Medicare

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 2021-06-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form AA-6 (01-12) Medicare Form and Instruction
Form RL-311-F (01-18) Employer Coverage Under an Employer Group Health Plan Form and Instruction
Request OMB Approval of NonSubstatative Change to ICR 3220-0082_Signed.pdf Justification for No Material/Nonsubstantive Change
3220-0082.docx Supporting Statement A
CMS-L564(8-20).pdf Supplementary Document
Form G-346 (03-18).pdf Supplementary Document
Form RL-9 (07-02).pdf Supplementary Document
Form RB-20 (01-18).pdf Supplementary Document
Form RB-3 (11-08).pdf Supplementary Document
Medicare Form and Instruction
Employer Coverage Under an Employer Group Health Plan Form and Instruction

All Historical Document Collections

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

OMB Details

Medicare

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Form AA-6 (01-12)	Employee Application for Medicare	Paper Only	Form and instruction
Form AA-8 (01-12)	Widow/Widower Application for Medicare	Paper Only	Form and instruction
Form AA-7 (01-12)	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.