Request for Medicare Payment

OMB 3220-0131

OMB 3220-0131

The Railroad Retirement Board (RRB) administers the Medicare program for persons covered by the Railroad Retirement System. The collection obtains the information needed by Palmetto GBA, the RRB's carrier, to pay claims for services covered under Part B of the program.

The latest form for Request for Medicare Payment expires 2022-09-30 and can be found here.

Latest Forms, Documents, and Supporting Material
All Historical Document Collections
Extension without change of a currently approved collection 2022-09-21
Approved with change
Revision of a currently approved collection 2019-04-30
Approved without change
Extension without change of a currently approved collection 2016-03-28
Approved without change
Revision of a currently approved collection 2012-11-20
Approved without change
Revision of a currently approved collection 2009-09-25
Approved without change
Extension without change of a currently approved collection 2006-07-11
Approved without change
Extension without change of a currently approved collection 2003-08-21
Approved without change
Extension without change of a currently approved collection 2002-08-15
Approved without change
Extension without change of a currently approved collection 1999-06-30
Approved without change
Extension without change of a currently approved collection 1996-06-25
Approved without change
Extension without change of a currently approved collection 1993-06-02
Approved without change
Extension without change of a currently approved collection 1992-01-31
Approved without change
Revision of a currently approved collection 1991-04-03
Approved with change
No material or nonsubstantive change to a currently approved collection 1989-04-03
Approved without change
Revision of a currently approved collection 1988-11-22
Approved with change
No material or nonsubstantive change to a currently approved collection 1988-02-11
Approved with change
No material or nonsubstantive change to a currently approved collection 1987-10-02
Approved with change
No material or nonsubstantive change to a currently approved collection 1986-09-30
Approved without change
Revision of a currently approved collection 1985-10-01
Approved with change
No material or nonsubstantive change to a currently approved collection 1985-09-09
Approved with change
No material or nonsubstantive change to a currently approved collection 1984-08-22
Approved without change
Revision of a currently approved collection 1982-09-03
Approved without change
New collection (Request for a new OMB Control Number) 1981-07-16

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