96-17253. Agency Forms Submitted for OMB Review

[Federal Register Volume 61, Number 131 (Monday, July 8, 1996)]
[Notices]
[Page 35820]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-17253]


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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 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: Request for Review of Part B Medicare Claim.
    (2) Form(s) submitted: G-790, G-791.
    (3) OMB Number: 3220-0100.
    (4) Expiration date of current OMB clearance: July 31, 1996.
    (5) Type of request: Extension of a currently approved collection.
    (6) Respondents: Individuals or households.
    (7) Estimated annual number of respondents: 4,000.
    (8) Total annual responses: 4,100.
    (9) Total annual reporting hours: 1,025.
    (10) Collection description: The Railroad Retirement Board 
administers the Medicare program for persons covered by the railroad 
retirement system. The request provides the means for obtaining reviews 
by the MetraHealth Insurance Company on claims for Part B Medicare 
benefits.

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. 96-17253 Filed 7-5-96; 8:45 am]
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