[Federal Register Volume 60, Number 231 (Friday, December 1, 1995)]
[Notices]
[Pages 61726-61728]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-29139]



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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 November 17, 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) or package(s), or write to her at the address listed 
after the information collections.)

SSA Reports Clearance Officer: Charlotte S. Whitenight.
    1. Quarterly Statistical Report on Recipients and Payments Under 
State-administered Assistance Programs for Aged, Blind and Disabled 
(Individuals and Couples) Recipients--0960-0130. The information 
collected on the SSA-9741 is used to provide statistical data on 
recipients and assistance payments under the SSI State-administered 
State supplementation programs. These data are needed to complement the 
data available for the federally administered programs under SSA and to 
more fully explain the impact of the public income support programs on 
the needy, aged, blind and disabled. The respondents are state agencies 
who administer supplementary payment programs under SSI.
    Number of Respondents: 23
    Frequency of Response: 4 times annually
    Average Burden Per Response: 1 hour
    Estimated Annual Burden: 92 hours
    2. Record of SSI Inquiry--0960-0140. The information collected on 
form SSA-3462 is used to document the earliest possible filing date and 
to determine potential eligibility for SSI benefits. The respondents 
are individuals who inquire about SSI eligibility for themselves or 
another individual.
    Number of Respondents: 1,200,000
    Frequency of Response: 1
    Average Burden Per Response: 5 minutes
    Estimated Annual Burden: 100,000
    3. Request for Workers' Compensation/Public Disability 
Information--0960-0098. The information collected on form SSA-1709 is 
used to verify workers compensation and public disability benefits 
payment amounts and to compute the correct reduction to the disability 
insurance benefits. The respondents are state and local governments 
and/or business that administer workers' compensation or other 
disability benefits.
    Number of Annual Responses: 140,000
    Frequency of Response: As needed to verify changes in the amount of 
workers compensation/public disability benefits
    Average Burden Per Response: 15 minutes
    Estimated Annual Burden: 35,000 hours
    4. Employee Work Activity Questionnaire--0960-0483. The information 
collected on form SSA-3033 is used to determine if a disability 
claimant has or has not either engaged in substantial gainful activity 
or received a non-specific subsidy. Such a determination is necessary 
in evaluating a claimant's eligibility for Social Security disability 
benefits. The respondents are current or former employers of disability 
claimants.
    Number of Respondents: 12,500
    Frequency of Response: 1
    Average Burden Per Response: 15 minutes
    Estimated Annual Burden: 3,125 hours
    5. Followup Survey for the Project Network Evaluation--0960-NEW. 
Project Network is a demonstration project that tests alternative 
approaches to assisting people with disabilities in 

[[Page 61727]]
finding and maintaining employment. Followup information collected from 
project participants (treatment and control group members) will be used 
to evaluate the extent to which the different demonstration service-
delivery systems assisted people with disabilities to find and maintain 
employment. The respondents are selected participants in the initial 
Project Network survey.
    Number of Respondents: 1,558
    Frequency of Response: 1
    Average Burden Per Response: 90 minutes
    Estimated Annual Burden: 2,337 hours
    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 October 6, 1995, have been submitted to OMB:
    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.

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                                                    SSA-777                               SSA-7770              
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Frequency of Response..............  1....................................  1.                                  
Average Burden per Response........  17 minutes...........................  8 minutes.                          
Estimated Annual Burden............  190,000 hours........................  190,000 hours.                      
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    7. Public Information Campaigns and News Releases--0960-0544. The 
purpose of the public information campaigns and news 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--4, 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.
    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, DC 20503. 

[[Page 61728]]

    (SSA) Social Security Administration, DCFAM, Attn: Charlotte S. 
Whitenight, 6401 Security Blvd, 1-A-21 Operations Bldg., Baltimore, MD 
21235.

    Dated: November 21, 1995.
Charlotte Whitenight,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 95-29139 Filed 11-30-95; 8:45 am]
BILLING CODE 4190-29-P