Request DR-423 For Waiver of Overpayment

UNITED STATES OF AMERICA

RAILROAD RETIREMENT BOARD

OFFICE HOURS: 9:00 AM TO 3:30 PM
MONDAY THROUGH FRIDAY EXCEPT FEDERAL HOLIDAYS

TOLL-FREE NUMBER: 1-877-772-5772
FACSIMILE NUMBER:

In reply refer to

This is concerning the overpayment described in earlier correspondence from our headquarters
and your request for waiver consideration.
In order to complete action on your request, the Railroad Retirement Board requires the disclosure
of financial information needed to determine your eligibility for a waiver. Therefore, you should
complete the enclosed Financial Disclosure Statement (Form DR-423). In addition, you should
submit a copy of your latest federal income tax return, if you have filed one in the past two years.
If you have any questions about the Financial Disclosure Statement, contact this office. Please
return the completed form and copy of your latest income tax return within 30 days. A return
envelope is enclosed for your convenience.
Sincerely,

Enclosures
Financial Disclosure Statement (DR-423)
Return Envelope

RL-423 (09-05)