Form BA-4 (01-12) PRIOR EDITIONS OBSOLETE 

REPORT OF CREDITABLE COMPENSATION ADJUSTMENTS

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

The information contained in this report, which is required by law under Section 9 of the Railroad Retirement Act (RRA) and Section 6 of the Railroad Unemployment Insurance Act (RUIA), is needed to adjust compensation and service creditable under the RRA and 

RUIA. 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. MONTH/YEAR SUBMITTED 2. EMPLOYER BA NO. 3. PAGE NO.

4a. CORPORATE NAME OF EMPLOYER 4b. OTHER NAME, IF ANY

FOR RRB USE ONLY

2—5 21—29 30—65 66—72 75—81 84—95 96—97 98—105 108—115 125—132 135—142 118—122

5.

YEAR

6.

EMPLOYEE

SOCIAL

SECURITY

NUMBER

7. EMPLOYEE

NAME

(Last Name;

First Name; and

Middle Initial)

8.

ADJUST 

TYPE

I = Incr

D = Decr

9. RUIA COMPENSATION 10. MONTHS ADJUSTED 11.

TOTAL

SM

ADJ.

12. RRA COMPENSATION 13.

LAST

DAILY

PAY

RATE

a.

CREDITABLE

AMT. ADJ.

b. MAXIMUM

BENEFIT

 AMT. ADJ.

J

A

N

F

E

B

M

A

R

A

P

R

M

A

Y

J

U

N

J

U

L

A

U

G

S

E

P

O

C

T

N

O

V

D

E

C

a.

TIER I

ADJ.

b.

TIER II

ADJ.

c.

MISCELLANEOUS

ADJ.

d.

SICK PAY

ADJ

(1)

(2)

(3)

(4)

(7)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

(15)

14. Record

 Count

15. Enter the compensation total amounts below for Items 9a through 12d. Include a decimal point and two digits representing cents ($$$$$$.¢¢). Enclose negative total amounts in parentheses (10000.00).

9a Total RUIA Creditable Amt. Adj. 9b Total RUIA Maximum Benefit Amt. Adj. 12a Total RRA Tier I Adj. 12b Total RRA Tier II Adj. 12c Total RRA Miscellaneous Adj. 12d Total RRA Sick Pay Adj.

16. ADJUSTMENT OUTSIDE OF THE STATUTE OF LIMITATIONS

Public Law Board Award ____________________ Settlement Allocation ____________________ Wage Continuation Plan ____________________ Railroad Retirement Board Request ____________________________________________________

Other Pay for Time Lost Allocation __________________ Specify Type: _________________________________________________________________________ Other __________________ Specify Type: _______________________________________________________________

UNITED STATES OF AMERICA

RAILROAD RETIREMENT BOARD

FORM APPROVED 

OMB NO. 3220-0008

EXHIBIT ONLY: Employer MUST Submit Report via Automated Format
Form BA-4 (01-12) PRIOR EDITIONS OBSOLETE 

INSTRUCTIONS 

This report, along with Form G-440, Report Specifications Sheet, is due by the last day of the month immediately following the calendar quarter in which the adjustment occurred or was determined. Mail the forms to the RAILROAD RETIREMENT 

BOARD, OFFICE OF PROGRAMS, P&S – COMPENSATION AND EMPLOYER SERVICES CENTER, 844 NORTH RUSH STREET, CHICAGO, ILLINOIS 60611-1275. Form BA-4 is used to correct creditable service months and RUIA Compensation 

as well as all RRA Compensation (Tier I, Tier II, Miscellaneous and Sick Pay) previously reported on or omitted from Form BA-3, Annual Report of Creditable Compensation (or obsolete Forms BA-3a, BA-3d, or BA-10). Additional information about 

reporting creditable compensation adjustments on this form may be found in the "Employer Reporting Instructions."

LIST ALL ITEMS THAT INCLUDE MISCELLANEOUS COMPENSATION OR SICK PAY SEPARATELY FROM OTHER ITEMS.

Item 

1. Enter the month and four-digit year for which the report is submitted. This entry does not refer to the date of the month(s) being adjusted by the Form BA-4.

2. Enter the four-digit Railroad Retirement Board (RRB) employer number. Do not enter the Internal Revenue Service employer identification number. 

3. Number each page submitted within a calendar month, including adjustment reports submitted at the request of the RRB. 

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

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

5. Enter the four digits of the year being adjusted. 

6. Enter the employee's social security number. 

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

8. Enter the appropriate code to indicate the type of adjustment. 

 I = Increase – If the adjustment is an increase to service or compensation previously reported for the employee for the year entered in Item 5 or

the adjustment is an initial report, for the year entered in Item 5, for an employee who was omitted from Form BA-3 (or obsolete Form BA-3a) Annual Report of Creditable Compensation. 

 D = Decrease – If the adjustment is a decrease to service or compensation previously reported for the employee for the year entered in Item 5. 

9. a. Enter the net increase or decrease amount for the compensation creditable under the RUIA. 

 b. Enter the net increase or decrease amount for the total maximum benefit compensation under the RUIA.

 Include a decimal point and two digits representing cents ($$$$$$.¢¢). 

 NOTE: See the "Employer Reporting Instructions" for details on creditability for these two amounts.

10. Enter a “1,” in the appropriate column for each month to be adjusted (added or removed) for the year. 

11. Enter the total number of months adjusted; this amount should equal the total number of months from Item 10 with a “1.”

12. a. Enter the net increase or decrease amount for regular creditable RRA Tier I compensation. 

 b. Enter the net increase or decrease amount for creditable RRA Tier II compensation. 

 c. Enter the net increase or decrease amount for miscellaneous RRA compensation. 

 d. Enter the net increase or decrease amount for sick pay RRA compensation. 

 Include a decimal point and two digits representing cents ($$$$$$.¢¢). 

13. For employees who were omitted from the annual Form BA-3: 

 Enter the employee's last daily pay rate (DPR), exclusive of overtime and other allowances. Include a decimal point and two digits representing cents ($$$.¢¢). Do not enter an amount greater than 200.00. 

 If the actual DPR is $200.00 or more use a rate of 200.00; if the DPR is less than $200.00 use the actual rate. Compute the last DPR for employees paid on an hourly, monthly, or annual basis as follows: 

  Hourly - Multiply the hourly rate by 8.  Monthly - Divide the monthly rate by 21.75.  Annual - Divide the annual rate by months employed, then divide the quotient by 21.75. 

 Do not use this form to change a previously reported daily pay rate. 

SUMMARY ITEMS 

14. Enter the total number of lines which are completed on the page. 

15. Summarize the total increase and decrease compensation amounts entered in each column of Items 9(a), 9(b) and 12(a) through 12(d). Enclose negative total amounts in parentheses. 

STATUTE OF LIMITATIONS ITEMS 

16. There is a four-year statute of limitations for adjusting a report of creditable compensation. If the calendar year being adjusted is prior to four years from the current reporting year, indicate the reason the employee's record is being adjusted by 

entering the number of the line being adjusted to the right of the reason. For example, if the employee on Line 1 is being adjusted for 2011 because the employee received a public law board award, complete the entry as follows: Public Law Board 

Award 1 . If more than one employee needs the same adjustment, for example, on Lines 1 and 5, complete the entry as follows: Public Law Board Award 1, 5 . 

Include on the Form G-440 a summary of each page of Form BA-4 record counts and compensation totals submitted during the current month. Compile the summaries into a grand total. 

We estimate this form takes an average of 75 minutes per response, including the time for reviewing the instructions, getting the needed data, and reviewing the completed form. Federal agencies may not conduct or sponsor, and respondents are not 

required to respond to, a collection of information unless it displays a valid OMB number. If you wish, send comments regarding the accuracy of our estimate or any other aspect of this form, including suggestions for reducing completion time, to 

ASSOCIATE CHIEF INFORMATION OFFICER FOR POLICY AND COMPLIANCE, RAILROAD RETIREMENT BOARD, 844 N. RUSH STREET, CHICAGO, IL 60611-1275. 

EXHIBIT ONLY: Employer MUST Submit Report via Automated Format
Electronic File Format for Form BA-4

Form BA-4 Record Format

Field 

Length

Record 

Position Data and Instructions

1 1 Blank

4 2-5 Four-digit year being reported. 

1 6 Code "4" for an increase adjustment.

Code "M" for a decrease adjustment.

4 7-10 Four-digit BA number assigned by the Railroad Retirement 

Board. 

10 11-20 Blank Filler. 

9 21-29 Employee's social security number. 

20 30-49 

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

in such names as Mc Carthy, St Clair, De La Cross are 

acceptable.

15 50-64 First fifteen (15) characters of the employee's first name. 

1 65 Employee’s middle initial.

7 66-72 

RUIA I ($$$$$¢¢) – Total compensation which is creditable 

under the RUIA to qualify for benefits. This amount should not 

exceed the RUIA I monthly maximum times 12. 

2 73-74 Blank Filler.

7 75-81 

RUIA II ($$$$$¢¢) – Total compensation which is creditable 

under the RUIA to determine maximum benefits. This amount 

should not exceed the RUIA II monthly maximum times 12. 

2 82-83 Blank Filler.

12 84-95 

84-Jan.

85-Feb.

86-March

87-April

88-May

89-June

90-July

91-August

92-Sept.

93-Oct.

94-Nov.

95-Dec.

Service Month Detail – All of the employment 

relation codes for non-worked months available on 

Form BA-3, Annual Report of Creditable 

Compensation, cannot be used on this adjustment 

report. Only use the following codes:

Code 1 = worked

Code 0 = not worked & employment relation 

unknown

NOTE: All 12 positions must be filled.
Electronic File Format for Form BA-4

Form BA-4 Record Format

Field 

Length

Record 

Position Data and Instructions

2 96-97 Service Month Total - The sum of the characters in positions 84-

95. Enter zeros if no months are reported.

8 98-105 Creditable Tier I compensation, up to the annual maximum for 

the year ($$$$$$¢¢). 

2 106-107 Blank Filler.

8 108-115 Creditable Tier II compensation, up to the annual maximum for 

the year ($$$$$$¢¢). 

2 116-117 Blank Filler. 

5 118-122 Last daily pay rate. ($$$¢¢) If pay rate exceeds $200.00, enter 

20000. 

2 123-124 Blank Filler.

8 125-132 Creditable Miscellaneous compensation ($$$$$$¢¢). 

2 133-134 Blank Filler. 

8 135-142 Creditable Sick Pay compensation ($$$$$$¢¢). 

58 143-200 Blank Filler (For future expansion).

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