[Federal Register Volume 62, Number 50 (Friday, March 14, 1997)]
[Notices]
[Pages 12262-12264]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-6240]


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SOCIAL SECURITY ADMINISTRATION


Agency Information Collection Activities; Proposed Collection 
Requests and Submissions for OMB Review

    This notice lists information collection packages that will require 
submission to the Office of Management and Budget as well as 
information collection packages submitted to the Office of Management 
and Budget for clearance.
    I. 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):
    1. 0960-0462--You Can Make Your Payments by Credit Cards. The 
information on Forms SSA-4588 & SSA-4589 will be used to update the 
individual's social security record to reflect that a payment has been 
made on their overpayment and to effectuate payment through the 
appropriate credit card company.
    Number of Respondents: 12,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 1,000 hours.
    2. 0960-0323--Third Party Liability Information Statement. Form 
SSA-8019 is used by the Social Security Administration to gather 
information or to make changes in existing information about third 
party insurance (other than Medicare or Medicaid), which could be 
responsible for payment for a beneficiary's medical care.
    Number of Respondents: 65,400.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.

[[Page 12263]]

    Estimated Annual Burden: 5,450 hours.
    3. 0960-0068--Representative Payee Report. Sections 205(j) and 
1631(a)(2) of the Social Security Act provide for the payment of 
supplemental social security benefits to a relative, another person or 
an organization when the best interests of the beneficiary will be 
served. Form SSA-6230 (20 CFR 404.2065) is sent to parents, stepparents 
and grandparents with custody of minor children receiving social 
security benefits. Form SSA-623 (20 CFR 404.2065 and 416.665) is sent 
to all other payees with or without custody of the beneficiary. Both 
forms are used to determine the continuing suitability of the 
individual/organization to serve as representative payee.
    Number of Respondents: 5,315,160.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 1,328,790 hours.
    4. Telephone Replacement Card Pilot Test--0960-NEW. The Social 
Security Administration will conduct a pilot study on obtaining 
information by telephone from individuals who need a duplicate Social 
Security Number (SSN) card. The information will be used to properly 
identify an individual prior to releasing a replacement SSN card, thus 
eliminating the need for the respondent to take or mail his/her 
identify documents to a Social Security office. The information 
provided, which should be known by the true Social Security number 
holder, will be compared to information available in our current 
electronic systems. The respondents are individuals in the pilot study 
who request a duplicate SSN replacement card by telephone.
    Number of Respondents: 500,000.
    Frequency of Response: 1.
    Average Burden Per Response: 2 minutes.
    Estimated Annual Burden: 16,667 hours.
    To receive a copy of the form(s) or clearance package(s), call the 
SSA Reports Clearance Officer on (410) 965-4123 or write to her at the 
address listed below the information collection(s). 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.
    II. 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. Claimant's Medications--0960-0289. The information on form HA-
4632 is used by the Social Security Administration to compile a current 
list of medications used by a claimant. The list is provided to an 
Administrative Law Judge (ALJ), who is considering the disability 
aspects of the claim. The affected public consists of claimants for 
disability benefits, who have requested a hearing before an ALJ.
    Number of Respondents: 227,107.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 56,777 hours.
    2. Request for SSI Benefit Estimate--0960-0492. The Social Security 
Administration collects the information on Form SSA-3716 for the sole 
purpose of complying with an SSI recipient's request for an estimate of 
the impact of his/her work on the receipt of SSI benefits.
    Number of Respondents: 50,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 4,167 hours.
    3. Statement of Employer--0960-0030. The information collected on 
Form SSA-7011 is used by the Social Security Administration to 
substantiate allegations of wages paid to workers when those wages do 
not appear in SSA's records of earnings, and the worker does not have 
proof of payment. This information is used to process claims for social 
security benefits and to resolve discrepancies in earnings records. The 
respondents are certain employers who can verify allegations of wages 
made by the wage earner.
    Number of Respondents: 925,000.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 308,333 hours.
    4. Supplemental Security Income Notice of Interim Assistance 
Reimbursement (two forms). Forms SSA-8125 0960-0546 and SSA-L8125 0960-
0563 collect interim assistance reimbursement (IAR) information from 
States which provide such assistance. Form SSA-8125 is used in most 
situations where IAR is applicable. Form SSA-L8125 is used in 
situations where an individual entitled to underpayments has received 
IAR from a State and his/her benefit will be controlled by SSA through 
the installment process. The respondents are states which provide IAR 
to SSI claimants.

------------------------------------------------------------------------
                                       SSA-8125            SSA-L8125    
------------------------------------------------------------------------
Number of Respondents...........  80,000............  60,000.           
Frequency of Response...........  1.................  1.                
Average Burden Per Response.....  10 minutes........  10 minutes.       
Estimated Annual Burden.........  13,333 hours......  10,000 hours.     
------------------------------------------------------------------------

    5. Work Reintegration Study--0960-0543. The purpose of the Work 
Reintegration Study is to identify those incentives and interventions 
that are most successful in assisting persons who are disabled due to a 
back condition to return to work. The information collected will be 
used primarily to complete a cross-national analysis of this issue. 
Data also will be gathered on subjects of particular importance in the 
U.S. The findings will provide policymakers with information that will 
be highly useful in establishing disability policy. The respondents are 
persons entitled to Social Security Disability Insurance, Supplemental 
Security Income (SSI) or State Temporary Disability Insurance.
    Number of Respondents: 800.
    Frequency of Response: 1.
    Average Burden Per Response: 1 hour.
    Estimated Annual Burden: 800 hours.
    6. Personal Earnings and Benefit Estimate Statement (PEBES)--
Identity Verification Survey--0960-NEW. The Social Security 
Administration (SSA) is conducting a survey to verify the identity and 
address of individuals who request their PEBES by means of the Form 
SSA-7004-SM, Request for Earnings and Benefit Statement and through the 
Internet. The information is needed to determine the number of invalid 
requests for PEBES using the SSA-7004-SM compared to the number of 
invalid PEBES requests using the Internet. The information will be used 
in the evaluation of whether to adopt the Internet as an appropriate 
vehicle to

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obtain PEBES requests. The respondents are a sample of PEBES requestors 
whose identity and address could not be verified through other means.
    Number of Respondents: 300.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 25 hours.
    To receive a copy of the form or clearance packages, call the SSA 
Reports Clearance Officer on (410) 965-4123 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 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: March 6, 1997.
Judith T. Hasche,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 97-6240 Filed 3-13-97; 8:45 am]
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