[Federal Register Volume 70, Number 115 (Thursday, June 16, 2005)]
[Notices]
[Page 35140]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-11871]


=======================================================================
-----------------------------------------------------------------------

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.
    (2) Form(s) submitted: AA-104.
    (3) OMB Number: 3220-0086.
    (4) Expiration date of current OMB clearance: 07/31/2005.
    (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 and for the amount due for covered hospital 
services received in Canada.

FOR FURTHER INFORMATION CONTACT: Copies of the forms and supporting 
documents can be obtained from Charles Mierzwa, the agency clearance 
officer ((312) 751-3363) or [email protected].
    Comments regarding the information collection should be addressed 
to Ronald J. Hodapp, Railroad Retirement Board, 844 North Rush Street, 
Chicago, Illinois 60611-2092 or [email protected] 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. 05-11871 Filed 6-15-05; 8:45 am]
BILLING CODE 7905-01-P