View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 3220-0082	ICR Reference No: 201501-3220-002
Status: Historical Active	Previous ICR Reference No: 201201-3220-001
Agency/Subagency: RRB	Agency Tracking No:
Title: Medicare
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/27/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/11/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2018	36 Months From Approved	04/30/2015
Responses	2,240	0	1,040
Time Burden (Hours)	365	0	165
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	2,240	1,040	1,200
Annual Time Burden (Hours)	365	165	200
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The annual responses for Form RL-311-F have increased by 1,200, from 800 to 2,000, and the burden hours have increased by 200, from 133 to 333. This increase is due to both more special enrollment periods(SEPS) during the last 3 years as well as better record keeping resulting in a better overall estimate. We are showing the increase as an adjustment.