95-15919. Agency Forms Submitted for OMB Review

[Federal Register Volume 60, Number 125 (Thursday, June 29, 1995)]
[Notices]
[Page 33884]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-15919]



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RAILROAD RETIREMENT BOARD

Agency Forms Submitted for OMB Review

SUMMARY: In accordance with the Paperwork Reduction Act of 1980 (44 
U.S.C. Chapter 35), the Railroad Retirement Board has submitted the 
following proposal(s) for the collection of information to the Office 
of Management and Budget for review and approval.

SUMMARY OF PROPOSAL(S):

    (1) Collection title: Report of Medicaid State Office on 
Beneficiary's Buy-in Status
    (2) Form(s) submitted: RL-380-F
    (3) OMB Number: 3220-0185
    (4) Expiration date of current OMB clearance: September 30, 1995
    (5) Type of request: Extension of a currently approved 
collection
    (6) Respondents: State, Local or Tribal Government
    (7) Estimated annual number of respondents: 600
    (8) Total annual responses: 600
    (9) Total annual reporting hours: 100
    (10) Collection description: Under the Railroad Retirement Act, 
the Railroad Retirement Board administers the Medicare program for 
persons covered by the railroad retirement system. The collection 
obtains information needed to determine if certain railroad 
beneficiaries are entitled to receive Supplementary Medical 
Insurance program coverage under a State buy-in agreement in States 
in which they reside.

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, 
Laura Oliven (202-395-7316), Office of Management and Budget, Room 
10230, New Executive Office Building, Washington, D.C. 20503.
Chuck Mierzwa,
Clearance Officer.
[FR Doc. 95-15919 Filed 6-28-95; 8:45 am]
BILLING CODE 7905-01-M