[Federal Register Volume 67, Number 106 (Monday, June 3, 2002)]
[Notices]
[Page 38300]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-13770]


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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 Proposal(s)

    (1) Collection title: Application for Reimbursement for Hospital 
Services in Canada.
    Form(s) submitted: AA-104.
    (3) OMB Number: 3220-0086.
    (4) Expiration date of current OMB clearance: 7/30/2002.
    (5) Type of request: Extension of a currently approved collection.
    (6) Respondents: Individuals or households.
    (7) Estimated annual number of respondents: 50.
    (8) Total annual responses: 50.
    (9) Total annual reporting hours: 8.
    (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 forms 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 to the 
OMB Desk Officer for the RRB, at the Office of Management and Budget, 
Room 10230, New Executive Office Building, Washington, DC 20503.

Chuck Mierzwa,
Clearance Officer.
[FR Doc. 02-13770 Filed 5-31-02; 8:45 am]
BILLING CODE 7905-01-M