ICR Documents

Supporting Statement A Document Date Uploaded 3220-0082_Final.docx 04/02/2025 Supporting Statement B Document Date Uploaded Supplementary Documents Title Document Document Type Date Uploaded Furnishing Evidence to Support Your Claim Form RB-3 (11-08).pdf Supplementary Document 01/08/2015 Medicare for Railroad Workers and Their Families Form RB-20 (01-18).pdf Supplementary Document 04/17/2018 Cover Letter for Medicare Applications Form RL-9 (07-02).pdf Supplementary Document 01/08/2015 Employee's Certification Form G-346 (03-18).pdf Supplementary Document 04/17/2018 Request for Employment Information CMS-L564(8-20).pdf Supplementary Document 06/29/2021 Nonsubstantive Change Request Memo Request OMB Approval of NonSubstatative Change to ICR 3220-0082_Signed.pdf Supplementary Document 06/16/2026 Form AA-6 (XX-XX) Proposed AA-6 (XX-XX) Proposed.pdf Supplementary Document 06/16/2026 Form AA-7 (XX-XX) Proposed AA-7 (XX-XX) Proposed.pdf Supplementary Document 06/16/2026 Form AA-8 (XX-XX) Proposed AA-8 (XX-XX) Proposed.pdf Supplementary Document 06/16/2026 Form AA-23 (XX-XX) Proposed AA-23 (XX-XX) Proposed.pdf Supplementary Document 06/16/2026 Form RL-311f (XX-XX) Proposed RL-311f (XX-XX) Proposed.pdf Supplementary Document 06/16/2026 Justification for the Nonsubstansive Change Request to Forms in the ICR 3220-0082_Nonsubstantive Changes to the Forms in the ICR.docx Justification for No Material/Nonsubstantive Change 06/16/2026 Public Comments Author Name Comment Document Author Affiliation Sponsoring Org. Type Category Date of Comment Date Comment Received