Railroad Employment Questionnaire

Screen facsimiles:

NHRR screen:

LnNo	0 1	1 2 3 4 5 6 7 7 234567890123456789012345678901234567890123456789012345678901234567890123456789	8 0
1	C	MCS TRANSFER TO: NH RAILROAD EMPLOYMENT NHRR
2	0	NH SSSSSSSSSS SSSSS SSSSSSSSSS CL SSSSSSSSS SSSSS SSSSSSSSSSS
3	l
4	u	RR EMPLOYEE: SSSSSSSSSS S SSSSSSSSSSSSSSSSSSSS SSN: SSSSSSSSSS
5	m	MONTHS WORKED IN RR AFTER 1936: XXX BEFORE 1937: XXX LAST 18 MOS (Y/N): X
6	n	EVER FILE FOR RRB RET/DISAB (Y/N): X IF YES, CLAIM NO: XXXXXXXXXXX
7	*	IF EMPLOYEE LIVING, REC'D RRB SICKNESS/UNEMPLOYMENT IN LAST 18 MOS (Y/N): X
8	o	IF RRB EMPLOYEE DECEASED, SURVIVOR EVER RECEIVE RRB BENEFITS (Y/N): X
9	n	EMPLOYEE WORK IN RR AFTER APPLYING FOR SOC SEC BENEFITS (Y/N): X
10	e
11		IF RR EMPLOYMENT IN LAST 18 MONTHS OR WORK AFTER FILING FOR SS BENEFITS:
12	r	RR EMPLOYER: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
13	e	WORK LOCATION: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
14	s	DEPT OCCUPATION: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
15	e
16	r	IF CLAIMANT EVER RECEIVED RRB BENEFITS:
17	v	RR APPLICANT: SSSSSSSSSSSS S SSSSSSSSSSSSSSSSSSS CLAIM NO: XXXXXXXXXXX
18	e	RR EMPLOYEE NAME: XXXXXXXXXX X XXXXXXXXXXXXXXXXXXX SSN: XXXXXXXX
19	d	RELATIONSHIP: XXXXXXXXXX
20		BENEFIT TYPE: X SELECT 1. MONTHLY 2. LUMP-SUM 3. RESIDUAL
21		HAS RRB NOTIFIED APPLICANT THAT RRB MAY BE AFFECTED BY ENTITLEMENT TO
22		SOCIAL SECURITY BENEFITS (Y/N): X
23
24		**************(Line 24 Reserved for Operating Systems Information)***********

SPRR screen:

LnNo	0 1	1 2 3 4 5 6 7 7 234567890123456789012345678901234567890123456789012345678901234567890123456789	8 0
1	C	MCS TRANSFER TO: SP RAILROAD EMPLOYMENT SPRR
2	0	NH SSSSSSSSS SSSSS SSSSSSSSSS CL SSSSSSSSS SSSSS SSSSSSSSSS
3	l
4	u	RR EMPLOYEE: SSSSSSSSSS S SSSSSSSSSSSSSSS SSN: SSSSSSSSS
5	m	MONTHS WORKED IN RR AFTER 1936: XXX BEFORE 1937: XXX LAST 18 MOS (Y/N): X
6	n	EVER FILE FOR RRB RET/DISAB (Y/N): X IF YES, CLAIM NO: XXXXXXXXXXX
7	*	IF EMPLOYEE LIVING, REC'D RRB SICKNESS/UNEMPLOYMENT IN LAST 18 MOS (Y/N): X
8	o	IF RRB EMPLOYEE DECEASED, SURVIVOR EVER RECEIVE RRB BENEFITS (Y/N): X
9	n	EMPLOYEE WORK IN RR AFTER APPLYING FOR SOC SEC BENEFITS (Y/N): X
10	e
11		IF RR EMPLOYMENT IN LAST 18 MONTHS OR WORK AFTER FILING FOR SS BENEFITS:
12	r	RR EMPLOYER: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
13	e	WORK LOCATION: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
14	s	DEPT OCCUPATION: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
15	e
16	r	IF CLAIMANT EVER RECEIVED RRB BENEFITS:
17	v	RR APPLICANT: SSSSSSSSSSSS S SSSSSSSSSSSSSSSSSSS CLAIM NO: XXXXXXXXXXX
18	e	RR EMPLOYEE NAME: XXXXXXXXXX X XXXXXXXXXXXXXXXXXXX SSN: XXXXXXXX
19	d	RELATIONSHIP: XXXXXXXXXX
20		BENEFIT TYPE: X SELECT 1. MONTHLY 2. LUMP-SUM 3. RESIDUAL
21		HAS RRB NOTIFIED APPLICANT THAT RRB MAY BE AFFECTED BY ENTITLEMENT TO
22		SOCIAL SECURITY BENEFITS (Y/N): X
23
24		**************(Line 24 Reserved for Operating Systems Information)***********

CLRR screen:

LnNo	0 1	1 2 3 4 5 6 7 7 234567890123456789012345678901234567890123456789012345678901234567890123456789	8 0
1	C	MCS TRANSFER TO: SP RAILROAD EMPLOYMENT CLRR
2	0	NH SSSSSSSSS SSSSS SSSSSSSSSS CL SSSSSSSSS SSSSS SSSSSSSSSS
3	l
4	u	RR EMPLOYEE: SSSSSSSSSS S SSSSSSSSSSSSSSS SSN: SSSSSSSSSS
5	m	MONTHS WORKED IN RR AFTER 1936: XXX BEFORE 1937: XXX LAST 18 MOS (Y/N): X
6	n	EVER FILE FOR RRB RET/DISAB (Y/N): X IF YES, CLAIM NO: XXXXXXXXXXX
7	*	IF EMPLOYEE LIVING, REC'D RRB SICKNESS/UNEMPLOYMENT IN LAST 18 MOS (Y/N): X
8	o	IF RRB EMPLOYEE DECEASED, SURVIVOR EVER RECEIVE RRB BENEFITS (Y/N): X
9	n	EMPLOYEE WORK IN RR AFTER APPLYING FOR SOC SEC BENEFITS (Y/N): X
10	e
11		IF RR EMPLOYMENT IN LAST 18 MONTHS OR WORK AFTER FILING FOR SS BENEFITS:
12	r	RR EMPLOYER: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
13	e	WORK LOCATION: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
14	s	DEPT OCCUPATION: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
15	e
16	r	IF CLAIMANT EVER RECEIVED RRB BENEFITS:
17	v	RR APPLICANT: SSSSSSSSSSSS S SSSSSSSSSSSSSSSSSSS CLAIM NO: XXXXXXXXXXX
18	e	RR EMPLOYEE NAME: XXXXXXXXXX X XXXXXXXXXXXXXXXXXXX SSN: XXXXXXXXX
19	d	RELATIONSHIP: XXXXXXXXXX
20		BENEFIT TYPE: X SELECT 1. MONTHLY 2. LUMP-SUM 3. RESIDUAL
21		HAS RRB NOTIFIED APPLICANT THAT RRB MAY BE AFFECTED BY ENTITLEMENT TO
22		SOCIAL SECURITY BENEFITS (Y/N): X
23
24		**************(Line 24 Reserved for Operating Systems Information)***********