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Effective Date: 
1/2011

Documents

Instructions

Updated: 1/2011

PURPOSE

To request information from the Railroad Retirement Board regarding the amount of an applicant/recipient's benefits.

PROCEDURE

Number of Copies

The worker completes an original and one copy of Form H1026-FTI.

Transmittal

The worker sends the original to the Railroad Retirement Board and keeps the duplicate in the case record. Attach Form H0003, 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, IL 60611.

Form Retention

Retain copy in case record until completed original form is received. Original Form H1026-FTI is kept in the case record for three years after the recipient's eligibility is denied.

DETAILED INSTRUCTIONS

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.

Federal Tax Information— If the request is based on information obtained on an Automated System for the Office of Inspector General (ASOIG) Match Worksheet, check the Yes box. Do not include a copy of the ASOIG Match Worksheet with the request. If the request is not based on information obtained on an ASOIG Match Worksheet, 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.