[Federal Register Volume 62, Number 40 (Friday, February 28, 1997)]
[Notices]
[Pages 9233-9234]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-4368]


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SOCIAL SECURITY ADMINISTRATION


Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

    The Social Security Administration publishes a list of information 
collection packages submitted 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 
collections listed below have been submitted to OMB:
    1. Physical Residual Functional Capacity Assessment; Mental 
Residual Functional Capacity Assessment--0960-0431. The information 
collected on forms SSA-4734-BK 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.
    2. Letter to Employer Requesting Wage Information--0960-0138. The 
information collected on form SSA-L4201 is used by the Social Security 
Administration to determine eligibility and proper payment for 
Supplemental Security Income (SSI) applicants/recipients. The 
respondents are employers of applicants for and recipients of SSI 
payments.
    Number of Respondents: 133,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 66,500 hours.
    3. State Agency Schedule for Equipment Purchases for SSA Disability 
Program--0960-0406. The information collected on form SSA-871 is used 
by the Social Security Administration to budget and account for 
expenditures of funds for equipment purchases by the State Disability 
Determination Services that administer the disability program. The 
respondents are State Disability Determination Services.
    Number of Respondents: 54.
    Frequency of Response: Annually.
    Average Burden Per Response: 1 hour.
    Estimated Annual Burden: 54 hours.
    To receive a copy of the forms or clearance packages, call the SSA 
Reports Clearance Officer on (410) 965-4125 or write to her at the 
address listed below. Written comments and recommendations regarding 
the information collection(s) should be directed within 30 days to the 
OMB

[[Page 9234]]

Desk Officer and SSA Reports Clearance Officer 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, 1-A-21 
Operations Bldg., 6401 Security Blvd., Baltimore, MD 21235

    Dated: February 14, 1997
Judith T. Hasche,
SSA Reports Clearance Officer, Social Security Administration.
[FR Doc. 97-4368 Filed 2-27-97; 8:45 am]
BILLING CODE 4190-29-P