[Federal Register Volume 61, Number 213 (Friday, November 1, 1996)]
[Notices]
[Pages 56601-56602]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-28055]


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SOCIAL SECURITY ADMINISTRATION


Agency Information Collection Activities

Proposed Collection Request

    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 Public Law 
104-13 effective October 1, 1995, The Paperwork Reduction Act of 1995. 
The information collection(s) listed below requires extension of the 
current OMB approval(s).

(Call the SSA Reports Clearance Officer on (410) 965-4125 for a copy 
of the form(s) or package(s), or write to her at the address listed 
below the information collections.)

    1. Statement of Funds You Provided to Another; Statement of Funds 
You Received--0960-0481. The information collected on forms SSA-2854 
and SSA-2855 is used by the Social Security Administration to determine 
if money borrowed on an informal basis from a noncommercial lender 
(friend or relative) is income to the borrower/claimant. The 
information is needed to insure that an individual is properly eligible 
for Supplemental Security Income (SSI) payments. The respondents are 
applicants for and recipients of SSI payments.
    Number of Respondents: 40,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 6,667 hours.
    2. Physical Residual Functional Capacity Assessment; Mental 
Residual Functional Capacity Assessment--0960-0431. The information 
collected on forms SSA-4734-U8 and SSA-4734 SUP is needed by the Social 
Security Administration to assist in the adjudication of disability 
claims involving physical and/or mental impairments. The forms assist 
the State Disability Determination Services (DDS) to evaluate 
impairment(s) by providing a standardized data collection format to 
present findings in a clear, concise and consistent manner. The 
respondents are State DDSs administering title II and title XVI 
disability programs.
    Number of Responses: 1,693,425.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 564,475 hours.
    Written comments and recommendations regarding the information 
collection(s) 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: Judith 
T. Hasche, 6401 Security Blvd., 1-A-21 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.

Submission for OMB Review; Comment Request

    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. 104-
13 effective October 1, 1995, The Paperwork Reduction Act of 1995. The 
information collection(s) listed below, which was published in the 
Federal Register on September 3, 1996, has been submitted to OMB.

(Call the SSA Reports Clearance Officer on (410) 965-4125 for copies 
of the form(s) or package(s).)

    OMB Desk Officer: Laura Oliven.
    SSA Reports Clearance Officer: Judith T. Hasche.
    1. Application for Supplemental Security Income--0960-0229. The 
information on form SSA-8000 is used by the Social Security 
Administration to determine a claimant's eligibility for benefits and 
the amount payable in claims for SSI. The respondents are certain 
applicants for SSI.
    Number of Respondents: 1,316,678.
    Frequency of Response: 1.
    Average Burden Per Response:

      35 minutes for paper application
      25 minutes for automated collection of information

    Estimated Annual Burden: 581,533 hours.
    2. Statement of Living Arrangements, In-Kind Support and 
Maintenance--0960-0174. The information on form SSA-8006 is used by the 
Social Security Administration to determine if an applicant or 
recipient meets the income

[[Page 56602]]

criteria for eligibility to SSI benefits. The respondents are 
individuals who apply for or are receiving SSI payments.
    Number of Respondents: 438,400.
    Frequency of Response: 1.
    Average Burden Per Response: 7 minutes.
    Estimated Annual Burden: 51,147 hours.
    Written comments and recommendations regarding the information 
collection(s) 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, 725 17th St., NW., Washington, 
D.C. 20503
(SSA), Social Security Administration, DCFAM, Attn: Judith T. Hasche, 
6401 Security Blvd, 1-A-21 Operations Bldg., Baltimore, MD 21235

    Date: October 25, 1996.
Frederick W. Brickenkamp,
Team Leader, FMRCT, Social Security Administration.
[FR Doc. 96-28055 Filed 10-31-96; 8:45 am]
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