05-1670. Proposed Collection; Comment Request

SUMMARY:

In accordance with the requirement of section 3506 (c)(2)(A) of the Paperwork Reduction Act of 1995 which provides opportunity for public comment on new or revised data collections, the Railroad Retirement Board (RRB) will publish periodic summaries of proposed data collections.

Comments are invited on: (a) Whether the proposed information collection is necessary for the proper performance of the functions of the agency, including whether the information has practical utility; (b) the accuracy of the RRB's estimate of the burden of the collection of the information; (c) ways to enhance the quality, utility, and clarity of the information to be collected; and (d) ways to minimize the burden related to the collection of information on respondents, including the use of automated collection techniques or other forms of information technology.

Title and Purpose of Information Collection: Medical Reports; OMB 3220-0038.

Under Sections 2(a)(1)(iv), 2(a)(2) and 2(a)(3) of the Railroad Retirement Act (RRA), annuities are payable to qualified railroad employees whose physical or mental condition is such that they are unable to (1) work in their regular occupation (occupational disability); or (2) work at all (permanent total disability). The requirements for establishment of disability and proof of continuance of disability are prescribed in 20 CFR part 220.

Under sections 2(c)(1)(ii)(c) and 2(d)(1)(ii) of the RRA, annuities are also payable to qualified spouses and widow(ers), respectively, who have a qualified child who is under a disability which began before age 22. Annuities are also payable to surviving children on the basis of disability under section 2(d)(1)(iii)(C) if the child's disability began before age 22 and to widow(ers) on the basis of disability under section 2(d)(1) (i)(B). To meet the disability standard, the RRA provides that individuals must have a permanent physical or mental condition such that they are unable to engage in any regular employment.

Under section 2(d)(1)(v) of the RRA, annuities are also payable to remarried and surviving divorced spouses on the basis of, inter alia, disability or having a qualified disabled child in care. However, the disability standard in these cases is that found in the Social Security Act. That is, individuals must be able to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment. The RRB also determines entitlement to a period of early disability and early Medicare entitlement for qualified claimants in accordance with Section 216 of the Social Security Act.

When making disability determinations, the RRB needs evidence from acceptable medical sources. The RRB currently utilizes Forms G-3EMP, Report of Medical Condition by Employer; G-250, Medical Assessment; G-250a, Medical Assessment of Residual Functional Capacity; G-260, Report of Seizure Disorder; RL-11b, Disclosure of Hospital Medical Records; and RL-11d, Disclosure of Medical Records from a State Agency; to obtain the necessary medical evidence.

The RRB proposes significant changes to the information collection. The primary change is to add proposed Form G-197, Authorization to Release Medical Information, to the information collection. Proposed Form G-197 will be the standard Health Insurance Portability and Accountability Act (HIPAA) compliant release form used by the RRB to obtain consent for the release of medical evidence under the RRA. The RRB also proposes to revise, renumber, and rename current Form G-250 to proposed Form RL-250, Request for Medical Assessment. Currently, Form G-250, requests a narrative report, copies of office records of the claimant's treatment, requests completion of Form G-250a, and includes a consent statement that the claimant must sign. Proposed Form RL-250 will not request the narrative report nor contain a consent statement. A new Form G-250, titled Medical Assessment is proposed. It is intended to provide more complete information while being more user-friendly by formatting responses into a question and answer format by body system being evaluated. Forms G-3EMP, and RL-11b are being revised to delete the consent portions from the versions currently in use. Minor editorial changes are proposed to Form G-250a which will continue to be used by agency hearings officers as a means to clarify, when necessary, information previously received or to obtain precise information needed to make a residual functional capacity determination. No changes are proposed to Form G-260. Completion is voluntary. One response is requested of each respondent.

Estimate of Respondent Burden

Form No.	Annual response	Time (min)	Burden (hours)
G-3EMP	600	10	100
G-197	6,000	10	1,000
G-250	11,950	30	5,975
G-250a	50	20	17
G-260	100	25	42
RL-11b	5,000	10	833
RL-250	11,950	10	1,992
Total	35,900		9,501

FOR FURTHER INFORMATION CONTACT:

To request more information or to obtain a copy of the information collection justification, forms, and/or supporting material, please call the RRB Clearance Officer at [phone] or send an e-mail request to [e-mail]. Comments regarding the information collection should be addressed to Ronald J. Hodapp, Railroad Retirement Board, 844 North Rush Street, Chicago, Illinois 60611-2092 or send an e-mail to [e-mail]. Written comments should be received within 60 days of this notice.

Charles Mierzwa,

Clearance Officer.