[Federal Register Volume 60, Number 194 (Friday, October 6, 1995)]
[Notices]
[Pages 52445-52447]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-24880]



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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 will require submission to 
the Office of Management and Budget (OMB) for clearance in compliance 
with P.L. 96-511, as amended (P.L. 104-13 effective October 1, 1995), 
The Paperwork Reduction Act. Since the last list was published in the 
Federal Register on September 22, 1995, the following information 
collections have been proposed or will require extension of the current 
OMB approvals.

(Call the Reports Clearance Officer on (410) 965-4142 for a copy of the 
form(s) 

[[Page 52446]]
or package(s), or write to her at the address listed after the 
information collections.)

    SSA Reports Clearance Officer: Charlotte S. Whitenight.
    1. Request To Be Selected As Payee--0960-0014. The information 
collected on form SSA-11-BK is used by the Social Security 
Administration to help determine the proper payee for a person who 
cannot receive his or her own Social Security benefits. The respondents 
will be individuals who apply to receive Social Security benefits on 
behalf of someone else.

Number of Respondents: 605,000
Frequency of Response: 1
Average Burden Per Response: 10.5 minutes
Estimated Annual Burden: 105,875 hours

    2. Disability Update Report--0960-0511. The information on form 
SSA-455 is used by the Social Security Administration to determine if a 
full medical continuing disability review (CDR) should be conducted. 
The respondents will be Social Security disability insurance 
beneficiaries who are scheduled to receive a CDR.

Number of Respondents: 431,200
Frequency of Response: 1
Average Burden Per Response: 15 minutes
Estimated Annual Burden: 107,800 hours

    3. Statement Regarding Marriage--0960-0017. The information 
collected via form SSA-753 is used by the Social Security 
Administration to make determinations regarding entitlement to spouse's 
benefits when a common law marriage is alleged. The respondents are 
third parties who can supply evidence concerning the existence of a 
common law marriage.

Number of Respondents: 40,000
Frequency of Response: 1
Average Burden Per Response: 9 minutes
Estimated Annual Burden: 6,000 hours

    4. State Contribution Return--0960-0041. The information on form 
SSA-3961 is used by the Social Security Administration to identify and 
account for all contributions due and paid by the states (or interstate 
instrumentalities) under Section 218 of the Social Security Act. The 
respondents are state agencies.

Number of Respondents: 117
Frequency of Response: on occasion
Average Burden Per Response: 3 minutes
Estimated Annual Burden: 500 hours

    5. Statement of Death by Funeral Director--0960-0142. The 
information collected on the SSA-721 is used by the Social Security 
Administration to verify the death of an individual insured under the 
Social Security Act and to determine if there is a survivor eligible 
for a lump sum death payment. The respondents will be funeral directors 
with knowledge of the death of a person insured for Social Security 
benefits.

Number of Respondents: 900,000
Frequency of Response: 1
Average Burden Per Response: 3.5 minutes
Estimated Annual Burden: 52,500 hours

    6. Annual Report of Earnings (long and short forms)--0960-0057. The 
information on forms SSA-777 and SSA-7770 is used by the Social 
Security Administration to determine the amount of yearly earnings of 
beneficiaries so that the proper benefit amounts are paid to them. The 
respondents will be beneficiaries under age 70 who have earned over the 
exempt amount for the year and still received benefits.

Number of Respondents: (SSA-777)-200,000; (SSA-7770)-1,000,000

------------------------------------------------------------------------
                                         SSA-777            SSA-7770    
------------------------------------------------------------------------
Frequency of Response...........  1...................  1               
Average Burden Per Response.....  17 minutes..........  8 minutes.      
Estimated Annual Burden.........  (1)190,000 hours                      
                                   (total for both                      
                                   forms).                              
------------------------------------------------------------------------

    7. Public Information Campaigns and News Releases-0960-0544. The 
purpose of the public information campaigns and new releases is to 
better inform the public about the programs and activities of the 
Social Security Administration (SSA). The information is used by SSA to 
determine media interest in airing and printing the public information 
materials and news releases and to determine which materials are used, 
how often, its effectiveness, and the need for more local 
announcements. The respondents are newspapers and public broadcasting 
systems such as television, cable, and radio stations.

Number of Respondents: TV--500, Newspaper-500, Radio--1,500, Cable--148
Frequency of Response: Public Service Announcements--4, News Releases-- 
Educational Tapes--2
Average Burden Per Response: 1 minute (solicitation card), 2 minutes 
(business reply card)
Estimated Annual Burden: 298 hours

    8. Work Reintegration Study--0960-0543. The information on the two 
forms used in this study will aid 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: 1,500
Frequency of Response: 1
Average Burden Per Response: 1 hour
Estimated Annual Burden: 1,500 hours

Social Security Administration

    Written comments and recommendations regarding these information 
collections should be sent within 60 days from the date of this 
publication, directly to the SSA Reports Clearance Officer at the 
following address: Social Security Administration, DCFAM, Attn: 
Charlotte S. Whitenight, 6401 Security Blvd., 1-B-22 Operations Bldg., 
Baltimore, MD 21235.
    In addition to your comments on the accuracy of the agency's burden 
estimate, we are soliciting comments on the need for the information; 
its practical utility; ways to enhance its quality, utility and 
clarity; and on ways to minimize burden on respondents, including the 
use of automated collection techniques or other forms of information 
technology.
    The following information collections, which were published in the 
Federal Register on August 4, 1995, have been submitted to OMB:
    1. Notice Regarding Substitution of Party Upon Death of Claimant--
Reconsideration of Disability Cessation--OMB Control No. 0960-0351. The 
information on form SSA-770 is used by the Social Security 
Administration to obtain information from substitute parties regarding 
their intention to pursue the appeals process on behalf of an 
individual who died. The respondents are such parties.

Number of Respondents: 1,200
Frequency of Response: 1
Average Burden Per Response: 5 minutes
Estimated Annual Burden: 100 hours


[[Page 52447]]

    2. Disability Determination and Transmittal--OMB Control No. 0960-
0437. The information on form SSA-831 will be used by the State 
disability determination services to document whether an individual who 
applies for disability benefits is eligible for those benefits based on 
his or her alleged disability. It is also used by SSA for program 
management and evaluation. The respondents are state agency employees 
who make disability determinations for SSA.

Number of Respondents: 3,525,600
Frequency of Response: 1
Average Burden Per Response: 15 minutes
Estimated Annual Burden: 881,400

    3. Cessation or Continuance of Disability or Blindness 
Determination and Transmittal--Title XVI--OMB Control No. 0960-0443. 
The information on form SSA-832 is used by State disability 
determination services to document determinations as to whether an 
individual's disability benefits should be terminated or continued on 
the basis of his/her impairment. The respondents are state disability 
determination services adjudicating Title XVI disability claims.

Number of Respondents: 53,700
Frequency of Response: 1
Average Burden Per Response: 30 minutes
Estimated Annual Burden: 26,850 hours

    4. Cessation or Continuance of Disability or Blindness 
Determination and Transmittal--Title II--OMB Control No. 0960-0442. The 
information on form SSA-833 is used by State disability determination 
services to prepare determinations of whether individuals receiving 
Title II disability or blindness benefits continue to be unable to 
engage in substantial gainful work by reason of their impairments and 
are still eligible for benefit payments. It is also used to collect 
data for program evaluation and program management.

Number of Respondents: 268,700
Frequency of Response: 1
Average Burden Per Response: 30 minutes
Estimated Annual Burden: 134,350 hours

Social Security Administration

    Written comments and recommendations regarding these information 
collections should be sent within 30 days of the date of this 
publication. Comments may be directed to OMB and SSA at the following 
addresses:

(OMB)
    Office of Management and Budget, OIRA, Attn: Laura Oliven, New 
Executive Office Building, Room 10230,Washington, D.C. 20503
(SSA)
    Social Security Administration, DCFAM, Attn: Charlotte S. 
Whitenight, 6401 Security Blvd, 1-A-21 Operations Bldg., Baltimore, MD 
21235

    Dated: October 2, 1995.
Charlotte Whitenight,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 95-24880 Filed 10-5-95; 8:45 am]
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