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 can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
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-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-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-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 (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
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-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
3220-0082_Final.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
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

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 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 (01-18) 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.