Information Collection Request
Medicare
ICR 202411-3220-012 · OMB 3220-0082 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form AA-6 (XX-XX) Propo Medicare |
Form and Instruction | Modified | Repair queued |
| Form RL-311F (08-22) Cu Employer Coverage Under an Employer Group Health Plan |
Form and Instruction | Modified | Repair queued |
 3220-0082_Final.docx |
Supporting Statement A | Uploaded 2025-04-02 | Repair queued |
 Request OMB Approval of NonSubstatative Change to ICR 3220-0082_Signed.pdf |
Justification for No Material/Nonsubstantive Change | Uploaded 2022-06-08 | Missing upstream |
| CMS-L564(8-20).pdf |
Supplementary Document | Uploaded 2021-06-29 | Repair queued |
| Form G-346 (03-18).pdf |
Supplementary Document | Uploaded 2018-04-17 | Repair queued |
| Form RL-9 (07-02).pdf |
Supplementary Document | Uploaded 2015-01-08 | Repair queued |
| Form RB-20 (01-18).pdf |
Supplementary Document | Uploaded 2018-04-17 | Repair queued |
| Form RB-3 (11-08).pdf |
Supplementary Document | Uploaded 2015-01-08 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 33882 |  Medicare |
Form and Instruction | Modified | |
| 186948 | Employer Coverage Under an Employer Group Health Plan |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | RRB |
| OMB Control No | 3220-0082 |
| Type of Information Collection | Reinstatement with change of a previously approved collection |
| Previous ICR Reference No | 202206-3220-004 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |