Information Collection

Medicare

IC 33882 under ICR 202411-3220-012 · OMB 3220-0082.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0082 can be found here:

2026-06-16 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AA-6 (XX-XX) Propo Medicare	Form and Instruction
Form AA-6 (XX-XX) Propo Employee Application for Medicare Medicare	Form and Instruction
Form AA-7 (XX-XX) Propo Spouse Divorced Spouse Application for Medicare Medicare	Form and Instruction
Form AA-8 (XX-XX) Propo Widow Widower Application for Medicare - Medical Insurance (Part B) Program Medicare	Form and Instruction
Form AA-23 (XX-XX) Prop Application for Medicare - Medical Insurance (Part B) Medicare	Form and Instruction
Form AA-24 (XX-XX) Prop Application for Medicare Part B - Exceptional Conditions Medicare	Form and Instruction
Form AA-6 (01-18) Curre Employee Application for Medicare Medicare	Form and Instruction
Form AA-7 (01-18) Curre Spouse Divorced Spouse Application for Medicare Medicare	Form and Instruction
Form AA-8 (01-18) Curre Widow Widower Application for Medicare - Medical Insurance (Part B) Program Medicare	Form and Instruction
AA-6 (XX-XX) Propo Employee Application for Medicare AA-6 Employee Application for Medicare (XX-XX) Proposed Final.pdf	Form and Instruction
AA-6 (XX-XX) Propo Employee Application for Medicare AA-6 Employee Application for Medicare (XX-XX) Proposed Final.pdf	Form and Instruction
AA-7 (XX-XX) Propo Spouse Divorced Spouse Application for Medicare AA-7 Spouse_Divorced Spouse Application for Medicare (XX-XX) Proposed.pdf	Form and Instruction
AA-7 (XX-XX) Propo Spouse Divorced Spouse Application for Medicare AA-7 Spouse_Divorced Spouse Application for Medicare (XX-XX) Proposed.pdf	Form and Instruction
AA-8 (XX-XX) Propo Widow Widower Application for Medicare - Medical Insuran AA-8 Widow_Widower Application for Medicare - Medical Insurance (Part B) Program (XX-XX) Proposed.pdf	Form and Instruction
AA-8 (XX-XX) Propo Widow Widower Application for Medicare - Medical Insuran AA-8 Widow_Widower Application for Medicare - Medical Insurance (Part B) Program (XX-XX) Proposed.pdf	Form and Instruction
AA-23 (XX-XX) Prop Application for Medicare - Medical Insurance (Part B) AA-23 Application for Medicare - Medical Insurance (Part B) (XX-XX) Proposed.pdf	Form and Instruction
AA-23 (XX-XX) Prop Application for Medicare - Medical Insurance (Part B) AA-23 Application for Medicare - Medical Insurance (Part B) (XX-XX) Proposed.pdf	Form and Instruction
AA-24 (XX-XX) Prop Application for Medicare Part B - Exceptional Conditions AA-24 Application for Medicare Part B - Exceptional Conditions (XX-XX) Proposed.pdf	Form and Instruction
AA-24 (XX-XX) Prop Application for Medicare Part B - Exceptional Conditions AA-24 Application for Medicare Part B - Exceptional Conditions (XX-XX) Proposed.pdf	Form and Instruction
AA-6 (01-18) Curre Employee Application for Medicare AA-6 (01-18).pdf	Form and Instruction
AA-6 (01-18) Curre Employee Application for Medicare AA-6 (01-18).pdf	Form and Instruction
AA-7 (01-18) Curre Spouse Divorced Spouse Application for Medicare AA-7 (01-18).pdf	Form and Instruction
AA-7 (01-18) Curre Spouse Divorced Spouse Application for Medicare AA-7 (01-18).pdf	Form and Instruction
AA-8 (01-18) Curre Widow Widower Application for Medicare - Medical Insuran AA-8 (01-18).pdf	Form and Instruction
AA-8 (01-18) Curre Widow Widower Application for Medicare - Medical Insuran AA-8 (01-18).pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Medicare

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 407 42 CFR 406

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Electronic Capability
Form and Instruction	AA-6 (XX-XX) Proposed	No	Paper Only
Form and Instruction	AA-7 (XX-XX) Proposed	No	Paper Only
Form and Instruction	AA-8 (XX-XX) Proposed	No	Paper Only
Form and Instruction	AA-23 (XX-XX) Proposed	No	Paper Only
Form and Instruction	AA-24 (XX-XX) Proposed	No	Paper Only
Form and Instruction	AA-6 (01-18) Current	No	Paper Only
Form and Instruction	AA-7 (01-18) Current	No	Paper Only
Form and Instruction	AA-8 (01-18) Current	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: RRB-20; Health Insurance and Supplementary Medical Insurance Enrollment and Premium Payment System (Medicare)

FR Citation: 79 FR 58874

Number of Respondents: 1,840

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,840	1,600	240
Annual IC Time Burden (Hours)	245	213	32
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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