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RRB Form G-250A: Residual Functional Capacity

Alongside a narrative report and office records, the Railroad Retirement Board asks a treating or examining source to rate a disability applicant's work-related limits on this 4-page form. It covers standing, walking, sitting and lifting across an 8-hour workday, postural and manipulative activities, environmental tolerances and mental functioning, and the RRB uses it to decide a Railroad Retirement Act disability annuity.

Who completes it

The claimant's treating physician or another examining medical source completes the whole form and signs the certification. The claimant does not complete any section.

Submitting and payment

How to submit it
Return it to the RRB Office of Programs in Chicago with your narrative report and office records, as the enclosed cover letter (RL-250) requests. It is a paper form sent per case, not posted on rrb.gov.
Who pays
The form itself does not mention a fee or any payment by the RRB.

Good to know

  • Relate every limit to particular medical findings, and leave out non-medical factors such as age, sex, education or work experience, as the instructions direct.
  • Enter NA when a function is not affected and UNK when you cannot assess it; any NO for repetitive use of the hands must be explained.
  • Frequently means one-third to two-thirds of an 8-hour workday and occasionally means up to one-third, both counted cumulatively rather than continuously.
  • The last question asks whether, in your opinion, the claimant can handle benefit payments in his or her own best interest.

Get the official form

Download the current version from the source each time; forms change without notice.

Medical Assessment of Residual Functional Capacity

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Can I put the RFC opinion in my narrative report instead of using G-250A?

Yes. The instructions say you may include the medical assessment in your narrative report, but the RRB prefers that you use Form G-250A. Either way, explain each limitation and tie it to specific medical findings rather than to age, education or work history.

What do mildly and moderately mean on Form G-250A?

For environmental and mental restrictions, mildly means the claimant's tolerance or ability to function is limited but satisfactory. Moderately means it is seriously limited but not precluded. The other choices are No and Totally, and each rating needs supporting medical findings.