[Federal Register Volume 59, Number 68 (Friday, April 8, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-8327]


[[Page Unknown]]

[Federal Register: April 8, 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 
Pub. L. 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 Friday, March 25, 1994.

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

    1. Supplement to Claim of Person Outside the United States--0960-
0051. The information on form SSA-21 is used by the Social Security 
Administration to determine continuing entitlement, proper benefit 
amount, and withholding tax liability of aliens who lived, live, or are 
planning to live, outside the U.S. for more than 6 months. The 
respondents are such aliens.

Number of Respondents: 35,000
Frequency of Response: On occasion
Average Burden Per Response: 5 minutes
Estimated Annual Burden: 2,917 hours

    2. Request for Withdrawal of Application--0960-0015. The 
information on form SSA-521 is used by the Social Security 
Administration to effectuate and record an applicant's withdrawal of 
his or her claim for benefits. The respondents are applicants who 
choose to withdraw their claims for benefits.

Number of Respondents: 100,000
Frequency of Response: 1
Average Burden Per Response: 5 minutes
Estimated Annual Burden: 8,333 hours

    3. Claim for Amounts Due in the Case of a Deceased Beneficiary--
0960-0101. The information on form SSA-1724 is used by the Social 
Security Administration to determine which applicant should receive any 
underpayment that is due a deceased beneficiary. The respondents are 
applicants for such underpayments.

Number of Respondents: 300,000
Frequency of Response: 1
Average Burden Per Response: 10 minutes
Estimated Annual Burden: 50,000 hours

    4. Claimant's Statement about Loan of Food or Shelter; Statement 
about Food or Shelter Provided to Another--0960-NEW. The information on 
forms SSA-5062 and SSA-L5063 will be used by the Social Security 
Administration to determine whether food or shelter provided to a 
recipient of Supplemental Security Income (SSI) payments should be 
counted as income. The respondents are SSI recipients who receive food 
or shelter and individuals who provide it to them.

Number of Respondents: 131,080
Frequency of Response: On occasion
Average Burden Per Response: 10 minutes
Estimated Annual Burden: 21,847 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.

    Date: April 4, 1994.
Charlotte Whitenight,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 94-8327 Filed 4-7-94; 8:45 am]
BILLING CODE 4190-29-P