OMB control number

Medicare

OMB 3220-0082 · RRB.

OMB 3220-0082

The Railroad Retirement Board administers the Medicare program for persons covered by the railroad retirement system. The forms in the collection obtain both information needed to enroll non-retired employees and survivor applicants in the plan and information from railroad employers needed to determine if a railroad retirement beneficiary is entitled to a special enrollment period when applying for supplemental medical coverage under Medicare.

The latest form for Medicare expires 2028-05-31 and is listed under ICR 202606-3220-013.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form AA-8 (01-18) Curre Widow Widower Application for Medicare - Medical Insurance (Part B) Program	Form and Instruction
Form AA-8 (01-18) Curre Widow Widower Application for Medicare - Medical Insurance (Part B) Program	Form and Instruction
Form AA-7 (01-18) Curre Spouse Divorced Spouse Application for Medicare	Form and Instruction
Form AA-7 (01-18) Curre Spouse Divorced Spouse Application for Medicare	Form and Instruction
Form AA-6 (01-18) Curre Employee Application for Medicare	Form and Instruction
Form AA-6 (01-18) Curre Employee Application for Medicare	Form and Instruction
Form AA-24 (XX-XX) Prop Application for Medicare Part B - Exceptional Conditions	Form and Instruction
Form AA-24 (XX-XX) Prop Application for Medicare Part B - Exceptional Conditions	Form and Instruction
Form AA-23 (XX-XX) Prop Application for Medicare - Medical Insurance (Part B)	Form and Instruction
Form AA-23 (XX-XX) Prop Application for Medicare - Medical Insurance (Part B)	Form and Instruction
Form AA-8 (XX-XX) Propo Widow Widower Application for Medicare - Medical Insurance (Part B) Program	Form and Instruction
Form AA-8 (XX-XX) Propo Widow Widower Application for Medicare - Medical Insurance (Part B) Program	Form and Instruction
Form AA-7 (XX-XX) Propo Spouse Divorced Spouse Application for Medicare	Form and Instruction
Form AA-7 (XX-XX) Propo Spouse Divorced Spouse Application for Medicare	Form and Instruction
Form AA-6 (XX-XX) Propo Employee Application for Medicare	Form and Instruction
Form RL-311F (XX-XX) Pr Evidence of Coverage Under an Employee Group Health Plan	Form and Instruction
Form RL-311F (XX-XX) Pr Evidence of Coverage Under an Employee Group Health Plan	Form and Instruction
Form RL-311F (08-22) Cu Evidence of Coverage Under an Employee Group Health Plan	Form and Instruction
Form RL-311F (08-22) Cu Evidence of Coverage Under an Employee Group Health Plan	Form and Instruction
3220-0082_Nonsubstantive Changes to the Forms in the ICR.docx	Justification for No Material/Nonsubstantive Change
3220-0082_Nonsubstantive Changes to the Forms in the ICR.docx	Justification for No Material/Nonsubstantive Change
RL-311f (XX-XX) Proposed.pdf	Supplementary Document
RL-311f (XX-XX) Proposed.pdf	Supplementary Document
AA-23 (XX-XX) Proposed.pdf	Supplementary Document
AA-23 (XX-XX) Proposed.pdf	Supplementary Document
AA-8 (XX-XX) Proposed.pdf	Supplementary Document
AA-8 (XX-XX) Proposed.pdf	Supplementary Document
AA-7 (XX-XX) Proposed.pdf	Supplementary Document
AA-7 (XX-XX) Proposed.pdf	Supplementary Document
AA-6 (XX-XX) Proposed.pdf	Supplementary Document
AA-6 (XX-XX) Proposed.pdf	Supplementary Document
Request OMB Approval of NonSubstatative Change to ICR 3220-0082_Signed.pdf	Supplementary Document
Request OMB Approval of NonSubstatative Change to ICR 3220-0082_Signed.pdf	Supplementary Document
3220-0082_Final.docx	Supporting Statement A
3220-0082_Final.docx	Supporting Statement A
CMS-L564(8-20).pdf	Supplementary Document
CMS-L564(8-20).pdf	Supplementary Document
Form G-346 (03-18).pdf	Supplementary Document
Form G-346 (03-18).pdf	Supplementary Document
Form RL-9 (07-02).pdf	Supplementary Document
Form RL-9 (07-02).pdf	Supplementary Document
Form RB-20 (01-18).pdf	Supplementary Document
Form RB-20 (01-18).pdf	Supplementary Document
Form RB-3 (11-08).pdf	Supplementary Document
Form RB-3 (11-08).pdf	Supplementary Document
Medicare	Form and Instruction
Medicare	Form and Instruction
Medicare	Form and Instruction
Medicare	Form and Instruction
Medicare	Form and Instruction
Medicare	Form and Instruction
Medicare	Form and Instruction
Medicare	Form and Instruction
Medicare	Form and Instruction
Medicare	Form and Instruction
Medicare	Form and Instruction
Medicare	Form and Instruction
Medicare	Form and Instruction
Medicare	Form and Instruction
Medicare	Form and Instruction
Medicare	Form and Instruction
Employer Coverage Under an Employer Group Health Plan	Form and Instruction
Employer Coverage Under an Employer Group Health Plan	Form and Instruction
Employer Coverage Under an Employer Group Health Plan	Form and Instruction
Employer Coverage Under an Employer Group Health Plan	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202606-3220-013	No material or nonsubstantive change to a currently approved collection	2026-06-16
202411-3220-012	Reinstatement with change of a previously approved collection	2025-04-02
202206-3220-004	No material or nonsubstantive change to a currently approved collection	2022-06-08	Approved without change
202106-3220-003	Revision of a currently approved collection	2021-06-30	Approved without change
201804-3220-005	Extension without change of a currently approved collection	2018-04-18	Approved without change
201501-3220-002	Extension without change of a currently approved collection	2015-02-11	Approved without change
201201-3220-001	Extension without change of a currently approved collection	2012-01-23	Approved without change
200810-3220-002	Revision of a currently approved collection	2008-12-22	Approved without change
200510-3220-004	Revision of a currently approved collection	2005-10-27	Approved without change
200211-3220-001	Revision of a currently approved collection	2002-11-22	Approved without change
200012-3220-001	No material or nonsubstantive change to a currently approved collection	2000-12-06	Approved without change
200008-3220-001	Revision of a currently approved collection	2000-08-02	Approved without change
199705-3220-002	Extension without change of a currently approved collection	1997-05-08	Approved without change
199404-3220-002	Extension without change of a currently approved collection	1994-04-04	Approved without change
199402-3220-002	No material or nonsubstantive change to a currently approved collection	1994-02-08	Approved with change
199112-3220-002	Revision of a currently approved collection	1991-12-03	Approved without change
198808-3220-002	Revision of a currently approved collection	1988-08-31	Approved without change
198507-3220-005	Revision of a currently approved collection	1985-07-31	Approved without change
198207-3220-001	Revision of a currently approved collection	1982-07-19	Approved without change
197704-3220-001	Extension without change of a currently approved collection	1977-04-26	Approved without change
197504-3220-009	No material or nonsubstantive change to a currently approved collection	1975-04-05	Approved with change

OMB Details

Medicare

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Information collection instruments
Form	Name	Electronic access	Type
Form AA-6 (01-18) Current	Employee Application for Medicare	Paper Only	Form and instruction
Form AA-8 (01-18) Current	Widow Widower Application for Medicare - Medical Insurance (Part B) Program	Paper Only	Form and instruction
Form AA-7 (01-18) Current	Spouse Divorced Spouse Application for Medicare	Paper Only	Form and instruction
Form AA-23 (XX-XX) Proposed	Application for Medicare - Medical Insurance (Part B)	Paper Only	Form and instruction
Form AA-24 (XX-XX) Proposed	Application for Medicare Part B - Exceptional Conditions	Paper Only	Form and instruction
Form AA-8 (XX-XX) Proposed	Widow Widower Application for Medicare - Medical Insurance (Part B) Program	Paper Only	Form and instruction
Form AA-6 (XX-XX) Proposed	Employee Application for Medicare	Paper Only	Form and instruction
Form AA-7 (XX-XX) Proposed	Spouse Divorced Spouse Application for Medicare	Paper Only	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.