99-13533. Agency Forms Submitted for OMB Review

[Federal Register Volume 64, Number 102 (Thursday, May 27, 1999)]
[Notices]
[Page 28844]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-13533]


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RAILROAD RETIREMENT BOARD


Agency Forms Submitted for OMB Review

SUMMARY: In accordance with the Paperwork Reduction Act of 1995 (44 
U.S.C. Chapter 35), the Railroad Retirement Board (RRB) has submitted 
the following proposal(s) for the collection of information to the 
Office of Management and Budget for review and approval.

Summary of Proposals

    (1) Collection title: Application for Reimbursement for Hospital 
Services in Canada.

    (2) Form(s) submitted: AA-104.
    (3) OMB Number: 3220-0086.
    (4) Expiration date of current OMB clearance: 7/31/1999.
    (5) Type of request: Extension of a currently approved collection.
    (6) Respondents: Individuals or households.
    (7) Estimated annual number of respondents: 35.
    (8) Total annual responses: 35.
    (9) Total annual reporting hours: 6.
    (10) Collection description: The Railroad Retirement Board 
administers the Medicare program for persons covered by the Railroad 
Retirement system. The collection obtains the information needed to 
determine eligibility for and the amount due for covered hospital 
services received in Canada.
ADDITIONAL INFORMATION OR COMMENTS: Copies of the form and supporting 
documents can be obtained from Chuck Mierzwa, the agency clearance 
officer (312-751-3363). Comments regarding the information collection 
should be addressed to Ronald J. Hodapp, Railroad Retirement Board, 844 
North Rush Street, Chicago, Illinois 60611-2092 and the OMB reviewer, 
Laurie Schack (202-395-7316), Office of Management and Budget, Room 
10230, New Executive Office Building, Washington, D.C. 20503.
Chuck Mierzwa,
Clearance Officer.
[FR Doc. 99-13533 Filed 5-26-99; 8:45 am]
BILLING CODE 7905-01-M