[Federal Register Volume 70, Number 19 (Monday, January 31, 2005)]
[Notices]
[Pages 4891-4892]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-1670]
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RAILROAD RETIREMENT BOARD
Proposed Collection; Comment Request
SUMMARY: In accordance with the requirement of section 3506 (c)(2)(A)
of the Paperwork Reduction Act of 1995 which provides opportunity for
public comment on new or revised data collections, the Railroad
Retirement Board (RRB) will publish periodic summaries of proposed data
collections.
Comments are invited on: (a) Whether the proposed information
collection is necessary for the proper performance of the functions of
the agency, including whether the information has practical utility;
(b) the accuracy of the RRB's estimate of the burden of the collection
of the information; (c) ways to enhance the quality, utility, and
clarity of the information to be collected; and (d) ways to minimize
the burden related to the collection of information on respondents,
including the use of automated collection techniques or other forms of
information technology.
Title and Purpose of Information Collection: Medical Reports; OMB
3220-0038.
Under Sections 2(a)(1)(iv), 2(a)(2) and 2(a)(3) of the Railroad
Retirement Act (RRA), annuities are payable to qualified railroad
employees whose physical or mental condition is such that they are
unable to (1) work in their regular occupation (occupational
disability); or (2) work at all (permanent total disability). The
requirements for establishment of disability and proof of continuance
of disability are prescribed in 20 CFR part 220.
Under sections 2(c)(1)(ii)(c) and 2(d)(1)(ii) of the RRA, annuities
are also payable to qualified spouses and widow(ers), respectively, who
have a qualified child who is under a disability which began before age
22. Annuities are also payable to surviving children on the basis of
disability under section 2(d)(1)(iii)(C) if the child's disability
began before age 22 and to widow(ers) on the basis of disability under
section 2(d)(1) (i)(B). To meet the disability standard, the RRA
provides that individuals must have a permanent physical or mental
condition such that they are unable to engage in any regular
employment.
Under section 2(d)(1)(v) of the RRA, annuities are also payable to
remarried and surviving divorced spouses on the basis of, inter alia,
disability or having a qualified disabled child in care. However, the
disability standard in these cases is that found in the Social Security
Act. That is, individuals must be able to engage in any substantial
gainful activity by reason of any medically determinable physical or
mental impairment. The RRB also determines entitlement to a period of
early disability and early Medicare entitlement for qualified claimants
in accordance with Section 216 of the Social Security Act.
When making disability determinations, the RRB needs evidence from
acceptable medical sources. The RRB currently utilizes Forms G-3EMP,
Report of Medical Condition by Employer; G-250, Medical Assessment; G-
250a, Medical Assessment of Residual Functional Capacity; G-260, Report
of Seizure Disorder; RL-11b, Disclosure of Hospital Medical Records;
and RL-11d, Disclosure of Medical Records from a State Agency; to
obtain the necessary medical evidence.
The RRB proposes significant changes to the information collection.
The primary change is to add proposed Form G-197, Authorization to
Release Medical Information, to the information collection. Proposed
Form G-197 will be the standard Health Insurance Portability and
Accountability Act (HIPAA) compliant release form used by the RRB to
obtain consent for the release of medical evidence under the RRA. The
RRB also proposes to revise, renumber, and rename current Form G-250 to
proposed Form RL-250, Request for Medical Assessment. Currently, Form
G-250, requests a narrative report, copies of office records of the
claimant's treatment, requests completion of Form G-250a, and includes
a consent statement that the claimant must sign. Proposed Form RL-250
will not request the narrative report nor contain a consent statement.
A new Form G-250, titled Medical Assessment is proposed. It is intended
to provide more complete information while being more user-friendly by
formatting responses into a question and answer format by body system
being evaluated. Forms G-3EMP, and RL-11b are being revised to delete
the consent portions from the versions currently in use. Minor
editorial changes are proposed to Form G-250a which will continue to be
used by agency hearings officers as a means to clarify, when necessary,
information previously received or to obtain precise information needed
to make a residual functional capacity determination. No changes are
proposed to Form G-260. Completion is voluntary. One response is
requested of each respondent.
Estimate of Respondent Burden
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Form No. Annual response Time (min) Burden (hours)
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G-3EMP................................................. 600 10 100
G-197.................................................. 6,000 10 1,000
G-250.................................................. 11,950 30 5,975
G-250a................................................. 50 20 17
G-260.................................................. 100 25 42
RL-11b................................................. 5,000 10 833
RL-250................................................. 11,950 10 1,992
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Total.............................................. 35,900 ................. 9,501
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[[Page 4892]]
FOR FURTHER INFORMATION CONTACT: To request more information or to
obtain a copy of the information collection justification, forms, and/
or supporting material, please call the RRB Clearance Officer at (312)
751-3363 or send an e-mail request to [email protected]. Comments
regarding the information collection should be addressed to Ronald J.
Hodapp, Railroad Retirement Board, 844 North Rush Street, Chicago,
Illinois 60611-2092 or send an e-mail to [email protected]. Written
comments should be received within 60 days of this notice.
Charles Mierzwa,
Clearance Officer.
[FR Doc. 05-1670 Filed 1-28-05; 8:45 am]
BILLING CODE 7905-01-P