70 FR 139 pg. 42113 - Submission for OMB Review; Comment Request for Review of a Revised Information Collection: RI 78-11
Type: NOTICEVolume: 70Number: 139Page: 42113
FR document: [FR Doc. 05-14239 Filed 7-20-05; 8:45 am]
Agency: OFFICE OF PERSONNEL MANAGEMENT
Official PDF Version: PDF Version
OFFICE OF PERSONNEL MANAGEMENT
Submission for OMB Review; Comment Request for Review of a Revised Information Collection: RI 78-11
AGENCY:
Office of Personnel Management.
ACTION:
Notice.
SUMMARY:
In accordance with the Paperwork Reduction Act of 1995 (Pub. L. 104-13, May 22, 1995), this notice announces that the Office of Personnel Management (OPM) has submitted to the Office of Management and Budget a request for review of a revised information collection. RI 78-11, Medicare Part B Certification, collects information from annuitants, their spouses, and survivor annuitants to determine their eligibility under the Retired Federal Employees Health Benefits Program for a Government contribution toward the cost of Part B of Medicare.
Approximately 100 RI 78-11 forms are completed annually. Each form requires approximately 10 minutes complete. The annual estimated burden is 17 hours.
For copies of this proposal, contact Mary Beth Smith-Toomey on (202) 606-8358, FAX (202) 418-3251 or via e-mail to mbtoomey@opm.gov. Please include a mailing address with your request.
DATES:
Comments on this proposal should be received within 30 calendar days from the date of this publication.
ADDRESSES:
Send or deliver comments to-
Pamela S. Israel, Chief, Operations Support Group, Retirement Services Programs, U.S. Office of Personnel Management, 1900 E Street, NW., Room 3349, Washington, DC 20415; and
Brenda Aguilar, OPM Desk Officer, Office of Information and Regulatory Affairs, Office of Management and Budget, New Executive Office Building, NW., Room 10235, Washington, DC 20503.
FOR FURTHER INFORMATION CONTACT:
Cyrus S. Benson, Team Leader, Publications Team, RIS Support Services/Support Group, (202) 606-0623.
Office of Personnel Management.
Linda M. Springer,
Director.
[FR Doc. 05-14239 Filed 7-20-05; 8:45 am]
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