G-19L.1, Instructions for Completing the Annual Earnings Questionnaire

Instructions for Completing the Annual Earnings Questionnaire

PART A - Use Part A to report earnings from your last pre-retirement non-railroad employer. This
is ge~ierallythe employment you performed immediately before your annuity beginning
date.
PART B - Use Part B to report earnings from self-employment. If you claim self-employment but
are incorporated, report your earnings in Part C, instead of Part B. If you attained full
retirement age prior to January 1,
, do not complete Part B.
PART C - Use Part C to report work and earnings that are not reported in Parts A or B. If you
, do not complete Part C.
attained full retirement age prior to January 1,

Follow these instructions for completing Parts A, B, and C:

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Enter the name and address of your employer. If you were self-employed, show the type of
work you performed and your business address.
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Show your earnings (and .the hours you worked in self-enlployment) for each month in
Complete this item only if your earr~ingsandlor self-employment hours were not
about the same in each month. In most cases, a monthly breakdown is not required and
this step can be skipped.
Enter the amount of your total earnings for
(Items 1, 4, and 7). The amount you enter
should be the same as the amount(s) shown on your Forms W-2, or Schedule SE if you
were self-employed.
Enter an estimate of your earnings for 1 (Items 2, 5, and 8).
If you stopped working, show the date you stopped work (Items 3, 6, and 9).

Do your best to complete all items that apply to your earnings, especially Items 1 through 9.
Always attach copies of your Forms W-2, and Schedule SE if you were self-employed.

If you have questions about how to complete the questionnaire or about how earnings affect your
annuity, contact us at the address shown at the bottom of the enclosed questionnaire. If you write
to us, please include a copy of Form G-l9L with your letter. If you visit us in person, bring Form
G I 9L and any other information you have about your claim. We suggest you call for an
appointment. Most Railroad Retirement Board offices are open to the public from 9:00 a.m. to 3:30
p.m., Monday .through Friday.
Read the next page for important information about your rights.

PAPERWORK REDUCTION AND PRIVACY ACT NOTICE
The U.S. Railroad Retirement Board is authorized to collect the requested information
under Section 7b(6) of the Railroad Retirement Act. This information is needed to
determine whether your earnings will affect your retirement benefits. You are not
required to provide us with the information requested by the G-l9L. However, if you fail
to provide the required information, we might be unable to pay you any benefits. The
information you provide may be disclosed for purposes of verification to the employers
you name in the report. We estimate that the G-19L takes an average of 15 minutes per
response to complete, 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 comments regarding the
accuracy of our estimate or any other aspect of this form, including suggestions for
reducing the completion time to: Chief of lnformation Resources Management, Railroad
Retirement Board, 844 N. Rush Street, Chicago, IL 60611-2092.

COMPUTER MATCHING AND PRIVACY PROTECTION ACT NOTICE
The Computer Matching and Privacy Act of 1988 requires the U.S. Railroad Retirement
Board (RRB) to advise you that information you have provided may be used, without
your consent, in automated matching programs. These matching programs are a
corrlputer corrlparison of RRB records with those kept by other Federal, state, or local
government agencies, lnformation from these matching programs can be used to
establish or verify a person's eligibility for federally funded or administered benefit
programs and for repayment of payments or delinquent debts under these programs.