[Federal Register Volume 74, Number 185 (Friday, September 25, 2009)]
[Notices]
[Pages 49046-49047]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-23196]


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RAILROAD RETIREMENT BOARD


Agency Forms Submitted for OMB Review, Request for Comments

Summary

    In accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. 
Chapter 35), the Railroad Retirement Board (RRB) is forwarding an 
Information Collection Request (ICR) to the Office of Information and 
Regulatory Affairs (OIRA), Office of Management and Budget (OMB) to 
request a revision to a currently approved collection of information. 
Our ICR describes the information we seek to collect from the public. 
Review and approval by OIRA ensures that we impose appropriate 
paperwork burdens.
    The RRB invites comments on the proposed collections of information 
to determine (1) the practical utility of the collections; (2) the 
accuracy of the estimated burden of the collections; (3) ways to 
enhance the quality, utility and clarity of the information that is the 
subject of collection; and (4) ways to minimize the burden of 
collections on respondents, including the use of automated collection 
techniques or other forms of information technology. Comments to RRB or 
OIRA must contain the OMB control number of the ICR. For proper 
consideration of your comments, it is best if RRB and OIRA receive them 
within 30 days of publication date.

Request for Medicare Payment; OMB 3220-0131

    Under section 7(d) of the Railroad Retirement Act, the RRB 
administers the Medicare program for persons covered by the railroad 
retirement system. The collection obtains the information needed by 
Palmetto GBA, the Medicare carrier for railroad retirement 
beneficiaries, to pay claims for payments under Part B of the Medicare 
program. Authority for collecting the information is prescribed in 42 
CFR 424.32.
    The RRB currently utilizes Forms G-740S, Patient's Request for 
Medicare Payment, (along with Centers for Medicare and Medicaid 
Services Form CMS-1500) to secure the information necessary to pay Part 
B Medicare Claims. One response is completed for each claim. Completion 
is required to obtain a benefit.

Information Collection Request (ICR)

    Title: Request for Medicare Payment.
    OMB Control Number: OMB 3220-0131.
    Form(s) submitted: G-740S, CMS-1500.
    Expiration date of current OMB clearance: 9/30/2009.
    Type of request: Revision of a currently approved collection.
    Affected public: Individuals or households.
    Abstract: The Railroad Retirement Board (RRB) administers the 
Medicare program for persons covered by the Railroad Retirement System. 
The collection obtains the information needed by Palmetto GBA, the 
RRB's carrier, to pay claims for services covered under part B of the 
program.

[[Page 49047]]

    Changes Proposed: The RRB proposes non-burden impacting editorial 
changes to Form G-740S.
    The total burden estimate for the ICR is as follows:
    Estimated annual number of respondents: See Justification (Item 
No.12).
    Total annual responses: 1.
    Total annual reporting hours: 1.
    Additional Information or Comments: Copies of the form and 
supporting documents can be obtained from Charles Mierzwa, the agency 
clearance officer at (312-751-3363) or <a href="/cdn-cgi/l/email-protection#4b08232a39272e386506222e39313c2a0b393929652c243d"><span class="__cf_email__" data-cfemail="e5a68d8497898096cba88c80979f9284a5979787cb828a93">[email protected]</span></a>.
    Comments regarding the information collection should be addressed 
to Ronald J. Hodapp, Railroad Retirement Board, 844 North Rush Street, 
Chicago, Illinois, 60611-2092 or <a href="/cdn-cgi/l/email-protection#7e2c11101f121a5036111a1f0e0e3e0c0c1c50191108"><span class="__cf_email__" data-cfemail="25774a4b4449410b6d4a41445555655757470b424a53">[email protected]</span></a> 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. E9-23196 Filed 9-24-09; 8:45 am]
BILLING CODE 7905-01-P


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