[Federal Register Volume 69, Number 219 (Monday, November 15, 2004)]
[Notices]
[Page 65662]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-25290]


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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: 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: 02/28/2005.
    (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 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.

Additional Information or Comments

    Copies of the forms and supporting documents can be obtained from 
Charles 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.

Charles Mierzwa,
Clearance Officer.
[FR Doc. 04-25290 Filed 11-12-04; 8:45 am]
BILLING CODE 7905-01-P