Agency Forms Submitted for OMB Review

[Federal Register Volume 64, Number 185 (Friday, September 24, 1999)]
[Notices]
[Page 51809]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-24870]


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RAILROD 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: 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: 11/30/1999.
    (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 UnitedHealthcare 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, Laurie Schack (202-395-
7316), Office of Management and Budget, Room 10230, New Executive 
Office Building, Washington, DC 20503.
Chuck Mierzwa,
Clearance Officer.
[FR Doc. 99-24870 Filed 9-23-99; 8:45 am]
BILLING CODE 7905-01-M