Medicare

ICR 200211-3220-001

OMB: 3220-0082

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
33881 Migrated
ICR Details
3220-0082 200211-3220-001
Historical Active 200012-3220-001
RRB
Medicare
Revision of a currently approved collection   No
Regular
Approved without change 12/04/2002
Retrieve Notice of Action (NOA) 11/22/2002
  Inventory as of this Action Requested Previously Approved
12/31/2005 12/31/2005 09/30/2003
1,040 0 1,040
165 0 165
0 0 0

The Railroad Retirement Board administers the Medicare program for persons covered by the railroad retirement system. The forms in the collection obtain information needed to enroll non-retired employees and survivor applicants in the plan and also obtain information from railroad employers needed to determine if a railroad retirement beneficiary is entitled to a special enrollment period when applying for supplemental medical coverage under Medicare.

None
None


No

1
IC Title Form No. Form Name
Medicare AA-6, AA-7, AA-8, RL-311-F

  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 1,040 1,040 0 0 0 0
Annual Time Burden (Hours) 165 165 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.
11/22/2002


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