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

ICR 201102-3220-001

OMB: 3220-0185

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2011-02-22
Supplementary Document
2007-11-30
IC Document Collections
ICR Details
3220-0185 201102-3220-001
Historical Active 200711-3220-002
RRB
Report of Medicaid State Office on Beneficiary's Buy-In Status
Extension without change of a currently approved collection   No
Regular
Approved without change 03/24/2011
Retrieve Notice of Action (NOA) 02/22/2011
  Inventory as of this Action Requested Previously Approved
03/31/2014 36 Months From Approved 03/31/2011
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 agreement in states in which they reside.

US Code: 45 USC 231(f) Name of Law: Railroad Retirement Act
   US Code: 42 USC 1395 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  75 FR 79056 12/17/2010
76 FR 9616 02/18/2011
No

1
IC Title Form No. Form Name
Report of Medicaid State Office on Beneficiary's Buy-In Status RL-380-F (02-08) Report of Medical State Office on Beneficiary's Buy-In Status

  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
Yes
No
No
No
Uncollected
Charles Mierzwa 312-751-3363 [email protected]

  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.
02/22/2011


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