[Federal Register: July 30, 2004 (Volume 69, Number 146)]
[Notices]
[Page 45879-45880]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr30jy04-154]
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SOCIAL SECURITY ADMINISTRATION
Agency Information Collection Activities: Proposed Request and
Comment Request
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 Public Law
104-13, the Paperwork Reduction Act of 1995, effective October 1, 1995.
The information collection packages that may be included in this notice
are new information collections.
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.
[[Page 45880]]
(SSA), Social Security Administration, DCFAM, Attn: Reports
Clearance Officer, 1338 Annex Building, 6401 Security Blvd., Baltimore,
MD 21235, Fax: 410-965-6400.
I. 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. Application for Medicare Prescription Drug Cost-Sharing
Subsidy--0960-NEW. The Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Pub. L. 108-173; MMA) establishes a new
Medicare Part D program for voluntary prescription drug coverage for
premium, deductible and cost-sharing subsidies for certain low-income
individuals. The MMA stipulates that subsidies must be available for
individuals who are eligible for the program and who meet eligibility
criteria for subsidization of premium, deductible, and/or co-payment
costs. Form SSA-1020, the Application for Medicare Prescription Drug
Cost-Sharing Subsidy, collects information about an applicant's income
and assets and is thus used by SSA to determine eligibility for this
assistance. The respondents are individuals who are eligible for
enrollment in the new program and are requesting assistance with the
related costs.
Type of Request: New information collection.
Number of Respondents: 5,000,000.
Frequency of Response: 1.
Average Burden Per Response: 35 minutes.
Estimated Annual Burden: 2,916,667 hours.
2. Request for Appeal of Medicare Part D Subsidy Determination--
0960-NEW. The Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Pub. L. 108-173; MMA) establishes a new
Medicare Part D program for voluntary prescription drug coverage and
provides for premium, deductible, and cost-sharing subsidies for
certain low-income individuals. An individual must be entitled to
benefits under Medicare Part A or be enrolled in Medicare Part B to
qualify for subsidization. SSA will make subsidy eligibility
determinations and appeal decisions for voluntary Medicare prescription
drug coverage. Form SSA-1021, the Request for Appeal of Medicare Part D
Subsidy Determinations, was developed to obtain information from
individuals who appeal SSA's decisions regarding eligibility or
continuing eligibility for a Medicare Part D subsidy. The respondents
are applicants who are appealing SSA's eligibility or continuing
eligibility decisions.
Type of Request: New information collection.
Number of Respondents: 37,500.
Frequency of Response: 1.
Average Burden Per Response: 8 minutes.
Estimated Annual Burden: 5,000 hours.
Dated: July 26, 2004.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 04-17353 Filed 7-29-04; 8:45 am]
BILLING CODE 4191-02-P