OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Request for Medicare Payment

OMB 3220-0131 · RRB.

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 2029-05-31 and can be found here.

Latest Forms, Documents, and Supporting Material
Document
Name
Form and Instruction
Form and Instruction
Supporting Statement A
Supporting Statement B
All Historical Document Collections
 Revision of a currently approved collection 2026-01-26
Approved without change
 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