# Submission for OMB Review; Comment Request for Review of a Revised Information Collection: RI 78-11
**AGENCY:**
Office of Personnel Management.
**ACTION:**
Notice.
**SUMMARY:**
In accordance with the Paperwork Reduction Act of 1995 (Pub. L. 104-13, May 22, 1995), this notice announces that the Office of Personnel Management (OPM) has submitted to the Office of Management and Budget a request for review of a revised information collection. RI 78-11, Medicare Part B Certification, collects information from annuitants, their spouses, and survivor annuitants to determine their eligibility under the Retired Federal Employees Health Benefits Program for a Government contribution toward the cost of Part B of Medicare.
Approximately 100 RI 78-11 forms are completed annually. Each form requires approximately 10 minutes complete. The annual estimated burden is 17 hours.
For copies of this proposal, contact Mary Beth Smith-Toomey on (202) 606-8358, FAX (202) 418-3251 or via e-mail to *[email protected].* Please include a mailing address with your request.
**DATES:**
Comments on this proposal should be received within 30 calendar days from the date of this publication.
**ADDRESSES:**
Send or deliver comments to—
Pamela S. Israel, Chief, Operations Support Group, Retirement Services Programs, U.S. Office of Personnel Management, 1900 E Street, NW., Room 3349, Washington, DC 20415; and
Brenda Aguilar, OPM Desk Officer, Office of Information and Regulatory Affairs, Office of Management and Budget, New Executive Office Building, NW., Room 10235, Washington, DC 20503.
**FOR FURTHER INFORMATION CONTACT:**
Cyrus S. Benson, Team Leader, Publications Team, RIS Support Services/Support Group, (202) 606-0623.
Office of Personnel Management.
Linda M. Springer,
Director.