2011-3715. Agency Forms Submitted for OMB Review, Request for Comments

SUMMARY:

In accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. chapter 35), the Railroad Retirement Board (RRB) is forwarding an Information Collection Request (ICR) to the Office of Information and Regulatory Affairs (OIRA), Office of Management and Budget (OMB) to request an extension without change of a currently approved collection of information: 3220-0185, Report of Medicaid State Office on Beneficiary's Buy-In Status consisting of Form RL-380-F, Report to State Medicaid Office. Our ICR describes the information we seek to collect from the public. Review and approval by OIRA ensures that we impose appropriate paperwork burdens.

The RRB invites comments on the proposed collection of information to determine (1) The practical utility of the collection; (2) the accuracy of the estimated burden of the collection; (3) ways to enhance the quality, utility and clarity of the information that is the subject of collection; and (4) ways to minimize the burden of collections on respondents, including the use of automated collection techniques or other forms of information technology. Comments to RRB or OIRA must contain the OMB control number of the ICR. For proper consideration of your comments, it is best if RRB and OIRA receive them within 30 days of publication date.

Under Section 7(d) of the Railroad Retirement Act, the RRB administers the Medicare program for persons covered by the railroad retirement system. Under Section 1843 of the Social Security Act, states may enter into “buy-in agreements” with the Secretary of Health and Human Services for the purpose of enrolling certain groups of low-income individuals under the Medicare medical insurance (Part B) program and paying the premiums for their insurance coverage. Generally, these individuals are categorically needy under Medicaid and meet the eligibility requirements for Medicare Part B. States can also include in their buy-in agreements, individuals who are eligible for medical assistance only. The RRB uses Form RL-380-F, Report to State Medicaid Office, to obtain 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. Completion of Form RL-380-F is voluntary. One response is received from each respondent.

The RRB proposes no changes to Form RL-380-F.

Previous Requests for Comments: The RRB has already published the initial 60-day notice (72 FR 57078 on December 17, 2010) required by 44 U.S.C. 3506(c)(2). That request elicited no comments.

Information Collection Request (ICR)

Title: Report of Medicaid State Office on Beneficiary's Buy-In Status.

OMB Control Number: 3220-0185.

Form(s) submitted: RL-380-F.

Type of request: An extension without change of a currently approved collection.

Affected public: State, local or Tribal government.

Abstract: Under the Railroad Retirement Act, the Railroad Retirement Board administers the Medicare program for persons covered by the railroad retirement system. The collection obtains the 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.

Changes Proposed: The RRB proposes no changes to Form RL-380-F.

The burden estimate for the ICR is as follows:

Estimated Completion Time for Form(s): Completion time for Form RL-380-F is estimated at 10 minutes.

Estimated annual number of respondents: 600.

Total annual responses: 600.

Total annual reporting hours: 100.

Additional Information or Comments: Copies of the forms and supporting documents can be obtained from Charles Mierzwa, the agency clearance officer (312-751-3363) or [e-mail].

Comments regarding the information collection should be sent to Patricia A. Henaghan, Railroad Retirement Board, 844 North Rush Street, Chicago, Illinois 60611-2092 or [e-mail] and to the Office of Management Budget at ATTN: Desk Officer for RRB, FAX: [phone] or via E-mail to [e-mail].

Charles Mierzwa,

Clearance Officer.