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

ICR 201401-3220-012

OMB: 3220-0185

Federal Form Document

Forms and Documents
IC Document Collections
ICR Details
3220-0185 201401-3220-012
Historical Active 201102-3220-001
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 04/29/2014
Retrieve Notice of Action (NOA) 03/26/2014
  Inventory as of this Action Requested Previously Approved
04/30/2017 36 Months From Approved 04/30/2014
600 0 600
100 0 100
0 0 0

Under the Railroad Retirement Act, the Railroad Retirement 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

  79 FR 676 01/06/2014
79 FR 16382 03/25/2014
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.
03/26/2014


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