Proposed Collection; Comment Request

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RAILROAD RETIREMENT BOARD

Proposed Collection; Comment Request

SUMMARY: In accordance with the requirement of Section 3506(c)(2)(A) of

the Paperwork Reduction Act of 1995 which provides opportunity for

public comment on new or revised data collections, the Railroad

Retirement Board (RRB) will publish periodic summaries of proposed data

collections.

Comments are invited on: (a) Whether the proposed information

collection is necessary for the proper performance of the functions of

the agency, including whether the information has practical utility;

(b) the accuracy of the RRB's estimate of the burden of the collection

of the information; (c) ways to enhance the quality, utility, and

clarity of the information to be collected; and (d) ways to minimize

the burden related to the collection of information on respondents,

including the use of automated collection techniques or other forms of

information technology.

Title and Purpose of information collection:

Application for Reimbursement for Hospital Insurance Services in

Canada; OMB 3220-0086.

Under Section 7(d) of the Railroad Retirement Act (RRA), the RRB

administers the Medicare program for persons covered by the railroad

retirement system. Payments are provided, under Section 7(d)(4) of the

RRA, for medical services furnished in Canada to the same extent as for

those furnished in the United States. However, payments for the

services furnished in Canada are made from the Railroad Retirement

Account rather than from the Federal Hospital Insurance Trust Fund,

with the payments limited to the amount by which insurance benefits

under Medicare exceed the amounts payable under Canadian Provincial

plans.

Form AA-104, Application for Canadian Hospital Benefits Under

Medicare--Part A, is provided by the RRB for use in claiming benefits

for covered hospital services received in Canada. The form obtains

information needed to determine eligibility for, and the amount of any

reimbursement due the applicant. One response is requested of each

respondent. Completion is required to obtain a benefit.

The RRB proposes minor editorial changes to RRB Form AA-104.

Estimate of Annual Respondent Burden

The estimated annual respondent burden is as follows:

------------------------------------------------------------------------

Annual Burden

Form No.(s) responses Time (min.) (hrs.)

------------------------------------------------------------------------

AA-104........................... 45 10 8

------------------------------------------------------------------------

ADDITIONAL INFORMATION OR COMMENTS: To request more information or to

obtain a copy of the information collection justification, forms, and/

or supporting material, please call the RRB Clearance Officer at (312)

751-3363. Comments regarding the information collection should be

addressed to Ronald J. Hodapp, Railroad Retirement Board, 844 N. Rush

Street, Chicago, Illinois 60611-2092. Written comments should be

received within 60 days of this notice.

Chuck Mierzwa,

Clearance Officer.

[FR Doc. 96-6169 Filed 3-14-96; 8:45 am]

BILLING CODE 7905-01-M