Agency Forms Submitted for OMB Review

RAILROAD RETIREMENT BOARD

Agency Forms Submitted for OMB Review

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: Evidence of coverage Under An Employer Group

Health Plan.

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

(3) OMB Number: 3220-0189.

(4) Expiration date of current OMB clearance: November 30, 1997.

(5) Type of request: Revision of a currently approved collection.

(6) Respondents: Business or other for profit.

(7) Estimated annual number of respondents: 1,000.

(8) Total annual responses: 1,000.

(9) Total annual reporting hours: 167.

(10) Collection description: The collection obtains information

from railroad employers which is needed to determine if a railroad

retirement beneficiary is entitled to a special enrollment period when

applying for supplemental medical insurance under Medicare.

ADDITIONAL INFORMATION OR COMMENTS: Copies of the forms and supporting

documents can be obtained from Chuck 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 the OMB reviewer,

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

10230, New Executive Office Building, Washington, D.C. 20503.

Chuck Mierzwa,

Clearance Officer.

[FR Doc. 97-25661 Filed 9-25-97; 8:45 am]

BILLING CODE 7905-01-M