70 FR 67 pg. 18064 - Agency Forms Submitted for OMB Review

Type: NOTICEVolume: 70Number: 67Page: 18064
FR document: [FR Doc. 05-7035 Filed 4-7-05; 8:45 am]
Agency: Railroad Retirement Board
Official PDF Version:  PDF Version


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 : Medical Reports.

(2) Form(s) submitted : G-3EMP, G-197, G-250, G-250a, G-260, RL-11b, RL-11d and RL-250.

(3) OMB Number : 3220-0038.

(4) Expiration date of current OMB clearance : November 30, 2005.

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

(6) Respondents : Businesses or other for-profit, Non-profit institutions, State, Local or Tribal Government.

(7) Estimated annual number of respondents : 35,900.

(8) Total annual responses : 35,900.

(9) Total annual reporting hours : 10,001.

(10) Collection description : The Railroad Retirement Act provides disability annuities for qualified railroad employees whose physical or mental condition renders them incapable of working in their regular occupation (occupational disability) or any occupation (total disability). The medical reports obtain information needed for determining the nature and severity of the impairment.

Additional Information or Comments : Copies of the forms and supporting documents can be obtained from Charles Mierzwa, the agency clearance officer (312-751-3363) or Charles.Mierzwa@rrb.gov .

Comments regarding the information collection should be addressed to RonaldJ. Hodapp, Railroad Retirement Board, 844 North Rush Street, Chicago, Illinois, 60611-2092 or Ronald.Hodapp@rrb.gov and to the OMB Desk Officer for the RRB, at the Office of Management and Budget, Room 10230, New Executive Office Building, Washington, DC 20503.

Charles Mierzwa,

Clearance Officer.

[FR Doc. 05-7035 Filed 4-7-05; 8:45 am]