Form BA-11 (01-12) PRIOR EDITIONS OBSOLETE 

REPORT OF GROSS EARNINGS

(SEE INSTRUCTIONS FOR COMPLETING AND MAILING THIS FORM ON REVERSE SIDE)

The purpose of this report is to obtain the gross earnings for a sample of employees. This information 

is required for computation of the Financial Interchange with the Social Security Administration and the 

Centers for Medicare & Medicaid Services. The report is required by law under Section 7(b)(6) of the 

Railroad Retirement Act. Failure to report or the making of a false or fraudulent report can result in

criminal prosecution or civil penalties, or both.

FORM G-440, REPORT SPECIFICATIONS SHEET, MUST ACCOMPANY THIS FORM.

1. YEAR 2. EMPLOYER BA NO. 3. PAGE NUMBER 4. TYPE OF REPORT

(Monthly, Quarterly or

Annual Breakdown)

5a. NAME OF EMPLOYER

5b. OTHER NAME, IF ANY

GROSS EARNINGS AMOUNTS

6. 7. 8(a) 8(b) 8(c) 8(d) 8(e) 8(f) 8(g) 8(h) 8(i) 8(j) 8(k) 8(l)

EMPLOYEE 

SOCIAL

SECURITY 

NUMBER

EMPLOYEE

NAME

(Last Name;

First Name; and

Middle Initial)

ANNUAL

1ST

QUARTER

2ND

QUARTER

3RD

QUARTER

4TH

QUARTER

JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER

For RRB

Use Only  11-19 20-55 56-64 65-73 74-82 83-91 92-100 101-109 56-64 65-73 74-82 83-91 92-100 101-109

FORM APROVED 

OMB NO. 3220-0132

UNITED STATES OF AMERICA

RAILROAD RETIREMENT BOARD

EXHIBIT ONLY: Employer MUST Submit Report via Automated Format
Form BA-11 (01-12) PRIOR EDITIONS OBSOLETE 

INSTRUCTIONS

This report, along with Form G-440, Report Specifications Sheet, is submitted annually. File this form no later than the last day of February in the year following the period for which compensation is being 

reported. Mail the forms to the RAILROAD RETIREMENT BOARD, BUREAU OF THE ACTUARY, 844 NORTH RUSH STREET, CHICAGO, ILLINOIS 60611-1275. Form BA-11 is not required if you have 

no employees with social security numbers ending with the digits “30.” Instead, check the appropriate box on the Form G-440 submitted with your Form BA-3, Annual Report of Creditable Compensation. 

Additional information about reporting gross earnings on this form may be found in the "Employer Reporting Instructions."

Gross earnings consist of all earnings taxable under the hospital insurance portion of the Tier I tax rate, including earnings above the annual creditable limit, sick pay, and miscellaneous compensation. 

Item

1. Enter the four-digit year covered by the report.

2. Enter the four-digit employer number assigned by the Railroad Retirement Board. Do not enter the Internal Revenue Service employer identification number.

3. Enter the page number. If there is more than one page, number each page consecutively.

4. Enter the appropriate type of report (monthly, quarterly, or annual breakdown).

 Employers with 5,000 or more employees on their payroll during the year are required to provide a monthly or quarterly breakdown of the year's earnings.

 Employers with fewer than 5,000 employees may submit only an annual amount, although a monthly or quarterly breakdown is preferable.

5. a. Enter the corporate name of the employer.

b. Enter other name, if any, commonly used for business purposes.

6. Enter the employee's social security number. Report only those employees whose social security number ends with the digits "30."

7. Enter the employee's last name (up to 20 letters), first name (up to 15 letters), and middle initial.

8. Enter either monthly, quarterly, or annual gross earning amounts under the appropriate column(s) for each employee. Include a decimal point and two digits representing cents ($$$$$$$.¢¢).

 Column 8(a) - Use when reporting annual amounts.

 Columns 8(a) through 8(d) - Use when reporting quarterly amounts.

 Columns 8(a) through 8(l) - Use when reporting monthly amounts.

EXHIBIT ONLY: Employer MUST Submit Report via Automated Format
Electronic File Format for Form BA-11

Report of Gross Earnings (Annual Earnings)

Field 

Length

Record 

Position Data and Instructions

2 1-2 "40"

4 3-6 Year being reported (CCYY).

4 7-10 Four-digit employer BA number assigned by the 

Railroad Retirement Board.

9 11-19

Employee's social security account number.

NOTE: Report only those employees whose social 

security number ends with the digits “30”. 

20 20-39

First twenty (20) characters of the employee's surname. 

Spaces in such names as O Grady or De La Cross are 

acceptable.

15 40-54 First fifteen (15) characters of the employee's first 

name.

1 55 Employee’s middle initial.

9 56-64 Annual Amount - 9 positions ($$$$$$$¢¢), preceded 

by zero(s) if necessary.

56 65-120 Leave blank or zero-fill.

NOTE: The file should be saved as a text (*.txt) file with the record format listed above.