Section 2.62 Appeal Under the Railroad Retirement Act or the Railroad Unemployment Insurance Act

• Library: Elder Law 2015 Forms

This form is available at:

www.rrb.gov/pdf/ha1.pdf

CLAIMANT APPEAL UNDER THE RAILROAD RETIREMENT ACT OR RAILROAD UNEMPLOYMENT INSURANCE ACT

IMPORTANT: Read the "Important Notice" on the next page and the accompanying Form HA-2 before completing this form.

RETURN the completed form to:

Bureau of Hearings and Appeals Railroad Retirement Board 844 North Rush Street Chicago. Illinois 60611-2092

RRB Claim Number

Print Name (First Middle Initial Last)

Print Address (Number Street/Apt No. Po Box)

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