sure that you can receive any private retirement or insur-ance benefits which may be offered by the employer.
  7. The Social Security Administration, Health Care Financing Administration, Pension Benefit Guarantee Corporation, Office of Personnel Management, Department of Veterans Affairs, or Federal, state, or local welfare or public aid agencies to determine if you can receive benefits from these organizations and if any previous benefits were paid incorrectly.
  8. The Internal Revenue Service or to state and local taxing authorities for figuring your taxes and for use in audits.
  9. Your last address and the name of your last employer may be released to the Department of Health and Human Services to be used in the Parent Locator Service.
  10. The General Accounting Office for audits and for collecting overpayments owed to the RRB or the Social Security Administration.
  11. The U.S. Department of Labor as required by the Federal Coal Mine and Safety Act.
  12. 1 In certain cases for law enforcement purposes and for court proceedings.
  13. Information about the determination and recovery of an overpayment made to you may be released to any other per-son from whom any portion of the overpayment is being recovered.
  14. Your name and address may be released to a Member of Congress to inform you about current or proposed legisla-tion which could affect the railroad retirement system.
  15. Professional Standard Review Organizations and State Licensing Boards when services provided by physicians or practitioners suggest unethical or unprofessional conduct.

We estimate the application process takes an average of 20 to 47 minutes per response to complete, including the time for reviewing the instructions, getting the needed data, and reviewing the completed application. 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 comments regarding the accuracy of our estimate or any other aspect of this process, including suggestions for reducing completion time, to the Chief of Information Resource Management, Railroad Retirement Board, 844 North Rush Street, Chicago, Illinois 60611-2092.

Computer Matching and Privacy Protection Act Notice

The Computer Matching and Privacy Protection Act of 1988 requires the Railroad Retirement Board (RRB) to advise you that information you have provided may be used, with-out your consent, in automated matching programs. These matching programs are a computer comparison of RRB records with records kept by other Federal, state, or local governmental agencies. Information from these matching programs can be used to establish or verify a person’s eligi-bility for Federally funded or administered benefit pro-grams and for repayment of payments or delinquent debts under these programs.

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