99-16844. Agency Forms Submitted for OMB Review

[Federal Register Volume 64, Number 127 (Friday, July 2, 1999)]
[Notices]
[Page 36052]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-16844]


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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 sumitted 
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: Request for Medicare Payment.
    (2) Form(s) submitted: G-740s,-HCFA-1500.
    (3) OMB Number: 3220-0131.
    (4) Expiration date of current OMB clearance: 08/31/1999.
    (5) Type of request: Extension of a currently approved collection.
    (6) Respondents: Individuals or households, business or other for-
profit.
    (7) Estimated annual number of respondents: See Justification (Item 
No. 12).
    (8) Total annual responses: 1.
    (9) Total annual reporting hours: 1.
    (10) Collection description: The Railroad Retirement Board (RRB) 
administers the Medicare program for persons covered by the Railroad 
Retirement System. The collection obtains the information needed by the 
United Healthcare Insurance Company, the RRB's carrier, to pay claims 
for services covered under Part B of the program.
    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, DC 
20503.
Chuck Mierzwa,
Clearance Officer.
[FR Doc. 99-16844 Filed 7-1-99; 8:45 am]
BILLING CODE 7905-01-M