[Federal Register Volume 59, Number 24 (Friday, February 4, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-2406]


[[Page Unknown]]

[Federal Register: February 4, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Social Security Administration

 

Agency Forms Submitted to the Office of Management and Budget for 
Clearance

    Normally on Fridays, the Social Security Administration publishes a 
list of information collection packages that have been submitted to the 
Office of Management and Budget (OMB) for clearance in compliance with 
Public Law 96-511, The Paperwork Reduction Act. The following clearance 
packages have been submitted to OMB since the last list was published 
in the Federal Register on Monday, December 27, 1993.

(Call Reports Clearance Officer on (410) 965-4142 for copies of 
package)

    1. Work Activity Report--Employee, 0960-New. The information on 
form SSA-821-BK will be used by the Social Security Administration 
(SSA) to obtain the same information regarding work activity that is 
currently obtained via forms SSA-821-F4 and SSA-3945-BK. Those two 
forms will be obsoleted. Work information is needed by SSA in order to 
determine initial or continuing entitlement to disability benefits.

Number of Respondents: 300,000
Frequency of Response: On occasion
Average Burden Per Response: 45 minutes
Estimated Annual Burden: 225,000 hours

    2. State Agency Schedule for Equipment Purchases for SSA Disability 
Programs, 0960-0406. The information on form SSA-871 is used by the 
Social Security Administration to reimburse State Disability 
Determination Services (DDS) agencies for equipment used in 
determinations regarding Social Security claims. The respondents are 
the 54 State DDSs.

Number of Respondents: 54
Frequency of Response: 1
Average Burden Per Response: 1 hour
Estimated Annual Burden: 54 hours
    3. Information about Joint Checking/Savings Account, 0960-0461. The 
information on form SSA-2574 is used by the Social Security 
Administration to determine if funds in a joint bank account belong to 
the Supplemental Security Income (SSI) applicant or recipient. The 
affected public is comprised of applicants for and recipients of SSI 
benefits who have joint bank accounts.

Number of Respondents: 200,000
Frequency of Response: on occasion
Average Burden Per Response: 7 minutes
Estimated Annual Burden: 23,333 hours

    4. Request for Supplemental Security Income (SSI) Benefit Estimate, 
0960-0492. The information on form SSA-3716 is used by the Social 
Security Administration to provide estimates of future SSI payments of 
recipients who may return to work. The respondents are current SSI 
recipients who may receive monetary compensation for work performed.

Number of Respondents: 50,000
Frequency of Response: On occasion
Average Burden Per Response: 5 minutes
Estimated Annual Burden: 4,167 hours

    5. Vocational Rehabilitation ``301'' Program Development, 0960-
0282. The information on form SSA-4290 is used by the Social Security 
Administration to determine an individual's continued entitlement to 
disability benefits when that individual has medically recovered while 
allegedly participating in a Vocational Rehabilitation (VR) program. 
The respondents are State VR agencies serving such beneficiaries.

Number of Respondents: 80
Frequency of Response: 100
Average Burden Per Response: 15 minutes
Estimated Annual Burden: 2,000 hours

    6. Third Party Liability Information Statement, 0960-0323. The 
information on form SSA-8019 is used by the Social Security 
Administration (SSA) to record commercial health insurance information 
from applicants and recipients of Supplemental Security Income (SSI) 
who may also be entitled to Medicaid. The respondents are such 
individuals who live in States which have agreed, under Section 1634 of 
the Social Security Act, to have SSA make determinations regarding 
eligibility for medical assistance under the State's plan.

Number of Respondents: 65,400
Frequency of Response: 1
Average Burden Per Response: 5 minutes
Estimated Annual Burden: 5,450 hours

    7. Referral and Treatment Status of SSI Drug Addicts or Alcoholics, 
0960-0331. The information on form SSA-8740 is used by the Social 
Security Administration to refer SSI recipients (who are disabled 
because of drug addiction or alcoholism) for treatment and to monitor 
such treatment. The respondents are State agencies who refer and 
monitor such recipients.

Number of Respondents: 38,500
Frequency of Response: 1
Average Burden Per Response: 10 minutes
Estimated Annual Burden: 6,417 hours

OMB Desk Officer: Laura Oliven.

    Written comments and recommendations regarding these information 
collections should be sent directly to the appropriate OMB Desk Officer 
designated above at the following address: OMB Reports Management 
Branch, New Executive Office Building, room 3208, Washington, DC 20503.

    Dated: January 26, 1994.
Charlotte Whitenight,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 94-2406 Filed 2-3-94; 8:45 am]
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