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Effective Date: 10/2002
To request information from the Railroad Retirement Board regarding the amount of an applicant/recipient's benefits.
Number of Copies
The worker completes an original and one copy of Form 1026-TSI.
The worker sends the original to the Railroad Retirement Board and keeps the duplicate in the case record. Attach Form 0003, Authorization to Furnish Information, (signed by the applicant, recipient, or responsible person) to the original. If the worker does not know the regional office address, he sends the original to Railroad Retirement Board, 844 Rush Street, Chicago, Illinois 60611.
Retain copy in case record until completed original form is received. Original Form 1026-TSI is kept in the case record for three years after the recipient's eligibility is denied.
To — Enter the address of the regional office of the Railroad Retirement Board.
From — Enter the worker's name and local office mailing address.
Applicant/Recipient Information — Enter the retiree's name, address, payee name if different, Railroad Retirement Claim number and Social Security number.
Tax Sensitive Information — If the request is based on information obtained on an RG-101, check the "Yes" box. Do not include a copy of the RG-101 with the request. If the request is not based on information obtained on an RG-101, check the "No" box.
The worker signs on Page 1, and enters the date and local office telephone number. The worker enters the "Return Form To:" information on Page 2. A Railroad Retirement Board representative completes all other items on Page 2.