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

United States of America
Railroad Retirement Board

REQUEST FOR INFORMATION ABOUT
NEW OR REVISED

EMPLOYER PENSION PLAN

1. Railroad Contact Official's Name and Address

Form Approved
OMB No. 3220-0089
DO NOT WRITE IN THIS AREA· FOR RRB USE ONLY
Date Received at RRB
Received by

2. BA No.

3. Date RRB Released Form to Railroad

Facsimile No.:
SECTION 1 INSTRUCTIONS FOR THE EMPLOYER
For assistance in completing this form, read Part VI, Chapter 6, of the Employer Reporting Instructions located on our
website at www.rrb.gov, which provide information about supplemental annuities and how they are affected by railroad
pensions and 401 (k) distributions. Also read the "Important Notices" below. Type or print legibly in ink. If you need more
space than is provided, use Section 5, Remarks. Based on your answer to a question, you may be told to "Go to" another
item. If no "Go to" instructions are given, answer the next item in order. Do not skip any items unless directed to

do so.
This form is used to obtain information about a private railroad pension or 401 (k) savings plan to determine if benefits
from the plan will cause a reduction in the supplemental annuitfes of covered employees. Submit a copy of the plan or a
summary plan description with the completed form. Complete a separate form for each plan submitted.

Return the completed form to the US Railroad Retirement Board, 844 N. Rush Street, P&S-RAC, Chicago, IL 60611-2092
or fax to (312) 751-4650.
IMPORTANT NOTICES
PAPERWORK REDUCTION ACT NOTICE
The information requested on this form is needed to determine if a reduction is required to the supplemental annuities of
your retired employees under Section 2(h) (2) of the Railroad Retirement Act (RRA) (45 USC 231 a(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 8 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, US Railroad Retirement Board, 844 N. Rush St, Chicago, Illinois
60611-2092.
SECTION 2

GENERAL INFORMATION ABOUT THE PLAN

4a. Indicate the type of plan.

o Monthly pension plan ­

Monthly benefit paid or
elected

o 401 (k) savings plan
o Other Describe below and
continue in Section 5,
Remarks, if necessary.

4b. Indicate the status of the plan.

o Newplan
o Old plan not reported to RRB
o Amended previous plan
reported to RRB

4c. Indicate the group(s) of
employees covered by the plan.

o All
o Salaried
o Non-agreement
o Agreement - If not all

agreement employees
covered, explain below.
Explain: _ _ _ _ _ __

o Amended plan not reported to
RRB

o Other:

_ _ _ _ _ __

G-88r (xx-xx)

5.

Enter the name of the plan.

6a. Enter the effective
date of the plan.
7.

f--:..:.;M=.on::.;t::.:,h---l_-,D:::.;a:::..l-_+-_Y.:...;e::;:a:::..r---j 6b. Enter the latest revision date f--M;.;:;.o;;.;.;nt;;;.;.h-t--,D:...;a::.<--t--,Y;...;;;e.;;;c.a;....r--1
of the plan, if different.
Otherwise, enter N/A

o
o

Has the plan been approved by the Internal Revenue
Service?

Yes - Attach a copy of the IRS letter approving the plan.

No - Submit a copy of the IRS letter approving the plan
when received.
Only complete Section 3 if this report is about a monthly pension plan, then go to Section 5.
Only complete Section 4 if this report is about a 401 (k) savings plan, then go to Section 5.
SECTION 3
8.

o
9.

o
o

Defined benefit plan
Defined contribution plan

Employer contributions only
Both employer and employee contributions
Employee contributions only Go to Section 6

o

o

o

Yes - Go to Item 14
No - Go to Section 6

14. Indicate what type of contributions are made.

10. Indicate if the monthly benefit is reduced, and if so, by
all or part of the supplemental annuity.

o

Yes - Go to Item 13
No - Go to Section 6

13. Indicate if the employer is obligated to make
contributions regardless of profit.

Indicate how the plan is funded.

o
o
o

DETAILS ABOUT 401(K) SAVINGS PLAN

12. Indicate if the employer contributes to the employee's
401 (k) savings account.

What type of defined plan is it?

o

~-------------------~

DETAILS ABOUT MONTHLY PENSION PLAN

o
o
o

Yes it is reduced
by aI/ of the supplemental annuity - Go to
Section 6
by part of the supplemental annuity - Enter
%
percentage:
No it is not reduced

o
o

Matching
Shares of company stock
Other: _ _ _ _ _ _ _ _ _ _ _ _ __

11. Indicate if the pension is reduced by a portion of the
actual or estimated regular railroad retirement annuity
(Tier 1, Tier 2, and Vested Dual Benefit).

o

o

Yes it is reduced Enter percentage:
No it is not reduced

%

SECTION 5 REMARKS
You may use this section to enter any additional information that you feel may be important to include. Be sure to include
the item number of any answer you wish to continue.

SECTION 6 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.

Business Tele hone Number

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G-88r (xx-xx)