[Federal Register: May 26, 2006 (Volume 71, Number 102)]
[Notices]
[Page 30464-30467]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr26my06-139]
=======================================================================
-----------------------------------------------------------------------
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 for new information
[[Page 30465]]
collections, approval of existing 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,
Fax: 202-395-6974.
(SSA), Social Security Administration, DCFAM, Attn: Reports Clearance
Officer, 1333 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. Function Report--Adult--Third Party--20 CFR 404.1512, 416.912--
0960-0635. The information collected on the SSA-3380-BK is needed to
make determinations on SSI and SSDI disability claims. This information
is necessary for case development and adjudication, and is used by
State Disability Determination Services evaluators as an evidentiary
source used in the disability evaluation process. The respondents are
third parties familiar with the functional limitations (or lack
thereof) of claimants who apply for Social Security benefits and
Supplemental Security Income disability payments.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 1,000,000.
Frequency of Response: 1.
Average Burden per Response: 60 minutes.
Estimated Annual Burden: 1,000,000 hours.
2. Request for Internet Services--Password Authentication--20 CFR
401.45--0960-0632. SSA has established a Password infrastructure for
using its Internet and Automated Telephone Response services to access
SSA records. These services are password protected due to the nature of
the information being transmitted or because the requested information
requires a higher level of protection to ensure the security and
confidentiality of records. Password Authentication is used to
establish a password process for verifying the identity of individuals
who choose to use these services for conducting business with SSA.
Individuals are required to provide identifying information to SSA,
such as their name, social security number, date of birth, and a shared
secret between themselves and SSA before they can create a password.
After this information is stored and verified, SSA sends the individual
their new personal identification number (PIN) and password to be used
to access SSA's password protected services. The password process
allows requestors to establish their identities with SSA and create a
password which they can then use to access their own personal
information. The respondents are persons electing to do business with
SSA through an electronic medium.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 1,630,771.
Frequency of Response: 1.
Average Burden per Response: 10 minutes.
Estimated Annual Burden: 271,795 hours.
3. Statement of Reclamation Action--31 CFR 210--0960-NEW. Form SSA-
1713 collects information regarding whether, how and when a Canadian
bank was able to return erroneous payments made after the death of a
beneficiary who elected to have payments sent to Canada. The SSA-1713
is sent with the SSA-1712, an SSA-generated cover sheet which provides
the Canadian bank with information regarding the deceased beneficiary.
In this way, SSA can reclaim funds which were erroneously paid. The
respondents are Canadian financial institutions to which Social
Security payments have been made.
Type of Request: Existing Information Collection in Use Without an
OMB Number.
Number of Respondents: 15.
Frequency of Response: 1.
Average Burden per Response: 5 minutes.
Estimated Annual Burden: 1 hour.
4. Request for Reconsideration--Disability Cessation--20 CFR
404.909, 416.1409--0960-0349. Form SSA-789-U4 is used by claimants to
request reconsideration of a determination and to indicate whether or
not they wish to appear at a disability hearing. This form can also be
used to submit any additional information/evidence for use in the
reconsidered determination and to indicate if an interpreter is needed
for the hearing. SSA will use this information to either arrange for a
hearing or to prepare a decision based on the evidence of record. The
respondents are applicants or claimants for Social Security benefits or
SSI payments.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 49,000.
Frequency of Response: 1.
Average Burden per Response: 13 minutes.
Estimated Annual Burden: 10,617 hours
5. Representative Payment Policies Regulation--20 CFR 404.2011,
404.2025, 416.611, 416.625--0960-0679. In cases where SSA determines
that it is not in a beneficiary's best interest to receive payments
directly as it may cause substantial harm, the beneficiaries may
dispute this decision. If they do, they provide SSA with information
which SSA will take into consideration when reevaluating the decision.
Representative payees must also provide SSA with information regarding
their relationship, responsibility, and how payments were used for the
beneficiary. Respondents are beneficiaries and representative payees.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average
Number of Frequency of burden per Estimated
CFR Section respondents response response annual burden
(minutes) hours
----------------------------------------------------------------------------------------------------------------
404.2011(a)(1).................................. 250 1 15 63
416.611(a)(1)...................................
[[Page 30466]]
404.2025........................................ 3,000 1 6 300
416.625.........................................
---------------- ---------------
Totals...................................... 3,250 .............. .............. 363
----------------------------------------------------------------------------------------------------------------
Estimated Annual Burden: 363 hours.
6. Psychiatric Review Technique--20 CFR 404.1520(a), 416.920(a)--
0960-0413. The SSA-2506-BK assists the DDSs in evaluating mental
impairments by helping to: organize and present the mental findings in
a clear, concise and consistent manner; consider and evaluate all
aspects of the mental impairment relevant to the individual's ability
to perform work-related mental functions; and identify additional
evidence needed to determine impairment severity. The respondents are
the 52 State DDSs administering the Title II and Title XVI programs.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 52.
Frequency of Response: 20,595.
Total Annual Responses: 1,070,940.
Average Burden per Response: 15 minutes.
Estimated Annual Burden: 267,735 hours.
7. Disability Hearing Officer's Decision--Title XVI Disabled Child
(DC) Continuing Disability Review--20 CFR 404.913-.914, 404.917,
416.994a, 416.1413-.1414, 416.1417--0960-0657. Form SSA-1209[dash]BK is
used by the disability hearing officer conducting the disability
hearing to prepare and issue a written reconsidered determination--
specifically for evaluating Title XVI childhood disability cases. The
form provides the framework for addressing the crucial elements of the
case in a sequential and logical fashion, and the completed form is the
official document of the decision. Respondents are disability hearing
officers in State Disability Determination Services (DDSs).
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 35,000.
Frequency of Response: 1.
Average Burden per Response: 75 minutes.
Estimated Annual Burden: 43,750 hours.
8. Certificate of Incapacity--5 CFR 890.302(d)--0960-NEW. Rules
governing the Federal Employee Health Benefits (FEHB) plan state that
for federal employees' children ages 22 or over to retain health
benefits, they must be incapable of self-support due to a disability
that (1) pre-dated the child's 22nd birthday, (2) is very serious, and
(3) can be expected to last at least one year. Form SSA-604, the
Certificate of Incapacity, is used by physicians to document and
certify such a disability for their patients who are children of
Federal employees. The respondents are physicians of federal employees'
children ages 22 or over who are seeking to retain health benefits
under their parent's FEHB coverage.
Type of Request: New information collection.
Number of Respondents: 38.
Frequency of Response: 1.
Average Burden per Response: 45 minutes.
Estimated Annual Burden: 29 hours.
9. Function Report--Adult--20 CFR 404.1512 and 419.912--0960-0681.
Form SSA-3373 is used to collect information about a disability
applicant's impairment-related limitations and ability to function. It
documents the types of information specified in SSA regulations and
provides disability interviewers with a convenient means to record
information about how the claimant's condition affects his or her
ability to function. This information, together with medical evidence,
forms the evidentiary basis upon which the initial disability process
is founded. The respondents are Title II and Title XVI benefits
applicants.
Type of Request: Revision to an OMB-approved information
collection.
Number of Respondents: 4,005,367.
Frequency of Response: 1.
Average Burden per Response: 60 minutes.
Estimated Annual Burden: 4,005,367.
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
packages by calling the SSA Reports Clearance Officer at 410-965-0454,
or by writing to the address listed above.
1. Statement of Employer--20 CFR 404.801-803--0960-0030. The
information collected on Form SSA-7011--F4 is needed to substantiate
allegations of wages paid to workers when wages do not appear in SSA's
records of earnings and the worker has no proof of said earnings. SSA
can use the information to process claims for benefits and resolve
discrepancies in the worker's earnings record. The respondents are
certain employers who can verify wage allegations made by the wage
earner.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 925,000.
Frequency of Response: 1.
Average Burden per Response: 20 minutes.
Estimated Annual Burden: 308,333 hours.
2. Request for Workers' Compensation/Public Disability Benefit
Information--20 CFR 404.408(e)--0960-0098. Section 224 of the Social
Security Act provides for an offset of disability insurance benefits
when workers' compensation (WC) or public disability benefits (PDB) is
also being received. The SSA-1709 is used to request and/or verify
information regarding WC/PDB given to Social Security disability
recipients so that the proper adjustment is made to their monthly
benefits. The respondents are Federal, State, and local agencies
administering WC/PDB, insurance carriers, and public or private self-
insured companies.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 120,000.
Frequency of Response: 1.
Average Burden per Response: 15 minutes.
Estimated Annual Burden: 30,000 hours.
3. Disability Report-Appeal--20 CFR 404.1512, 416.912, 404.916(c),
416.1416(c)--0960-0144. The SSA-3441-BK is used to secure updated
resource and condition information from claimants seeking
reconsideration of denied disability benefits. The claimant also has
the option of providing the information during a personal interview or
through SSA's Internet application. This information assists the State
Disability Determination Services and administrative law judges in
preparing
[[Page 30467]]
for appeals and hearings and in issuing a decision. Respondents are
individuals who appeal denial of Social Security disability income and
Supplemental Security Income (SSI) benefits, cessation of benefits, or
who are requesting a hearing.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden
Collection method Number of Frequency of per response: Estimated
respondents response (minutes) annual burden
----------------------------------------------------------------------------------------------------------------
SSA-3441 (Paper Form)........................... 404,506 1 45 303,380
Electronic Disability Collection System (EDCS).. 635,873 1 45 476,905
I3441 (Internet Form)........................... 72,341 1 120 144,682
---------------- ---------------
Totals...................................... 1,112,720 .............. .............. 924,967
----------------------------------------------------------------------------------------------------------------
Estimated Annual Burden: 924,967 hours.
4. Third Party Liability Information Statement--42 CFR 433.136-
433.139--0960-0323. Identification of sources of third party insurance
liable for medical care or services for Medicaid beneficiaries, which
could be used to reduce Medicaid costs, is required under 42 U.S.C.
1396a(a)(25). Medicaid State agencies are mandated under 42 CFR
433.136-.139 to obtain this information on Medicaid applications and
redeterminations as a condition of Medicaid eligibility. States are
permitted to enter into agreements with the Commissioner of Social
Security to make Medicaid eligibility determinations for aged, blind
and disabled beneficiaries in those States. Applications for and
redeterminations of SSI eligibility in jurisdictions with such
agreements are also applications and redeterminations of Medicaid
eligibility. Under these agreements, SSA obtains third party liability
information using form SSA-8019 and provides that information to the
State agencies which provide Medicaid under the terms of an approved
plan in Title XIX of the Social Security Act. The Medicaid State
agencies then use the information provided to attempt to bill any third
parties liable for medical care, support or services for a beneficiary
to guarantee that Medicaid remains the payer of last resort. The
respondents are SSI applicants and beneficiaries.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 73,540.
Frequency of Response: 1.
Average Burden per Response: 5 minutes.
Estimated Annual Burden: 6,128 hours.
5. Claimant Statement About Loan of Food or Shelter; Statement
About Food or Shelter Provided to Another--20 CFR 416.1130-416.1148--
0960-0529. Forms SSA-5062 and SSA-L5063 are used to obtain statements
about food and/or shelter provided to an SSI claimant or recipient. SSA
uses this information to determine whether food and/or shelter are bona
fide loans or should be counted as income for SSI purposes. This
determination can affect eligibility for SSI and the amount of SSI
benefits payable. The respondents are claimants/recipients for SSI
benefits and individuals that provide loans of food and/or shelter to
SSI claimants/recipients.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden
Form number Number of Frequency of per response: Estimated
respondents response (minutes) annual burden
----------------------------------------------------------------------------------------------------------------
SSA-5062........................................ 65,540 1 10 10,923
SSA-L5063....................................... 65,540 1 10 10,923
---------------- ---------------
Totals...................................... 131,080 .............. .............. 21,846
----------------------------------------------------------------------------------------------------------------
Estimated Annual Burden: 21,846 hours.
Dated: May 18, 2006.
Elizabeth A. Davidson,
Social Security Administration, Reports Clearance Officer.
[FR Doc. E6-7995 Filed 5-25-06; 8:45 am]
BILLING CODE 4191-02-P