[Federal Register Volume 59, Number 226 (Friday, November 25, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-29055]


[[Page Unknown]]

[Federal Register: November 25, 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, October 21, 1994.

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

    1. Notice of Proposed Rulemaking Concerning Wage Reports and 
Pension Information--0960-NEW. The information provided in connection 
with OR-418P is used by the Social Security Administration to identify 
the requester of pension plan information and ascertain that the 
individual is entitled to the data we provide. The respondents are 
requesters of pension plan information.
    Number of Respondents: 2,280.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 1,140.
    2. Final regulation at 20 CFR 401.600 regarding the Social Security 
Administration's (SSA's) Blood Donor Locator Service (BDLS)--0960-0501. 
The information obtained by OR-209F is used by SSA to notify the States 
or authorized blood donation facilities that a donor may be infected 
with the Human Immunodeficiency Virus. Respondents are States or other 
authorized blood donation facilities which have entered into an 
agreement with SSA to participate in the BDLS by providing this 
information.
    Number of Respondents: 10.
    Frequency of Response: 5.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 13 hours.
    3. Application for Retirement Insurance Benefits--0960-0007. The 
information on form SSA-1 is used by the Social Security Administration 
to determine an individual's entitlement to retirement insurance 
benefits. The respondents are claimants for those benefits.
    Number of Respondents: 1,560,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10.5.
    Estimated Annual Burden: 273,000 hours.
    4. Child Relationship Statement--0960-0116. The information on Form 
SSA-2519 is used by the Social Security Administration to entitle 
children to benefits under the deemed relationship provision. The 
respondents are individuals who have knowledge of a child's 
relationship to the insured worker.
    Number of Respondents: 50,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 12,500 hours.
    5. Request To Have Supplemental Security Income Overpayment 
Withheld From My Social Security Benefits--0960-NEW. The information on 
form SSA-730-U2 will be used by the Social Security Administration to 
verify that a request has been made of a beneficiary to recover an SSI 
overpayment from his or her Title II benefits and that the request was 
freely, voluntarily and knowingly made.
    Number of Respondents: 10,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 833.3 hours.
    6. Physician's/Medical Officer's Statement of Patient's Capability 
to Manage Benefits--0960-0024. The information on form SSA-787 is used 
by the Social Security Administration to determine the individual's 
capability or lack thereof in handling his or her own benefits. The 
information also provides leads, if necessary, for SSA to follow up on 
in selecting a representative.
    Number of Respondents: 120,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 20,000.
    7. Public Service Announcements--0960-NEW. These forms accompany 
public service announcements of up to 60 seconds which are sent out to 
radio and television (TV) stations to better inform the public about 
the programs of the Social Security Administration (SSA). The 
information on the various forms is used by SSA to determine which 
spots are played, how often, their effectiveness, and the need for more 
local announcements. The forms are completed and returned to a 
contractor who works for SSA by the receiving radio or TV station.
    Number of Respondents: 1,044.
    Frequency of Response: 4.
    Average Burden Per Response: 2 minutes.
    Estimated Annual Burden: 139 hours.
    8. Work Reintegration Study--0960-NEW. The information on the two 
forms used in this study will aide the Social Security Administration 
in determining what steps it can take to help beneficiaries who are 
disabled due to a back condition to return to work.
    Number of Respondents: 2,000.
    Frequency of Response: 1.
    Average Burden Per Response: 1 hour.
    Estimated Annual Burden: 2,000 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: Office of Management and 
Budget, OIRA, New Executive Office Building, Room 10230, Washington, DC 
20503.

    Dated: November 18, 1994.
Charlotte Whitenight,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 94-29055 Filed 11-23-94; 8:45 am]
BILLING CODE 4190-29-P