Agency Forms Submitted for OMB Review

RAILROAD RETIREMENT BOARD

Agency Forms Submitted for OMB Review

SUMMARY: In accordance with the Paperwork Reduction Act of 1980 (44

U.S.C. Chapter 35), the Railroad Retirement Board 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: Evidence of Coverage Under An Employer Group

Health Plan

(2) Form(s) submitted: RL-311-F

(3) OMB Number: New Collection

(4) Expiration date of current OMB clearance: Three years from date of

OMB approval

(5) Type of request: New Collection

(6) Frequency of response: On occasion

(7) Respondents: Individuals or households, Businesses or other for-

profit

(8) Estimated annual number of respondents: 300

(9) Total annual responses: 600

(10) Average time per response: .16667 hours

(11) Total annual reporting hours: 100

(12) Collection description: The collection obtains information from

employers which is needed by the Railroad Retirement Board for

determining if a railroad retirement beneficiary is entitled to a

special enrollment period when applying for supplementary medical

insurance coverage under Medicare.

ADDITIONAL INFORMATION OR COMMENTS: Copies of the form and supporting

documents can be obtained from Dennis Eagan, the agency clearance

officer (312-751-4693). 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,

Laura Oliven (202-395-7316), Office of Management and Budget, Room

3002, New Executive Office Building, Washington, DC 20503.

Dennis Eagan,

Clearance Officer.

[FR Doc. 94-18699 Filed 8-1-94; 8:45 am]

BILLING CODE 7905-01-M