[Federal Register Volume 59, Number 126 (Friday, July 1, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-15755]


[[Page Unknown]]

[Federal Register: July 1, 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, May 27, 1994.

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

    1. Certification by a Religious Group--0960-0093. The information 
on form SSA-1458 is used by the Social Security Administration to 
determine whether or not the members of a specific religious group can 
be exempted from paying self-employment tax. The respondents are 
members of such groups. 

                                                                        
                                                                        
                                                                        
Number of Respondents.................................  180             
Frequency of Response.................................  1               
Average Burden Per Response...........................  15 minutes.     
Estimated Annual Burden...............................  45 hours.       
                                                                        

    2. SSA-2765 (Request for Self-Employment Information), SSA-3365 
(Request for Employment Information), SSA-4002 (Request for Employer 
Information)--0960-0508. The information on these forms is used by the 
Social Security Administration to determine who reported earnings 
belong to. The respondents are workers or employers who are requested 
to complete one of these forms regarding certain unidentifiable 
earnings. 

                                                                        
                                                                        
                                                                        
Number of Respondents.................................  3,000,000       
Frequency of Response.................................  1               
Average Burden Per Response...........................  10 minutes.     
Estimated Annual Burden...............................  500,000 hours.  
                                                                        

    3. Disability Report; Vocational Report--0960-0141. The information 
on forms SSA-3368 and SSA-3369 is used by the Social Security 
Administration to help develop complete disability and vocational 
information in claims for disability benefits. The respondents are 
claimants for those benefits. 

                                                                        
                                          SSA-3368          SSA-3369    
                                                                        
Number of Respondents...............  2,264,000.......  1,000,000       
Frequency of Response...............  1...............  1               
Average Burden Per Response.........  45 mins.........  30 mins.        
Estimated Annual Burden.............  1,698,000 hours.  500,000 hours.  
                                                                        

    4. Medical History and Disability Report--0960-0504. The 
information on form SSA-3820 is used by the Social Security 
Administration to help make determinations in claims for disabled 
child's benefits. The respondents are claimants who file for those 
benefits. 

                                                                        
                                                                        
                                                                        
Number of Respondents.................................  453,000         
Frequency of Response.................................  1               
Average Burden Per Response...........................  20 minutes.     
Estimated Annual Burden...............................  151,000 hours.  
                                                                        

    5. Social Security Request for Information--0960-NEW. The 
information on form SSA-6231 will be used by the Social Security 
Administration to complete or clarify data previously provided by 
representative payees on forms SSA-623 or SSA-6230. The respondents 
will be payees who furnished incomplete or unclear information. 

                                                                        
                                                                        
                                                                        
Number of Respondents.................................  100,000         
Frequency of Response.................................  1               
Average Burden Per Response...........................  15 minutes.     
Estimated Annual Burden...............................  25,000 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, D.C. 
20503.

    Date: June 23, 1994.
Charlotte Whitenight,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 94-15755 Filed 6-30-94; 8:45 am]
BILLING CODE 4190-29-P