Document Headings

                    Document headings vary by document type but may contain                    the following:                  
                -                       the agency or agencies that issued and signed a document                    
                -                       the number of the CFR title and the number of each part                      the document amends, proposes to amend, or is directly                      related to                    
                -                       the agency docket number / agency internal file number                    
                -                       the RIN which identifies each regulatory action listed in                      the Unified Agenda of Federal Regulatory and Deregulatory                      Actions                    

                    See the                                          Document Drafting Handbook                                        for more details.                  

###### Railroad Retirement Board

*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