Letter Requesting Applicant to Furnish Evidence

Form RL-57A-F (10-82).pdf

Statement Regarding Contributions and Support

Letter Requesting Applicant to Furnish Evidence

OMB: 3220-0099

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UNITED STATES OF AMERICA

RAILROAD RETIREMENT BOARD



CURRENT


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

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

In reply refer to

Please furnish us with the items indicated on the enclosed checklist, which are needed to support
your claim under the Railroad Retirement Act. If you have difficulty in obtaining any of the
documents, let us know so that we can help you obtain them or an acceptable substitute.
If you have any questions about this letter, or if you need additional information, please contact this
office. If you write to us, give us a telephone number at which you can be reached.
Sincerely,

Enclosures:
Form G-242
Envelope

RL-57A-F (10-82)


File Typeapplication/pdf
File TitleRL-57A-F (10-82)
Authordmh
File Modified2016-04-20
File Created2016-04-20

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