[Federal Register: March 5, 2004 (Volume 69, Number 44)]
[Notices]
[Page 10494-10497]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr05mr04-138]
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SOCIAL SECURITY ADMINISTRATION
Agency Information Collection Activities: Emergency Request,
Proposed Request, Comment Request and Notice of OMB Approval
The Social Security Administration (SSA) publishes a list of
information collection packages that will require clearance by the
Office of Management and Budget (OMB) in compliance with Pub. L. 104-
13, the Paperwork Reduction Act of 1995, effective October 1, 1995. The
information collection packages that may be included in this notice are
for new information collections, approval of existing information
collections, revisions to OMB-approved information collections, and
extensions (no change) of OMB-approved information collections.
[[Page 10495]]
SSA is soliciting comments on the accuracy of the agency's burden
estimate; the need for the information; its practical utility; ways to
enhance its quality, utility, and clarity; and on ways to minimize
burden on respondents, including the use of automated collection
techniques or other forms of information technology. Written comments
and recommendations regarding the information collection(s) should be
submitted to the OMB Desk Officer and the SSA Reports Clearance
Officer. The information can be mailed and/or faxed to the individuals
at the addresses and fax numbers listed below:
(OMB),
Office of Management and Budget,
Attn: Desk Officer for SSA,
New Executive Building, Room 10235,
725 17th St., NW.,
Washington, DC 20503,
Fax: 202-395-6974.
(SSA),
Social Security Administration, DCFAM,
Attn: Reports Clearance Officer,
1338 Annex Building,
6401 Security Blvd.,
Baltimore, MD 21235,
Fax: 410-965-6400.
I. SSA is requesting emergency consideration within 2 weeks of
publication of the information collection listed below.
Youth Transition Process Demonstration Evaluation Data Collection--
0960-NEW. To further the President's New Freedom Initiative goal of
increasing employment of individuals with disabilities, SSA has awarded
seven cooperative agreements for the purpose of developing service
delivery systems to assist youth with disabilities to successfully
transition from school to work. SSA is funding two coordinated
contracts to provide (1) technical assistance and (2) an evaluation.
SSA will work with the Evaluation Contractor to use the results to
conduct a net outcome evaluation to determine the long-term
effectiveness of the interventions, impacts and benefits of the
demonstration. Evaluation data will be used by the projects to improve
the efficiency of the project's operations; use of staff; linkages
between the project and the agencies through which comprehensive
services are arranged; and specific aspects of service delivery to
better meet the needs of the targeted population. This type of project
is authorized by sections 1110 and 234 of the Social Security Act. The
respondents will be youth with disabilities who have enrolled in the
project.
Type of Request: New Collection.
Number of Respondents: 5,000.
Frequency of Response: 4.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 5,000 hours.
II. The information collections listed below are pending at SSA and
will be submitted to OMB within 60 days from the date of this notice.
Therefore, your comments should be submitted to SSA within 60 days from
the date of this publication. You can obtain copies of the collection
instruments by calling the SSA Reports Clearance Officer at 410-965-
0454 or by writing to the address listed above.
1. Supplemental Statement Regarding Farming Activities of Persons
Living Outside the U.S.A.--0960-0103. Form SSA-7163A-F4 is used by SSA
to collect needed information whenever a Social Security beneficiary or
claimant reports work on a farm outside the U.S. The information is
used to make a determination for work deduction purposes. The
respondents are Social Security beneficiaries or claimants who are
engaged in farming activities outside the U.S.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 1,000.
Frequency of Response: 1.
Average Burden Per Response: 60 minutes.
Estimated Annual Burden: 1,000 hours.
2. Notice Regarding Substitution of Party Upon Death of Claimant-
Reconsideration of Disability Cessation--20 CFR 404.907-.921 and
416.1407-.1421--0960-0351. SSA uses form SSA-770 to obtain information
from substitute parties regarding their intention to pursue the appeals
process for an individual who has died. The respondents are such
parties.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 1,200.
Frequency of Response: 1.
Average Burden Per Response: 5 minutes.
Estimated Annual Burden: 100 hours.
3. Disability Hearing Officer's Decision--20 CFR 404.917 and
416.1417--0960-0441. The Social Security Act requires that SSA provide
an evidentiary hearing at the reconsideration level of appeal for
claimants who have received an initial or revised determination that a
disability did not exist or has ceased. Based on the hearing, the
disability hearing officer (DHO) completes form SSA-1207 and all
applicable supplementary forms (which vary depending on the type of
claim). The DHO uses the information in documenting and preparing the
disability decision. The form will aid the DHO in addressing the
crucial elements of the case in a sequential and logical fashion. The
respondents are DHOs in the State Disability Determination Services
(DDS).
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 100,000.
Frequency of Response: 1.
Average Burden Per Response: 45 minutes.
Estimated Annual Burden: 75,000 hours.
4. Work History Report--20 CFR 404.1512 and 416.912--0960-0578. The
information collected by form SSA-3369 is needed to determine
disability by the State DDS. The information will be used to document
an individual's past work history. The respondents are applicants for
disability benefits.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 1,000,000.
Frequency of Response: 1.
Average Burden Per Response: 30 minutes.
Estimated Annual Burden: 500,000 hours.
5. Medical History and Disability Report, Disabled Child--20 CFR
416.912--0960-0577. The Social Security Act requires claimants to
furnish medical and other evidence to prove they are disabled. Form
SSA-3820 is used to obtain various types of information about a child's
condition, his/her treating sources and/or other medical sources of
evidence. The i3820 allows the claimant for disability benefits to go
online and furnish the same information. The Electronic Disability
Collect System (EDCS) is an internal collection process. Using EDCS,
Field Office (FO) employees key information provided by applicants or
their representatives onto EDCS screens, which establish a data base
that the adjudicating component can access. Both the i3820 and EDCS
screens have been designed to capture the same information as the
revised paper version of the SSA-3820. The information collected on the
SSA-3820 is needed for the determination of disability by the State
DDSs. The respondents are applicants for Title XVI (SSI) child
disability benefits.
Type of Request: Extension of an OMB-approved information
collection.
[[Page 10496]]
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Average
Number of Frequency of burden per Estimated
respondents response response annual burden
(hours) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3820........................................ 366,000 1 1 366,000
i3820........................................... 2,500 1 2 5,000
EDCS............................................ 157,000 1 1 157,000
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Total Estimated Annual Burden: 528,000 hours.
6. Annual Registration Statement Identifying Separated Participants
with Deferred Benefits, Schedule SSA--0960-0606. Schedule SSA is a form
filed annually as part of a series of pension plan documents required
by section 6057 of the IRS Code. Administrators of pension benefit
plans are required to report specific information on future plan
benefits for those participants who left plan coverage during the year.
SSA maintains the information until a claim for Social Security
benefits has been approved. At that time, SSA notifies the beneficiary
of his/her potential eligibility for payments from the private pension
plan. The respondents are administrators of pension benefit plans, or
their service providers employed to prepare the Schedule SSA on behalf
of the pension benefit plan. Below are the estimates of the cost and
hour burdens for completing and filing Schedule SSA(s). We have used an
average to estimate the hour burden. However, the burden may be greater
or smaller depending on whether the respondent is a large or small
pension benefit plan and how many Schedule SSA's are filed in a given
year.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 1.
Average Burden Per Response: 2.5 hours.
Estimated Annual Burden: 220,000 hours.
Estimated Annual Cost Burden for All Respondents: $12,194,400.
7. State Agency Report of Obligations for SSA Disability Programs
and Addendum, SSA-4513; Time Report of Personnel Services for
Disability Determination Services, SSA-4514; and State Agency Schedule
of Equipment Purchased for SSA Disability Programs, SSA-871--0960-0421.
SSA uses the information collected by forms SSA-4513 and 4514 to
conduct a detailed analysis and evaluation of the costs incurred by the
State Disability Determination Services (DDSs) in making the disability
determination for SSA. The data is also used to determine funding
levels for each DDS. SSA uses the information collected by form SSA-871
to budget and account for expenditures of funds for equipment purchases
by the State DDSs that administer the disability determination program.
The respondents are DDSs that have the responsibility for making
disability determinations for SSA.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average
Number of Frequency of burden per Estimated
respondents response response annual burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4513........................................ 52 4 90 312
SSA-4514........................................ 52 4 90 312
SSA-871......................................... 52 4 30 104
----------------------------------------------------------------------------------------------------------------
Total Estimated Annual Burden: 728 hours.
8. Summary of Evidence--20 CFR 416.1407--0960-0430. Form SSA-887 is
used by the State Disability Determination Services (DDS) to provide
claimants with a list of medical/vocational reports pertaining to their
disability. The form will aid claimants in reviewing the evidence in
their folders and will also be used by hearing officers in preparing
for and conducting hearings. The respondents are State DDSs that make
disability determinations.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 49,000.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 12,250 hours.
9. Wage Reports and Pension Information--20 CFR 422.122(b)--0960-
0547. The information collected by form OR-418P is used by SSA to
identify the requester of pension plan information and to confirm that
the individual is entitled to the data SSA provides. The respondents
are requesters of pension plan information.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 600.
Frequency of Response: 1.
Average Burden Per Response: 30 minutes.
Estimated Annual Burden: 300 hours.
III. The information collections listed below have been submitted
to OMB for clearance. Your comments on the information collections
would be most useful if received by OMB and SSA within 30 days from the
date of this publication. You can obtain a copy of the OMB clearance
packages by calling the SSA Reports Clearance Officer at 410-965-0454,
or by writing to the address listed above.
1. Pain Report-Child--20 CFR 416.912 and 416.1512--0960-0540. The
information collected by form SSA-3371-BK will be used to obtain the
types of information specified in the regulations, and to provide
disability interviewers (and applicants/claimants in self-help
situations) with a convenient means of recording the information
obtained. This information is used by the State disability
determination services (DDS) adjudicators and administrative law judges
to assess the effects of symptoms on functionality for determining
disability under the Social Security Act. The respondents are
applicants for Supplemental Security Income (SSI) benefits.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 250,000.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 62,500 hours.
[[Page 10497]]
2. Medical Permit Parking Application--0960-0624. SSA issues
medical parking assignments at SSA-owned and -leased facilities to
individuals who have a medical condition which meets the criteria for
medical parking. In order to issue a medical parking permit, SSA must
obtain medical evidence from the applicant's physician. Form SSA-3192-
F4 is used to collect this information. SSA then uses the information
to determine whether the individual qualifies for a medical parking
permit and whether or not to issue the permit. The respondents are
physicians of applicants for medical parking permits.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 144.
Frequency of Response: 1.
Average Burden Per Response: 60 minutes.
Estimated Annual Burden: 144 hours.
IV. Notice of OMB Approval
As required by the Paperwork Reduction Act of 1995 (44 U.S.C.
3507), the Social Security Administration (SSA) is providing notice of
OMB's approval of the information collections contained in 20 CFR
404.610, 404.611, and 422.505, Filing of Applications and Related
Forms. In compliance with the Paperwork Reduction Act, persons are not
required to respond to an information collection unless it displays a
valid Office of Management and Budget control number. The OMB number is
0960-0685, which expires February 28, 2007.
Dated: March 1, 2004.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 04-4889 Filed 3-4-04; 8:45 am]
BILLING CODE 4191-02-P