BA-9 (electronic e Report of Separation Allowance (file format/electronic e

Effective 01-2008

OMB Approved 3220-0173
PROPOSED

Employer Reporting Instructions

Electronic File Format for BA-9, Report of Separation Allowance and Severance Pay
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) and is authorized for collection under OMB
control number 3220-0173, is needed for two purposes: to establish eligibility for an additional lump-sum amount
under the RRA and to establish a disqualification period under the RUIA and is authorized for collection under OMB
number 3220-0173. Failure to report or the making of a false or fraudulent report can result in criminal prosecution or
civil penalties, or both. We estimate the electronic version(s) of this form, (magnetic tape, diskettelCD-ROM, secure
E-mail and File Transfer Protocol (FTP)) takes an average of 1.27 hours per response to complete, including time for
reviewing the instructions, getting the needed data, and reviewing the completed report.

Form BA-9, Report of Separation Allowance and Severance Pay
Data Position

Data Description and Format

1

Constant "L"

2-5

Four -digit applicable tax year
Code "4" for increase
Code "M for decrease
Four-digit employer number (BA-NO)
Employee's social security number
First 20 letters of the employee's surname
First Name
Middle Initial
Blank.
An eight-digit separation allowance amount -Do not use a decimal place -Format is $$$$$$cc
Code 1 for an initial report
Code 2 for an adjustment report
Code 3 for a periodic payment -not the final payment
Code 4 for a periodic payment -final payment
Date employee relinquished employment rights -Format is MMDDCCYY

74

Blank.

75-82

Eight-digit compensation amount -Format is $$$$$$cc

83-86

Four digit applicable earnings year

87-92

Total gross amount of separation allowance -In whole dollars -Format is $$$$$$

93

Blank

94- 100

Last rate of pay; format includes a floating decimal place

101

Pay rate code: 1 =per hour;
3 =per week;
Work week code: 5 = five-day wk;
7 = seven-day wk;

103-120

2 =per day1 1 00 (or 150) miles:
4 =per month.
6 = six-day wk
8 = T&E; 9 = dining car

Blank (Filler is included to allow for future expansion.)

Federal agencies may not conduct or sponsor, and respondents are not required to respond to, any collection of
information unless it displays a valid OMB number. If you wish, send comments regarding the accuracy of our
estimates or any other aspect of these forms, including suggestions for reducing completion time, to CHIEF OF
INFORMATION RESOURCES MANAGEMENT, RAILROAD RETIREMENT BOARD, 844 N RUSH STREET,
CHICAGO, IL 60611-2092.