G-88r Request for Information About New or Revised Pension Pla

'

Form Approved
OMB NO.3220-0089

United States of America
Railroad Retirement Board

REQUEST FOR INFORMATION ABOUT NEW OR REVISED EMPLOYER PENSION PLAN
INSTRUCTIOIVS: The Railroad Retirement Board (RRB) requests you to complete a separate form for each
employer pension plan being reported. Please read "Important Notices" on the next page and complete
Section Ithrough Section 4.
1. Railroad Contact Official's Name and Address

2.

BA No.

3.

Date RRB Released Form to Railroad

1

I

I

Facsimile No.:

~

SECTION 1 - GENERAL RAILROAD PENSION INFORMATION
-

4. Enter an " X in the appropriate box:
I have enclosed a copy of the pension
plan or a summary plan description.
This pension plan is described as
shown.

5.

Enter the name of the pension plan.

6.

Enter the effective date of the pension
plan.

7. Describe the groups of employees
covered by this pension plan.

-

-

New Pension Plan - No Prior Pension Agreement.
Amended Pension Plan - Previous Pension Plan
Was Reported To The RRB.

3

Amended Pension Plan - Previous Pension Plan Was Not
Reported To The RRB.

3

3
3

-

SECTION 2 DETAILS OF 'THE PENSION PLAN

8. Describe the funding of the pension
plan. (For example, funded by a trust
fund, paid out of current income, etc.)

3

The employees described in Item 7 make contributions toward the
funding of the pension plan.
10. Enter an "X" in the appropriate box:

The employer pension is reduced by
the Railroad Retirement Tier 1 or
Tier 2.

1

3
NO
I

YES - Actual Railroad Retirement Tier 1 or Tier2 Rate
YES - Estimated Railroad Retirement Tier 1 or Tier 2 Rate
NO

I

1 q YES

11. Enter an "X" in the appropriate box:
The employer pension is reduced by all or part of the Railroad
Retirement Supplemental Annuity.

3
1 3 0

12. Enter an " X in the appropriate box:
The employer pension plan has been approved by the Internal
Revenue Service (IRS).

YES

(Attach a copy of the IRS letter approving the pension plan.)

-

SECTION 3 REMARKS

You may use this section to enter any additional information that you feel may be important to include.

--

-

SECTION 4 EMPLOYER CERTIFICATION BY SUPPLEMENTAL ANNUITY CONTACT OFFICIAL
Always complete this item.

I certify that I have examined this report, that it is made in good faith and that to the best of my knowledge and
belief all entries made.herein are true and correct, and in accordance with the laws and regulations applicable
hereto. I understand that providing false or fraudulent information or failing to provide required information is a
violation of federal law punishable by fine, imprisonment or both.
Title

Signature of RR Contact Official
Business Telephone Number (Include Area Code)
Return this form to:

(

)

Date

U.S. Railroad Retirement Board
A&T-QRSC
844 N Rush Street
Chicago, IL 6061 1-2092
Facsimile No.: (312) 751-7190
IMPORTANT NOTICES

PAPERWORK REDUCTION ACT NOTICE

The information requested on this form is needed to determine if a reduction to the supplemental annuities of your retired
employees is required under Section 2(h)(2) of the Railroad Retirement Act (RRA) (45 USC 231a(h)(2)). Furnishing this
information is required by law (Section 7(b)(6) of the RRA (45 USC 231f(b)(6))).
We estimate this form takes an average of 10 minutes 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 completion time, to Chief of Information Resources Management, Railroad Retirement Board, 844 N. Rush St,
Chicago, Illinois 6061 1-2092.
Date Reply Received at RRB

DO NOT WRITE IN THIS AREA -- FOR RRB USE ONLY
Received By:

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G-88r (03-03)