| UNITED STATES OF AMERICA | CURRENT | Form Approved | ||||||||||||||||||||||||
| RAILROAD RETIREMENT BOARD | OMB No. 3220-0203 | |||||||||||||||||||||||||
 
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| Medicare Wages and Tips, RRTA Gross Compensation, Stock Options and Other Payments | ||||||||||||||||||||||||||
| 1. | 2. | 3. | 4. | 5. | 6. | 7. | 8. | 9. | 10. | 11. | 12. | 13. | 14. | 15. | 16. | 17. | 18. | 19. | 20. | 21. | 22. | 23. | 24. | 25. | 26. | 27. | 
| I = Initial; R = Replacement | Year being reported (CCYY). | BA Number | Employee's SSN | Last Name (20) | First Name (15) | MI | Filler, leave blank | Medicare wages and tips Q1  - 10 positions ($$$$$$$$¢¢)  | 
		Medicare wages and tips Q2  - 10 positions ($$$$$$$$¢¢)  | 
		Medicare wages and tips Q3  - 10 positions ($$$$$$$$¢¢)  | 
		Medicare wages and tips Q4  - 10 positions ($$$$$$$$¢¢)  | 
		Filler, leave blank | RRTA Gross Compensation Q1  - 10 positions ($$$$$$$$¢¢)  | 
		RRTA Gross Compensation Q2  - 10 positions ($$$$$$$$¢¢)  | 
		RRTA Gross Compensation Q3  - 10 positions ($$$$$$$$¢¢)  | 
		RRTA Gross Compensation Q4  - 10 positions ($$$$$$$$¢¢)  | 
		Filler, leave blank | NQSOs  Q1 - 10 positions ($$$$$$$$¢¢)  | 
		NQSOs  Q2 - 10 positions ($$$$$$$$¢¢)  | 
		NQSOs  Q3 - 10 positions ($$$$$$$$¢¢)  | 
		NQSOs  Q4 - 10 positions ($$$$$$$$¢¢)  | 
		Filler, leave blank | Ratification Payments Q1  - 10 positions ($$$$$$$$¢¢)  | 
		Ratification Payments Q2  -10 positions ($$$$$$$$¢¢)  | 
		Ratification Payments Q3  -10 positions ($$$$$$$$¢¢)  | 
		Ratification Payments Q4  -10 positions ($$$$$$$$¢¢)  | 
	
| Form BA-15 (12-21) | ||||||||||||||||||||||||||
 
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| Electronic File Format for Form BA-15 | |||
| Report of Stock Options and Other Payments | |||
| Column | Field Length  | 
		Record Position  | 
		Data and Instructions | 
| 1 | 1 | 1 | I = Initial; R = Replacement | 
| 2 | 4 | 2-5 | Year being reported (CCYY). | 
| 3 | 4 | 6-9 | Four-digit employer BA number assigned by the Railroad Retirement Board. | 
| 4 | 9 | 10-18 | Employee's social security account number. | 
| 5 | 20 | 19-38 | First twenty (20) characters of the employee's surname. Spaces in such names as O Grady or De La Cross are acceptable. | 
| 6 | 15 | 39-53 | First fifteen (15) characters of the employee's first name. | 
| 7 | 1 | 54 | Employee’s middle initial. | 
| 8 | 1 | 55 | Filler, leave blank | 
| 9 | 10 | 56-65 | Medicare Wages and Tips First Quarter Amount - 10 positions ($$$$$$$$¢¢), preceded by zero(s) if necessary. | 
| 10 | 10 | 66-75 | Medicare Wages and Tips Second Quarter Amount -10 positions ($$$$$$$$¢¢), preceded by zero(s) if necessary. | 
| 11 | 10 | 76-85 | Medicare Wages and Tips Third Quarter Amount - 10 positions ($$$$$$$$¢¢), preceded by zero(s) if necessary. | 
| 12 | 10 | 86-95 | Medicare Wages and Tips Fourth Quarter Amount - 10 positions ($$$$$$$$¢¢), preceded by zero(s) if necessary. | 
| 13 | 1 | 96 | Filler, leave blank | 
| 14 | 10 | 97-106 | RRTA Gross Compensation First Quarter Amount - 10 positions ($$$$$$$$¢¢), preceded by zero(s) if necessary. | 
| 15 | 10 | 107-116 | RRTA Gross Compensation Second Quarter Amount - 10 positions ($$$$$$$$¢¢), preceded by zero(s) if necessary. | 
| 16 | 10 | 117-126 | RRTA Gross Compensation Third Quarter Amount - 10 positions ($$$$$$$$¢¢), preceded by zero(s) if necessary. | 
| 17 | 10 | 127-136 | RRTA Gross Compensation Fourth Quarter Amount - 10 positions ($$$$$$$$¢¢), preceded by zero(s) if necessary. | 
| 18 | 1 | 137 | Filler, leave blank | 
| 19 | 10 | 138-147 | Non-Qualified Stock Options First Quarter Amount - 10 positions ($$$$$$$$¢¢), preceded by zero(s) if necessary. | 
| 20 | 10 | 148-157 | Non-Qualified Stock Options Second Quarter Amount - 10 positions ($$$$$$$$¢¢), preceded by zero(s) if necessary. | 
| 21 | 10 | 158-167 | Non-Qualified Stock Options Third Quarter Amount - 10 positions ($$$$$$$$¢¢), preceded by zero(s) if necessary. | 
| 22 | 10 | 168-177 | Non-Qualified Stock Options Fourth Quarter Amount - 10 positions ($$$$$$$$¢¢), preceded by zero(s) if necessary. | 
| 23 | 1 | 178 | Filler, leave blank | 
| 24 | 10 | 179-188 | Ratification Payments First Quarter Amount - 10 positions ($$$$$$$$¢¢), preceded by zero(s) if necessary. | 
| 25 | 10 | 189-198 | Ratification Payments Second Quarter Amount - 10 positions ($$$$$$$$¢¢), preceded by zero(s) if necessary. | 
| 26 | 10 | 199-208 | Ratification Payments Third Quarter Amount - 10 positions ($$$$$$$$¢¢), preceded by zero(s) if necessary. | 
| 27 | 10 | 209-218 | Ratification Payments Fourth Quarter Amount - 10 positions ($$$$$$$$¢¢), preceded by zero(s) if necessary. | 
| NOTE: If there are no earnings for the quarter, zero-fill. | |||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet | 
| File Modified | 0000-00-00 | 
| File Created | 0000-00-00 |