G-346sum (03-18) Employee's Certification Summary

CURRENT (ALL)

United States of America
Railroad Retirement Board

Form Approved
OMB No. 3220-0140

(Only printed if the application being filed is for a spouse annuity and the employee application is not
being filed at the same time and the entry on the Summary screen is equal to “V.”)
EMPLOYEE’S CERTIFICATION
INSTRUCTIONS
The following information was either supplied by or verified by you. Review the information for accuracy. If
there are any errors, notify the Railroad Retirement Board (RRB) immediately and no later than 10 days
from the date you receive this summary.
EMPLOYEE INFORMATION
1. Railroad Retirement Claim Number
2. Employee’s Social Security Number
3. Employee’s Name
YOUR MARRIAGE INFORMATION
4. I am currently married to (Spouse’s Name).

(Printed if previously married question is
answered “Yes.” Prefilled from employee
application.)

5. I was not married before my current marriage.

(Printed if previously married question is
answered “No.” Prefilled from employee
application.)

6. The following is a list of my marriages before my current marriage.
Date Began
Spouse’s Name
Ended by
Date Ended
99/99/9999
xxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxx
99/99/9999
(Printed if previously married question is answered “Yes.” Prefilled from employee application.)
7. RELINQUISHMENT OF RIGHTS BY DISABILITY ANNUITANTS AND CERTIFICATION
I recognize that my spouse may not begin to receive an annuity while I hold rights to return to work for a
railroad employer. I authorize the RRB to relinquish any rights I may have to return to work for a railroad
employer. Based on this authorization, my rights will be relinquished if my spouse becomes entitled to a
spouse’s annuity. I understand this authorization remains in effect unless I revoke it in writing.
Certification
This information is certified by you to be true and correct to the best of your knowledge. You have been
informed and you acknowledge that making a false or fraudulent statement or withholding information,
in order to receive benefits from the RRB, is a crime under Federal law, which may be punishable by
fines, imprisonment, or both.

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RRB Form G-346sum (03-18)

United States of America
Railroad Retirement Board

Form Approved
OMB No. 3220-0140

Paperwork Reduction Act and Privacy Act Notices
The Railroad Retirement Board is authorized to collect the information on this form by Section 7(b)(6) of the
Railroad Retirement Act. This information is needed to determine your spouse’s or former spouse’s
entitlement to benefits under the Railroad Retirement Act. You are not required to provide the information
requested by this form, however, your failure to do so may result in your spouse or former spouse not
receiving these benefits.
We estimate this form takes an average of 5 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 the Associate Chief
Information Officer for Policy and Compliance, Railroad Retirement Board, 844 North Rush Street, Chicago,
IL 60611-1275.

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RRB Form G-346sum (03-18)