G-197 (xx-xx). Form Approved OMB No. 3220-0038-2026

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The document is a proposed authorization form (Form G-197) from the Railroad Retirement Board of the United States, allowing individuals to disclose personal information, including medical and educational records, for the purpose of determining eligibility for railroad retirement disability benefits. It outlines the types of information that can be disclosed, the sources from which it can be obtained, and the rights of individuals regarding their personal data. The form emphasizes compliance with privacy laws and provides instructions for revocation of consent.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your personal information in the designated fields, including your name, date of birth, RRB claim number, and social security number.
Carefully read through the authorization section. Ensure you understand what information you are permitting to be disclosed.
In the 'Whose Records to be Disclosed' section, specify all relevant medical and educational sources from which information will be obtained.
Complete the purpose of disclosure by indicating that it is for determining eligibility for railroad retirement disability benefits.
Sign and date the form in Item B using blue or black ink. If applicable, have a witness sign as well.

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Versions	Form popularity	Fillable & printable
2015	4.3 Satisfied (42 Votes)
2014	4.8 Satisfied (40 Votes)

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