OMB control number

Medicare Request for Retirement Benefit Information (CMS-R-285)

OMB 0938-0769 · HHS/CMS.

OMB 0938-0769

This information is needed to determine whether a beneficiary meets the requirements for reduction of the Part A premium to zero.

The latest form for Medicare Request for Retirement Benefit Information (CMS-R-285) expires 2027-11-30 and is listed under ICR 202408-0938-005.

Latest forms, documents, and information collections
Document	Type
Form CMS-R-285 Request for Retirement Benefit Informatin	Form
CMS-R-285 - Supporting Statement A_.docx	Supporting Statement A
Response to Comments OMB 0938 0769.docx	Supplementary Document
Crosswalk of Changes CMS R285_508.pdf	Supplementary Document
Justification - Use of SSN.docx	Supplementary Document
Request for Retirement Benefit Informatin	Form

Historical document collections
Reference	Filing	Received	Action
202408-0938-005	Reinstatement with change of a previously approved collection	2024-08-08
202012-0938-017	Extension without change of a currently approved collection	2020-12-29
201707-0938-005	Reinstatement without change of a previously approved collection	2017-07-14	Approved with change
201309-0938-016	Reinstatement without change of a previously approved collection	2013-09-13	Approved without change
200903-0938-005	Extension without change of a currently approved collection	2009-03-10	Approved without change
200601-0938-001	Extension without change of a currently approved collection	2006-01-06	Approved without change
200301-0938-007	Extension without change of a currently approved collection	2003-01-06	Approved with change
199911-0938-007	Extension without change of a currently approved collection	1999-11-19	Approved without change
199905-0938-007	New collection (Request for a new OMB Control Number)	1999-05-21	Approved without change