[Federal Register Volume 59, Number 165 (Friday, August 26, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-20933]


[[Page Unknown]]

[Federal Register: August 26, 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, July 29, 1994.
    (Call Reports Clearance Officer on (410) 965-4142 for copies of 
package.)
    1. Compliance With Pass-Along--0960-0240. The information obtained 
by this regulation is used by the Social Security Administration to 
determine that certain States which administer their own supplementary 
payments programs have complied with the requirements. The respondents 
are States which have entered into an agreement with the Secretary to 
administer their own supplementary payments programs.
    Number of Respondents: 26.
    Frequency of Response: 11 States @ 1, 15 States @ 4.
    Average Burden Per Response: 60 minutes.
    Estimated Annual Burden: 71 hours.
    2. Waiver of Benefit Payments--0960-NEW. The information on form 
SSA-149 is used by the Social Security Administration to document the 
fact that a beneficiary has requested that his or her benefits not be 
paid. The respondents are beneficiaries who use this form to make such 
requests.
    Number of Respondents: 100.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 8 hours.
    3. Application for Benefits under a U.S. International Social 
Security Agreement--0960-0448. The information on form SSA-2490 is used 
by the Social Security Administration to determine a claimant's 
eligibility to either U.S. Social Security benefits or benefits from a 
country which has entered into an agreement with the U.S. The 
respondents are individuals who have filed for such benefits.
    Number of Respondents: 10,000.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 3,333 hours.
    4. Employment Relationship Questionnaire--0960-0040. The 
information on form SSA-7160 is used by the Social Security 
Administration to determine the employment relationship of alleged 
employees in various occupations. The affected public consists of 
claimants and their alleged employers when the claimant's employee 
status is questionable.
    Number of Respondents: 47,500.
    Frequency of Response: 1.
    Average Burden Per Response: 25 minutes.
    Estimated Annual Burden: 19,792 hours.
    5. Questionnaire About Employment or Self-Employment Outside the 
United States--0960-0050. The information on form SSA-7163 is used by 
the Social Security Administration to determine whether work done 
outside the U.S. by a beneficiary should cause a reduction in benefits. 
The respondents are beneficiaries who may be subject to deductions 
because of such work.
    Number of Respondents: 20,000.
    Frequency of Response: 1.
    Average Burden Per Response: 12 minutes.
    Estimated Annual Burden: 4,000 hours.
    6. Waiver of Right to Appear--Disability Hearing--0960-NEW. The 
information on form SSA-773 is used by the Social Security 
Administration to provide a claimant for disability benefits with a 
structured means to request a waiver of his or her right to a hearing. 
It also documents the fact that the claimant understands the effects of 
this decision to waive that right. The respondents are claimants for 
disability benefits who wish to waive their right to a hearing.
    Number of Respondents: 194.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 48 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: Office of Management and 
Budget, OIRA, New Executive Office Building, Room 10230, Washington, DC 
20503.

    Dated: August 20, 1994.
Charlotte Whitenight,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 94-20933 Filed 8-25-94; 8:45 am]
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