[Federal Register Volume 61, Number 18 (Friday, January 26, 1996)]
[Notices]
[Pages 2566-2567]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-966]



=======================================================================
-----------------------------------------------------------------------

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. The information collections listed below, 
which were published in the Federal Register on December 1, have been 
submitted to OMB.

(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 businesses 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. 

[[Page 2567]]
    Project Network is a demonstration project that tests alternative 
approaches to assisting people with disabilities in 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: 1,579.
    Frequency of Response: 1.
    Average Burden Per Response: 90 minutes.
    Estimated Annual Burden: 2,369 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: January 18, 1996.
Charlotte Whitenight,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 96-966 Filed 1-25-96; 8:45 am]
BILLING CODE 4190-29-P