Report of Medicare State Office on Beneficiary's Buy-In Status

ICR 199807-3220-001

OMB: 3220-0185

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
3220-0185 199807-3220-001
Historical Active 199506-3220-003
RRB
Report of Medicare State Office on Beneficiary's Buy-In Status
Extension without change of a currently approved collection   No
Regular
Approved without change 09/10/1998
Retrieve Notice of Action (NOA) 07/16/1998
  Inventory as of this Action Requested Previously Approved
09/30/2001 09/30/2001 09/30/1998
600 0 600
100 0 100
0 0 0

Under the Railroad Retirement Act, the Railroad Board administers the Medicare program for persons covered by the railroad retirement system. The collection obtains the information needed to determine if certain railroad beneficiaries are entitled to receive supplementary medical insurance program coverage under a State buy-in agreeement in States in which they reside.

None
None


No

1
IC Title Form No. Form Name
Report of Medicare State Office on Beneficiary's Buy-In Status RL-380F

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 600 600 0 0 0 0
Annual Time Burden (Hours) 100 100 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/16/1998


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