[Federal Register Volume 75, Number 42 (Thursday, March 4, 2010)]
[Notices]
[Pages 9992-9997]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-4448]
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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 requiring clearance by the Office of
Management and Budget (OMB) in compliance with Public Law (Pub. L. 104-
13), the Paperwork Reduction Act of 1995, effective October 1, 1995.
This notice includes revisions and extensions 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 ways to minimize burden
on respondents, including the use of automated collection techniques or
other forms of information technology. Mail, e-mail, or fax your
comments and recommendations on the information collection(s) to the
OMB Desk Officer and SSA Reports Clearance Director to the following
addresses or fax numbers.
(OMB), Office of Management and Budget, Attn: Desk Officer for SSA.
Fax: 202-395-6974. E-mail address: [email protected].
(SSA), Social Security Administration, DCBFM, Attn: Director, Center
for Reports Clearance, 1333 Annex Building, 6401 Security Blvd.,
Baltimore, MD 21235. Fax: 410-965-0454. E-mail address:
[email protected].
I. The information collections below are pending at SSA. SSA will
submit them to OMB within 60 days from the date of this notice. To be
sure we consider your comments, we must receive them no later than May
3, 2010. Individuals can obtain copies of the collection instruments by
calling the SSA Director for Reports Clearance at 410-965-0454 or by
writing to the above e-mail address.
1. Application for Lump Sum Death Payment--20 CFR 404.390-404.392--
0960-0013. SSA uses Form SSA-8-F4 to collect information needed to
authorize payment of the lump sum death payment (LSDP) to a widow,
widower, or children as defined in section 202(i) of the Social
Security Act. Respondents complete the application for this one-time
payment via paper form, telephone, or an in-person interview with SSA
employees. Respondents are applicants for the LSDP.
Type of Request: Revision of an OMB-approved information
collection.
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Estimated
Collection method Number of completion time Burden hours
respondents (minutes)
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MCS.................................................... 278,825 10 46,471
MCS/Signature Proxy.................................... 278,825 9 41,824
Paper.................................................. 29,350 10 4,892
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Totals:............................................ 587,000 ................. 93,187
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2. Certificate of Responsibility for Welfare and Care of Child Not
in Applicant's Custody--20 CFR 404.330, 404.339-341, and 404.348-
404.349--0960-0019. SSA uses Form SSA-781 to determine if non-custodial
parents who are filing for spouse's or mother's and father's benefits
based on having a child in their care meet the in-care requirements.
Respondents are applicants for spouse's and/or mother's and father's
benefits.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 14,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 2,333 hours.
3. Supplemental Statement Regarding Farming Activities of Person
Living Outside the U.S.A.--0960-0103. SSA uses Form SSA-7163A to
document beneficiary or claimant reports of working on a farm outside
the United States (U.S.). Specifically, the information provided on
this form helps us to determine if we should apply foreign work
deductions to the recipient's benefits. We collect the information
either annually or every other year, depending on the respondent's
country of residence. Respondents are Social Security recipients
engaged in farming activities outside the U.S.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 1,000.
Frequency of Response: 1.
Average Burden Per Response: 1 hour.
Estimated Annual Burden: 1,000 hours.
4. Disability Report--Appeal--20 CFR 404.1512, 416.912, 404.916(c),
416.1416(c), 405 Subpart C, 422.140--0960-0144. SSA requires disability
claimants who are appealing an unfavorable disability determination to
complete Form SSA-3441-BK. This form allows claimants to disclose any
changes to their disability or resources that might influence SSA's
unfavorable determination. SSA may use the information to: (1)
Reconsider and review an initial disability determination; (2) review a
continuing disability; and (3) evaluate a request for a hearing. This
information assists the State Disability Determination Services and
administrative law judges (ALJ) in: (1) Preparing for the appeals and
hearings; and (2) issuing a determination or decision on an
individual's entitlement (initial or continuing) to disability
benefits. Respondents are individuals who appeal denial, reduction, or
cessation of Social Security disability income and Supplemental
Security Income (SSI) payments, or who are requesting a hearing before
an ALJ.
Type of Request: Revision of an OMB-approved information
collection.
[[Page 9993]]
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Average burden
Collection method Number of Frequency of per response Estimated annual
respondents response (minutes) burden (hours)
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SSA-3441 (Paper Form)................... 12,604 1 45 9,453
Electronic Disability Collect System 843,090 1 45 632,318
(EDCS).................................
I3441 (Internet Form)................... 417,268 1 120 834,536
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Totals.............................. 1,272,962 ................ ................ 1,476,307
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5. Request for Hearing by Administrative Law Judge--20 CFR 404.929,
404.933, 416.1429, 404.1433, 405.722, 418.1350--0960-0269. When SSA
denies applicants' or beneficiaries' requests for new or continuing
benefits, those applicants/beneficiaries are entitled to request a
hearing to appeal the decision. SSA uses Form HA-501 to document such
requests. Although SSA collects this information, the actual hearings
take place before ALJs employed by the Department of Health and Human
Services (HHS). The respondents are: (1) Applicants for or current
recipients of various Social Security benefits who want to appeal SSA's
denial of their requests for new or continued benefits; and (2)
Medicare Part B recipients whom SSA has determined must pay the
Medicare Part B Income-Related Monthly Adjustment Amount, both of whom
wish to appeal this decision at a hearing before an HHS ALJ.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 669,469.
Frequency of Response: 1.
Average Burden per Response: 10 minutes.
Estimated Annual Burden: 111,578 hours.
6. Information about Joint Checking/Savings Accounts--20 CFR
416.120, 416.1208--0960-0461. SSA considers a person's resources when
evaluating eligibility for SSI payments. Generally, we consider funds
in checking and savings accounts to be resources owned by the
individuals whose names appear on the account. Individuals applying for
SSI, however, may rebut an assumption of ownership in a joint account
if they submit certain evidence establishing the funds do not belong to
them. SSA uses Form SSA-2574 to collect information from SSI
applicants/recipients who object to the assumption they own all or part
of the funds in a joint checking or savings account bearing their
names. SSA collects information about the account from both the SSI
applicant/recipient and other account holder(s). After receiving the
completed form, SSA can determine if we should consider the account to
be a resource for the SSI payments applicant/recipient. The respondents
are applicants and recipients of SSI and individuals who list
themselves as joint owners of financial accounts with SSI applicants/
recipients.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 200,000.
Frequency of Response: 1.
Average Burden per Response: 7 minutes.
Estimated Annual Burden: 23,333 hours.
7. Request for Earnings and Benefit Estimate Statement--20 CFR
404.810--0960-0466. SSA uses the information collected by Form SSA-7004
to identify respondents' Social Security earnings records, extract
posted earnings information, calculate potential benefit estimates,
produce the resulting Social Security statements, and mail them to the
requesters. The respondents are Social Security number holders
requesting information about their Social Security earnings records and
estimates of their potential benefits.
Type of Request: Revision of an OMB-approved information
collection.
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Average burden
Modality Number of Frequency of per response Total annual
respondents response (minutes) burden (hours)
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Paper Version........................... 127,000 1 5 10,583
Internet Version........................ 426,000 1 5 35,500
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Totals.............................. 553,000 ................ ................ 46,083
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8. Beneficiary Recontact Form--20 CFR 404.703, 404.705--0960-0502.
SSA must ensure that recipients of disability payments continue to be
eligible for their payments. Research has indicated benefit recipients
may fail to report circumstances that affect their benefits. Two such
cases are: (1) When parents receiving disability benefits for their
child marry; and (2) the removal of an entitled child from parents'
care. SSA uses Form SSA-1588-OCR-SM to ask mothers/fathers about their
marital status and children in care to detect overpayments and avoid
continuing payment to those are no longer entitled. Respondents are
recipients of mother/father Social Security benefits.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 133,400.
Frequency of Response: 1.
Average Burden per Response: 5 minutes.
Estimated Annual Burden: 11,117 hours.
9. Complaint Form for Allegations of Discrimination in Programs or
Activities Conducted by the Social Security Administration--0960-0585.
SSA uses Form SSA-437 to investigate and formally resolve complaints of
discrimination based on disability, race, color, national origin
(including limited English proficiency), sex, sexual orientation, age,
religion, or retaliation for having participated in a proceeding under
this administrative complaint process in connection with an SSA program
or activity. SSA also uses this form to review, investigate, and
resolve complaints alleging discrimination based on status as a parent
in education, training programs, or activities conducted by SSA.
Individuals who believe SSA discriminated against them on any of the
above bases may file a written complaint of discrimination. SSA uses
the information to identify the complainant; identify the alleged
discriminatory act; ascertain the date of such alleged act; obtain the
identity of any individual(s) with information about the alleged
discrimination; and ascertain other relevant information that
[[Page 9994]]
would assist in the investigation and resolution of the complaint.
Respondents are individuals who believe SSA or SSA employees,
contractors, or agents in programs or activities conducted by SSA
discriminated against them.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 140.
Frequency of Response: 1.
Average Burden per Response: 1 hour.
Estimated Annual Burden: 140 hours.
10. Social Security Benefits Application--20 CFR 404.310-404.311,
404.315-404.322, 404.330-404.333, 404.601-404.603, and 404.1501-
404.1512--0960-0618. This collection comprises the various application
modalities for retirement, survivors, and disability benefits. These
modalities include paper forms (SSA Forms SSA-1, SSA-2, and SSA-16),
Modernized Claims System (MCS) screens for in-person field office
interview applications, and the Internet-based iClaim application. This
information collection request (ICR) is for additions and revisions to
the information collection.
Type of Request: Revision of an OMB-approved information
collection.
Paper Forms/Accompanying MCS Screens Burden Information:
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Average burden
Collection method Number of Frequency of per response Estimated annual
respondents response (minutes) burden (hours)
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Form SSA-1
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MCS..................................... 172,200 1 11 31,570
MCS/Signature Proxy..................... 1,250,800 1 10 208,467
Paper................................... 20,000 1 11 3,667
Medicare-only MCS....................... 299,000 1 7 34,883
Medicare-only Paper..................... 1,000 1 7 117
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Totals.............................. 1,743,000 ................ ................ 278,704
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Form SSA-2
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MCS..................................... 36,860 1 15 9,215
MCS/Signature Proxy..................... 331,740 1 14 77,406
Paper................................... 3,800 1 15 950
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Totals.............................. 372,400 ................ ................ 87,571
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Form SSA-16
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MCS..................................... 218,657 1 20 72,886
MCS/Signature Proxy..................... 1,967,913 1 19 623,172
Paper................................... 24,161 1 20 8,054
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Totals.............................. 2,210,731 ................ ................ 704,112
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iClaim
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iClaim 3rd Party........................ 28,118 1 15 7,030
iClaim Applicant after 3rd Party 28,118 1 5 2,343
Completion.............................
First Party iClaim...................... 541,851 1 15 135,463
Medicare-only iClaim.................... 200,000 1 10 33,333
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Totals.............................. 798,087 ................ ................ 178,169
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Aggregate Public Reporting Burden: 1,248,556 hours.
11. SSI Telephone Wage Reporting System (SSITWR)--20 CFR 416.701-
0732--0960-0715. SSA requires SSI recipients to report changes that
could affect their eligibility for and the amount of their SSI
payments, such as changes in income, resources, and living
arrangements. The SSITWR, formerly the Statement for SSI Monthly Wage
Reporting (Telephone), enables SSI recipients to meet these
requirements by providing them with a fully automated mechanism to
report their monthly wages by telephone, instead of contacting their
local field offices. The SSITWR allows callers to report their wages
either by speaking their responses through voice recognition
technology, or by keying in responses using the telephone key pad. To
ensure the security of the information provided, SSITWR asks callers to
provide information SSA can compare against its records for
authentication purposes. Once the system authenticates the identity of
the callers, the callers can speak or key in their wage data. The
respondents are SSI recipients, deemors, and representative payees of
recipients.
Type of Request: Revision of an OMB-approved information
collection.
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Estimated
Collection method Frequency of Number of completion time Burden (hours)
reporting respondents (minutes)
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Training/Instruction.................... 1 85,000 35 49,584
SSITWR.................................. 12 85,000 5 85,000
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[[Page 9995]]
Total............................... ................ *85,000 ................ 134,584
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Note: * The same 85,000 respondents are completing both activities, so the actual total number of respondents is
only 85,000.
12. Treating Physician Consultative Examination Interest Form--20
CFR 404.1519g--20 CFR 404.1519i--0960-0751. When an applicant for
Social Security disability benefits has not consulted a physician for a
specified period preceding the application, SSA will ask the applicant
to complete a consultative examination (CE). If the applicant has a
treating physician (TP), SSA sends a medical evidence of record request
letter and Form SSA-84 to the applicant's TP; the TP completes the
latter form and returns it to SSA to indicate interest in conducting
the CE. If the TP does not return the form, SSA assumes the TP is not
interested in performing the CE. Respondents are disability benefits
applicants' treating physicians.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 168.
Frequency of Response: 1.
Average Burden Per Response: 5 minutes.
Estimated Annual Burden: 14 hours.
13. Claimant Travel Reimbursement Request--20 CFR 404.999a-20 CFR
404.99c--0960-0752. SSA sends Form SSA-104 to Social Security benefits
recipients with a CE appointment notice. To receive reimbursement for
their travel expenses to the CE, recipients must: (1) Submit an
itemized list of expenditures for their round trip; and (2) complete,
sign, and return the SSA-104 to SSA. SSA collects this information to
determine the amount of reimbursement. Respondents are applicants for
disability claims applying for reimbursement of travel expenses to a
CE.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 11,092.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 1,849 hours.
II. SSA has submitted the information collections listed below to
OMB for clearance. Your comments on the information collections would
be most useful if OMB and SSA receive them within 30 days from the date
of this publication. To be sure we consider your comments, we must
receive them no later than April 5, 2010. You can obtain a copy of the
OMB clearance packages by calling the SSA Director for Reports
Clearance at 410-965-0454 or by writing to the above e-mail address.
1. Farm Self-Employment Questionnaire--20 CFR 404.1082(c) &
404.1095--0960-0061. Section 211(a) of the Social Security Act requires
the existence of a trade or business as a prerequisite for determining
if an individual or partnership can claim net earnings from self-
employment. During a personal interview, the requesting Social Security
field office uses Form SSA-7165 to elicit the information necessary to
establish the existence of an agricultural trade or business and
subsequent covered earnings for Social Security entitlement purposes.
The respondents are applicants for Social Security benefits whose
entitlement depends on whether the worker has covered earnings from
self-employment as a farmer.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 47,500.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 7,917 hours.
2. Statement for Determining Continuing Eligibility Supplemental
Security Income Payment--20 CFR 416.204--0960-0145. SSA uses the
information from Form SSA-8202-BK to conduct low- and middle-error-
profile (LEP-MEP) telephone or face-to-face redetermination (RZ)
interviews with SSI recipients and representative payees. The
information SSA collects during the interview is needed to determine
whether SSI recipients have met and continue to meet all statutory and
regulatory requirements for SSI eligibility and whether they have been,
and are still receiving, the correct payment amount.
Note: SSA published this information collection with the
incorrect burden information on December 28, 2009 at 74 FR 68655.
The correct information is below.
Type of Request: Revision of an OMB-approved information
collection.
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Average burden
Form No. Number of Frequency of per response Total annual
respondents response (minutes) burden (hours)
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SSA-8202-BK............................. 235,390 1 21 82,387
MSSICS.................................. 333,408 1 20 111,136
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Totals.............................. 568,798 ................ ................ 193,523
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3. Claimant Statement About Loan of Food or Shelter; Statement
About Food or Shelter Provided to Another--20 CFR 416.1130-416.1148--
0960-0529. SSA uses Forms SSA-5062 and SSA-L5063 to obtain statements
about food and/or shelter provided to SSI claimants or recipients. SSA
uses this information to determine whether food and/or shelter are bona
fide loans or if SSA should count them as income for SSI purposes. This
determination can affect a claimant or recipient's eligibility for SSI
and the amount of SSI payments. The respondents are claimants and
recipients for SSI payments and individuals who provide loans of food
or shelter to them.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 131,080.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 21,847 hours.
4. Request To Resolve Questionable Quarters of Coverage (QC);
Request for QC History Based on Relationship--0960-0575. The Personal
Responsibility and Work Opportunity Reconciliation Act states that
aliens admitted for lawful residence who have worked and earned 40
qualifying QCs for Social Security
[[Page 9996]]
purposes can generally receive State benefits. States complete Form
SSA-512 to request clarification from SSA on questionable QC
information. Specifically, States use this form to request QC
information for an alien's spouse or child in cases where the alien
does not sign a consent form giving permission to access his/her Social
Security records. We can allocate QCs to a spouse and/or to a child
under age 18, if needed, to obtain 40 qualifying QCs for the alien. The
respondents are State agencies that require QC information to determine
eligibility for benefits.
Note: This is a correction notice. SSA published this
information collection with the incorrect burden information on
December 28, 2009 at 74 FR 68655. In addition, since we are revising
the Privacy Act Statement, this is now a revision of an OMB-approved
information collection.
Type of Request: Revision of an OMB-approved information
collection.
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Average burden
Form No. Number of Frequency of per response Total annual
respondents response (minutes) burden (hours)
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SSA-512................................. 25,000 1 2 833
SSA-513................................. 25,000 1 2 833
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Totals.............................. 50,000 ................ ................ 1,666
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5. Site Review Questionnaire for Volume and Fee-for-Service Payees
and Beneficiary Interview Form--20 CFR 404.2035, 404.2065, 416.665,
416.701, and 416.708--0960-0633. SSA asks organizational representative
payees to complete Form SSA-637, Site Review Questionnaire for Volume
and Fee-for-Service Payees, to provide information on how they carry
out their representative payee responsibilities, including how they
manage beneficiary funds. SSA then obtains information from the
beneficiaries these organizations represent via the SSA-639,
Beneficiary Interview Form, to corroborate the payees' statements. Due
to the sensitivity of the information, SSA employees always complete
the forms based on the answers respondents give during the interview.
The respondents are individuals, State and local governments, and non-
profit and for-profit organizations that serve as representative payees
and the beneficiaries they serve.
Note: This is a correction notice. SSA published this
information collection as an extension on December 08, 2009 at 74 FR
64801. Since we are revising the Privacy Act Statement, this is now
a revision of an OMB-approved information collection.
Type of Request: Revision of an OMB-approved information
collection.
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Average burden
Form No. Number of Frequency of per response Total annual
respondents response (minutes) burden (hours)
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SSA-637................................. 2,001 1 120 4,002
SSA-639................................. 9,341 1 10 1,557
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Totals.............................. 11,342 ................ ................ 5,559
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6. Direct Deposit Sign-Up Form (Country)--31 CFR 210--0960-0686.
SSA's International Direct Deposit Program allows beneficiaries living
abroad to receive their payments via direct deposit to an account at a
financial institution outside the United States. SSA uses Form SSA-1199
to obtain the direct deposit information for such foreign accounts.
Routing account number information varies slightly for each foreign
country, so we use a variation of the Treasury Department's Form SF-
1199A for each country. The respondents are Social Security
beneficiaries residing abroad who want SSA to deposit their benefits
payments directly to a foreign financial institution.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 5,000.
Frequency of Response: 1.
Average Burden per Response: 5 minutes.
Estimated Annual Burden: 417 hours.
7. Certification of Prisoner Identity Information--20 CFR 422.107--
0960-0688. This regulation stipulates that when a valid agreement is in
place, prison officials may verify the identity of certain incarcerated
U.S. citizens who need replacement Social Security cards. Information
the prison officials provide will come from the official prison files,
sent on prison letterhead. SSA uses this information to establish the
applicant's identity in the replacement Social Security card process.
The respondents are prison officials who certify the identities of
prisoners applying for replacement Social Security cards.
Note: This is a correction notice. SSA published this
information collection as an extension on December 08, 2009 at 74 FR
64801. Since we are revising the Privacy Act Statement, this is now
a revision of an OMB-approved information collection.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 1,000.
Frequency of Response: 200.
Average Burden per Response: 3 minutes.
Estimated Annual Burden: 10,000 hours.
8. Temporary Extension of Attorney Fee Payment System to Title XVI;
5-Year Demonstration Project Extending Fee Withholding and Payment
Procedures to Eligible Non-Attorney Representatives; Definition of
Past-Due Benefits; and Assessment for Fee Payment Services--20 CFR
404.1717, 404.1730(c)(1), 404.1730(c)(2)(i), 404.1730(c)(2)(ii),
416.1517, 416.1528(a), 416.1530(c)(1), 416.1530(c)(2)(i),
416.1530(c)(2)(i)--0960-0745. Section 302 of the Social Security
Protection Act of 2004 (SSPA), Public Law 108-203, amended section
1631(d)(2) of the Social Security Act to temporarily extend the Title
II attorney fee withholding and direct payment process to Title XVI.
Section 303 of the SSPA directed SSA to develop and conduct a 5-year
nationwide demonstration project to allow qualifying non-attorneys the
option of
[[Page 9997]]
fee withholding and direct payment of fees under both Titles II and
XVI. SSA uses the information obtained through this demonstration
project to administer fee withholding and direct payment to certain
non-attorney representatives. Respondents are non-attorneys who are
eligible to receive direct payment of fees for representing individuals
before SSA.
Type of Request: Extension of an OMB-approved information
collection.
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Average burden
Regulation section Number of Frequency of response per response Estimated annual
respondents (minutes) burden (hours)
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404.1730(c)(2)(i)................ 841 10/year................ 30 4,205
404.1730(c)(2)(ii)............... 600 1...................... 3 30
416.1530(c)(2)(i)................ 561 10/year................ 30 2,805
416.1530(c)(2)(ii)............... 400 1...................... 3 20
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Totals....................... 2,402 ....................... ................ 7,060
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Dated: February 26, 2010.
Faye I. Lipsky,
Acting Reports Clearance Officer, Social Security Administration.
[FR Doc. 2010-4448 Filed 3-3-10; 8:45 am]
BILLING CODE 4191-02-P