[Federal Register Volume 59, Number 102 (Friday, May 27, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-12913]


[[Page Unknown]]

[Federal Register: May 27, 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 Friday, April 8, 1994.
    (Call Reports Clearance Officer on (410) 965-4142 for copies of 
package).

    1. Application for Disability Insurance Benefits--0960-0060. The 
information on form SSA-16 is used by the Social Security 
Administration to determine an applicant's eligibility to disability 
insurance benefits. The respondents are such applicants.
    Number of Respondents: 1,000,000.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 333,333 hours.

    2. Statement of Care and Responsibility for Beneficiary--0960-0109. 
The information on form SSA-788 is used by the Social Security 
Administration to evaluate the concern that a potential payee shows 
toward the beneficiary. The respondents are individuals or institutions 
who have custody of a beneficiary for whom someone else has filed to be 
representative payee.
    Number of Respondents: 130,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 21,667 hours.

    3. Statement of Claimant or Other Person--0960-0045. The 
information on form SSA-795 is used by the Social Security 
Administration (SSA) to document special circumstances in connection 
with a claim for benefits. The respondents are claimants or other 
persons who need to provide information to SSA which is not asked for 
on other forms.
    Number of Respondents: 305,500.
    Frequency of Response: On occasion.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 76,375 hours.

    4. SSA-2930-BK, RSI/DI Quality Review Case Analysis-Sampled Number 
Holder; SSA-2931-BK, RSI/DI Quality Review Case Analysis-Auxiliaries/
Survivors; SSA-2932-BK, RSI/DI Quality Review Case Analysis-Parent; and 
the SSA-4659-BK, RSI/DI Quality Review Case Analysis-Annual Earnings 
Test--0960-0189. The information on these forms is used by the Social 
Security Administration to provide a national payment accuracy rate and 
data regarding the major types and sources of program deficiencies. The 
affected public consists of beneficiaries who are selected to 
participate in a quality review analysis.
    Number of Respondents: 12,120 (for all forms).
    Frequency of Response: 1.
    Average Burden Per Response: 20-30 minutes (depending on form 
used).
    Estimated Annual Burden: 5,674 hours.

    5. Questionnaire for Children Claiming SSI Benefits--0960-0499. The 
information obtained by form SSA-3881 concerns the evaluation of 
disability in children and is used by the Social Security 
Administration to comply with the requirements of the Zebley court 
case. The respondents are individuals who apply for Supplemental 
Security Income as a disabled child.
    Number of Respondents: 276,000.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 92,000 hours.

    6. Statement for Determining Continuing Eligibility for 
Supplemental Security Income Payments--0960-0145. The information 
collected by the revised SSA-8202-F6 will be used by the Social 
Security Administration to reevaluate factors of an SSI recipient's 
eligibility in order to determine continuing eligibility and payment 
amount.
    Number of Respondents: 800,000.
    Frequency of Response: Annually.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 133,333 hours.

    7. Annual Earnings Stuffer Questionnaire--0960-NEW. This stuffer 
will be sent to a 3% sampling of beneficiaries during the annual mid-
year mailing. The information collected will be used by the Social 
Security Administration to determine if payments were made to recently 
retired beneficiaries which should not count in the annual earnings 
test. The respondents will be selected beneficiaries who receive this 
stuffer and who return it voluntarily to SSA.
    Number of Respondents: 6,000.
    Frequency of Response: One time only.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 1,000 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: May 23, 1994.
Charlotte Whitenight,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 94-12913 Filed 5-26-94; 8:45 am]
BILLING CODE 4190-29-P-M