[Federal Register: April 15, 2003 (Volume 68, Number 72)]
[Notices]
[Page 18318-18319]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr15ap03-132]
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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 Pub. L. 104-13
effective October 1, 1995, The Paperwork Reduction Act of 1995. The
information collection packages that may be included in this notice are
for new information collections, revisions to OMB-approved information
collections and extensions (no change) of OMB-approved 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 Office Building, Room 10235, 725 17th St., NW., Washington,
DC 20503, Fax: 202-395-6974.
(SSA), Social Security Administration, DCFAM, Attn: Reports Clearance
Officer, 1300 Annex Bldg., 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. Employee Work Activity Questionnaire--20 CFR, Subpart P,
404.1574 and .1592--0960-0483. Form SSA-3033 is used to determine if
the claimant meets the disability requirements of the law, when the
claimant returns to work after the alleged or established onset date of
disability. When a possible unsuccessful work attempt or nonspecific
subsidy is involved, Form SSA-3033 will be used to request a
description of the employee's work effort. The respondents are
employers of Old-Age and Survivors Disability Insurance (OASDI) and
Supplemental Security Income (SSI) disability applicants and
beneficiaries.
Type of Request: Extension of an OMB-approved Information
Collection.
Number of Respondents: 15,000.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 3,750 hours.
2. Request for Internet Services Representative Payee Report--20
CFR 401.45--0960-0668.
Background
SSA is testing the Internet Representative Payee Report form (I623)
that electronically reports on the use of benefit payments made on
behalf of Social Security beneficiaries and SSI recipients. In support
of this process, a proof of concept (POC) test limited to 40
organizational representative payees use the I623 to complete and file
the representative payee report instead of using the paper SSA-623.
Initially SSA projected a 6-month POC test, but is planning to expand
the POC to a full operational year.
The Collection
Organizations participating in the POC will designate up to three
employees that will be authenticated using SSA's existing Integrated
Registration for Employers and Submitters (IRES) OMB control number
0960-0626. Once authenticated, the employee will be required to enter a
Personal Identification Number (PIN) and Password to gain access to the
online I623 application. The PIN and
[[Page 18319]]
Password will serve as the electronic signature. SSA will use the
information collected through the I623 to determine whether the
payments provided to the representative payee have been used for the
beneficiary's current maintenance and personal needs and whether the
representative payee continues to be concerned with the beneficiary's
welfare. The respondents are organizational representative payees
designated to receive funds on behalf of Social Security beneficiaries
and/or SSI recipients.
Type of request: Extension of an OMB-approved Information
Collection.
Number of Respondents: 40 organizations.
Frequency of Response: 117.5 per respondent.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 1,175 hours.
3. Statement of Claimant or Other Person--0960-0045. In special
situations, when there is no standard form or questionnaire, Form SSA-
795 is used by SSA to obtain information from claimants or other
persons having knowledge of facts in connection with many aspects of
the Social Security or SSI programs. The information requested on form
SSA-795 must be of sufficient importance that a signed statement,
including a penalty clause, is necessary. The information collected is
used to process such issues as claims for benefits or continuing
eligibility, benefit amount, insured status, use of funds by a
representative payee or a myriad of other program-related matters. The
most typical respondents are applicants for Social Security or SSI
benefits or beneficiaries of these programs. However, respondents could
also include friends and relatives of the involved parties, coworkers,
neighbors, or anyone else in a position to provide information
pertinent to the issue(s).
Number of Respondents: 305,500.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 76,375 hours.
II. 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 package
by calling the SSA Reports Clearance Officer at 410-965-0454, or by
writing to the address listed above.
1. Claimant's Medications--20 CFR, Subpart P, 404.1512 and Subpart
I, 416.912--0960-0289. The information on Form HA-4632 is used to
process title II and title XVI disability claims. Claimants provide an
updated list of medications using form HA-4632. This information
enables the Administrative Law Judge who conducts the hearing to fully
inquire into medical treatment the claimant is receiving and the effect
of medications on the claimant?s medical treatment. The respondents are
applicants for title II and title XVI benefits.
Type of Request: Extension of an OMB-approved Information
Collection.
Number of Respondents: 171,939.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 42,985 hours.
2. Letter to Employer Requesting Wage Information--0960-0138. Form
SSA--L4201-U2 is used to collect wage data from employers to establish
and/or verify wage information for SSI claimants, beneficiaries and
deemors. SSA uses the data to determine if an individual is eligible
for SSI and, if so, to determine the amount of the payment due. The
respondents are employers of applicants for and recipients of SSI
payments.
Type of Request: Extension of an OMB-approved Information
Collection.
Number of Respondents: 133,000.
Frequency of Response: 1.
Average Burden Per Response: 30 minutes.
Estimated Annual Burden: 66,500 hours.
Dated: April 8, 2003.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 03-9085 Filed 4-14-03; 8:45 am]
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