[Federal Register Volume 59, Number 203 (Friday, October 21, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-26163]


[[Page Unknown]]

[Federal Register: October 21, 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 
P.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, October 7, 1994.

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

    1. Supplemental Security Income Reply Form--0960-NEW. The 
information on form SSA-417 will be used to contact an applicant, whose 
claim for Supplemental Security Income (SSI) payments was denied, if he 
or she checks ``yes'' on this form. The respondents will be applicants 
for SSI whose claim was denied.

Number of Respondents: 60,000
Frequency of Response: 1
Average Burden Per Response: 2 minutes
Estimated Annual Burden: 2,000 hours

    2. Claimant's Statement When Request for Hearing is Filed and the 
Issue is Disability--0960-0316. The information on form HA-4486 is used 
by the Social Security Administration to update the work background and 
medical history of an individual whose claim for benefits based on 
disability has been denied and who requested a hearing. The respondents 
are such claimants.

Number of Respondents: 283,460
Frequency of Response: 1
Average Burden Per Response: 15 minutes
Estimated Annual Burden: 70,865 hours

    3. Report of Function-Child (5 forms-various ages)--0960-NEW. The 
information on forms SSA-3375, 6, 7, 8, and 9 will be used by the 
Social Security Administration to help determine if a child claiming 
title XVI disability benefits is disabled. The respondents will be 
parents or guardians who file for such benefits on behalf of a child.

Number of Respondents: 500,000
Frequency of Response: 1
Average Burden Per Response: 20 minutes
Estimated Annual Burden: 166,667 hours

    4. Plan for Achieving Self-Support (PASS) study form. The 
information on the questionnaire will be used by the Social Security 
Administration to determine the effectiveness of the Agency's 
implementation, monitoring, and control of the PASS activities. The 
study form will be used to obtain various PASS information from 
Supplemental Security Income recipients.

Number of Respondents: 1,900
Frequency of Response: 1
Average Burden Per Response: 20 minutes
Estimated Annual Burden: 633 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, 
D.C. 20503.

    Dated: October 18, 1994.
Charlotte Whitenight,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 94-26163 Filed 10-20-94; 8:45 am]
BILLING CODE 4190-29-P