OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

CERTIFICATION OF ELIGIBILITY TO RECEIVE THE FEHBP PREMIUM REBATE UNDER THE MEDICARE CATASTROPHIC COVERAGE ACT

ICR 198809-3206-002 · OMB 3206-0181 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
157050 CERTIFICATION OF ELIGIBILITY TO RECEIVE THE FEHBP PREMIUM REBATE UNDER THE MEDICARE CATASTROPHIC COVERAGE ACT Form Migrated
ICR Details
3206-0181 198809-3206-002
Historical Active
OPM
CERTIFICATION OF ELIGIBILITY TO RECEIVE THE FEHBP PREMIUM REBATE UNDER THE MEDICARE CATASTROPHIC COVERAGE ACT
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 11/30/1988
Retrieve Notice of Action (NOA) 09/14/1988
THIS REQUEST,AS AMENDED BY THE ADDITIONAL MATERIAL DATED 11-22-88 SUBMITTED BY OPM TO JOE LACKEY OF OMB, IS APPROVED.
  Inventory as of this Action Requested Previously Approved
09/30/1991 09/30/1991
900,000 0 0
450,000 0 0
0 0 0
P. L. 100-360, THE MEDICARE CATASTROPHIC COVERAGE ACT OF 1988, EXPANDS BENEFITS PROVIDED UNDER MEDICARE PARTS A AND B. THESE BENEFITS PROVIDED UNDER MEDICARE PARTS A AND B. THESE BENEFITS DUPLICATE BENEFITS UNDER REHBP. ANNUITANTS, SURVIVOR ANNUITANTS AND FORMER SPOUSES COMPLETE THIS FORM TO DETERMINE ELIGIBILITY FOR FEHBP PREMIUM REBATES UNDER THE LAW.
None
None
No
1
IC Title Form No. Form Name
CERTIFICATION OF ELIGIBILITY TO RECEIVE THE FEHBP PREMIUM REBATE UNDER THE MEDICARE CATASTROPHIC COVERAGE ACT RI 79-14
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 900,000 0 0 900,000 0 0
Annual Time Burden (Hours) 450,000 0 0 450,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/14/1988