[Federal Register Volume 81, Number 32 (Thursday, February 18, 2016)]
[Notices]
[Pages 8262-8264]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-03328]


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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 
three Information Collection Requests (ICR) to the Office of 
Information and Regulatory Affairs (OIRA), Office of Management and 
Budget (OMB). 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 the 
RRB or OIRA must contain the OMB control number of the ICR. For proper 
consideration of your comments, it is best if the RRB and OIRA receive 
them within 30 days of the publication date.
    1. Title and purpose of information collection: Application for 
Survivor Insurance Annuities; OMB 3220-0030.
    Under Section 2(d) of the Railroad Retirement Act (RRA), monthly 
survivor annuities are payable to surviving widow(er)s, parents, 
unmarried children, and in certain cases, divorced spouses, mothers 
(fathers), remarried widow(er)s, and grandchildren of deceased railroad 
employees if there are no qualified survivors of the employee 
immediately eligible for an annuity. The requirements relating to the 
annuities are prescribed in 20 CFR 216, 217, 218, and 219.
    To collect the information needed to help determine an applicant's 
entitlement to, and the amount of, a survivor annuity the RRB uses 
Forms AA-17, Application for Widow(er)'s Annuity; AA-17b, Applications 
for Determination of Widow(er)'s Disability; AA-18, Application for 
Mother's/Father's and Child's Annuity; AA-19, Application for Child's 
Annuity; AA-19a, Application for Determination of Child's Disability; 
AA-20, Application for Parent's Annuity, and electronic Forms AA-
17cert, Application Summary and Certification, and AA-17sum, 
Application Summary.
    The AA-17 application process obtains information from an applicant 
about their marital history, work history, benefits from other 
government agencies, and Medicare entitlement for a survivor annuity. 
An RRB representative interviews the applicant either at a field office 
(preferred), an itinerant point, or by telephone. During the interview, 
the RRB representative enters the information obtained into an on-line 
information system. Upon completion of the interview, the on-line 
information system generates a summary of the information that was 
provided on either Form AA-17cert, Application Summary and 
Certification, or Form AA-17sum, Application Summary, for the applicant 
to review and approve. Form AA-17cert documents approval using the 
traditional pen and ink ``wet'' signature, and Form AA-17sum, documents 
approval using the alternative signature method called Attestation. 
When the RRB representative is unable to contact the applicant in 
person or by telephone, for example, the applicant lives in another 
country, a manual version of Form AA-17 is used.
    One response is requested of each respondent. Completion of the 
forms is required to obtain a benefit.
    Previous Requests for Comments: The RRB has already published the 
initial 60-day notice (80 FR 75140 on December 1, 2015) required by 44 
U.S.C. 3506(c)(2). That request elicited no comments.

Information Collection Request (ICR)

    Title: Application for Survivor Insurance Annuities.
    OMB Control Number: 3220-0030.
    Form(s) submitted: AA-17, AA-17b, AA-17cert, AA-17sum, AA-18, AA-
19, AA-19a, and AA-20.
    Type of request: Revision of a currently approved collection.
    Affected public: Individuals or Households.
    Abstract: Under Section 2(d) of the Railroad Retirement Act, 
monthly survivor annuities are payable to surviving widow(er)s, 
parents, unmarried children, and in certain cases, divorced wives 
(husbands), mothers (fathers), remarried widow(er)s and grandchildren 
of deceased railroad employees. The collection obtains information 
needed by the RRB to determine entitlement to and the amount of the 
annuity applied for.
    Changes proposed: The RRB proposes to remove the manual version of 
Forms AA-17, AA-18, AA-19 and AA-20 from the information collection due 
to receiving less than 10 responses annually. No changes are proposed 
to Forms AA-17b and AA-19a.
    The burden estimate for the ICR is as follows:

----------------------------------------------------------------------------------------------------------------
                                                                      Annual           Time           Burden
                           Form number                               responses       (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
AA-17 Application Process:
    AA-17cert...................................................             900              20             300
    AA-17sum....................................................           2,100              19             665
AA-17b:
    (With assistance)...........................................             250              40             167
    (Without assistance)........................................              20              50              17
AA-19a:

[[Page 8263]]

 
    (Without assistance)........................................             200              45             150
    (Without assistance)........................................              15              65              16
                                                                 -----------------------------------------------
        Total...................................................           3,485  ..............           1,315
----------------------------------------------------------------------------------------------------------------

    2. Title and purpose of information collection: Application for 
Spouse Annuity Under the Railroad Retirement Act; OMB 3220-0042.
    Section 2(c) of the Railroad Retirement Act (RRA), provides for the 
payment of annuities to spouses of railroad retirement annuitants who 
meet the requirements under the RRA. The age requirements for a spouse 
annuity depend on the employee's age, date of retirement, and years of 
railroad service. The requirements relating to the annuities are 
prescribed in 20 CFR 216, 218, 219, 232, 234, and 295.
    To collect the information needed to help determine an applicant's 
entitlement to, and the amount of, a spouse annuity the RRB uses Form 
AA-3, Application for Spouse/Divorced Spouse Annuity, and electronic 
Forms AA-3cert, Application Summary and Certification, and AA-3sum, 
Application Summary.
    The AA-3 application process gathers information from an applicant 
about their marital history, work history, benefits from other 
government agencies, railroad pensions and Medicare entitlement for a 
spouse annuity. An RRB representative interviews the applicant either 
at a field office (preferred), an itinerant point, or by telephone. 
During the interview, the RRB representative enters the information 
obtained into an on-line information system. Upon completion of the 
interview, the on-line information system generates a summary of the 
information that was provided on either Form AA-3cert, Application 
Summary and Certification, or Form AA-3sum, Application Summary, for 
the applicant to review and approve. Form AA-3cert documents approval 
using the traditional pen and ink ``wet'' signature, and Form AA-3sum 
documents approval using the alternative signature method called 
Attestation. When the RRB representative is unable to contact the 
applicant in person or by telephone, for example, the applicant lives 
in another country, a manual version of Form AA-3 is used.
    One response is requested of each respondent. Completion of the 
forms is required to obtain a benefit.
    Previous Requests for Comments: The RRB has already published the 
initial 60-day notice (80 FR 75141 on December 1, 2015) required by 44 
U.S.C. 3506(c)(2). That request elicited no comments.

Information Collection Request (ICR)

    Title: Application for Spouse Annuity Under the Railroad Retirement 
Act.
    OMB Control Number: 3220-0042.
    Form(s) submitted: AA-3, AA-3cert, and AA-3sum.
    Type of request: Revision of a currently approved collection.
    Affected public: Individuals or Households.
    Abstract: The Railroad Retirement Act provides for the payment of 
annuities to spouses of railroad retirement annuitants who meet the 
requirements under the Act. The application obtains information 
supporting the claim for benefits based on being a spouse of an 
annuitant. The information is used for determining entitlement to and 
amount of the annuity applied for.
    Changes proposed: The RRB proposes to remove the manual version of 
Form AA-3, from the information collection due to receiving less than 
10 responses annually.
    The burden estimate for the ICR is as follows:

----------------------------------------------------------------------------------------------------------------
                                                                      Annual           Time           Burden
                           Form number                               responses       (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
AA-3 online process:
    AA-3cert (with assistance)..................................           4,700              30           2,350
    AA-3sum (with assistance)...................................           7,000              29           3,383
                                                                 -----------------------------------------------
        Total...................................................          11,700  ..............           5,733
----------------------------------------------------------------------------------------------------------------

    3. Title and Purpose of information collection: 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 & 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.
    Previous Requests for Comments: The RRB has already published the 
initial 60-day notice (80 FR 72998 on November 23, 2015) required by 44 
U.S.C. 3506(c)(2). That request elicited no comments.

Information Collection Request (ICR)

    Title: Request for Medicare Payment.
    OMB Control Number: 3220-0131.
    Form(s) submitted: G-740S, CMS-1500.
    Type of request: Extension without change of a currently approved 
collection.
    Affected public: Individuals or Households.
    Abstract: The 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.
    Changes proposed: The RRB proposes no changes to RRB Form G-740S.
    The burden estimate for the ICR is as follows:
    Estimated annual number of respondents: See Justification (Item No. 
12).

[[Page 8264]]

    Total annual responses: 1.
    Total annual reporting hours: 1.
    Additional Information or Comments: Copies of the forms and 
supporting documents can be obtained from Dana Hickman at (312) 751-
4981 or <a href="/cdn-cgi/l/email-protection#8bcfeae5eaa5c3e2e8e0e6eae5cbd9d9c9a5ccc4dd"><span class="__cf_email__" data-cfemail="c185a0afa0ef89a8a2aaaca0af81939383ef868e97">[email protected]</span></a>.
    Comments regarding the information collection should be addressed 
to Charles Mierzwa, Railroad Retirement Board, 844 North Rush Street, 
Chicago, Illinois, 60611-2092 or <a href="/cdn-cgi/l/email-protection#85c6ede4f7e9e0f6abc8ece0f7fff2e4c5d7d7c7abc2cad3"><span class="__cf_email__" data-cfemail="32715a53405e57411c7f5b5740484553726060701c757d64">[email protected]</span></a> and to the OMB 
Desk Officer for the RRB, Fax: 202-395-6974, Email address: 
<a href="/cdn-cgi/l/email-protection#703f3922312f2305121d190303191f1e301f1d125e151f005e171f06"><span class="__cf_email__" data-cfemail="e0afa9b2a1bfb395828d899393898f8ea08f8d82ce858f90ce878f96">[email protected]</span></a>.

Charles Mierzwa,
Chief of Information Resources Management.
[FR Doc. 2016-03328 Filed 2-17-16; 8:45 am]
 BILLING CODE 7905-01-P


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