[Federal Register Volume 62, Number 65 (Friday, April 4, 1997)]
[Notices]
[Pages 16208-16209]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-8564]
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SOCIAL SECURITY ADMINISTRATION
Agency Information Collection Activities: Proposed Collection
Requests
This notice lists information collection packages that will require
submission to the Office of Management and Budget (OMB), in compliance
with Pub. L. 104-13 effective October 1, 1995, The Paperwork Reduction
Act of 1995.
1. Request for Withdrawal of Application--0960-0015. In certain
situations receiving social security benefits may be to the applicant's
disadvantage and they wish to withdraw their application. The
information collected on Form SSA-521 is used by the Social Security
Administration to process a request for withdrawal of an application
for benefits. The respondents are individuals who file a claim and
later wish to withdraw it.
Number of Respondents: 100,000.
Frequency of Response: 5 minutes.
Average Burden Per Response: 5 minutes.
Estimated Annual Burden: 8,333 hours.
2. SSA/DDS Cost-Effectiveness Measurement System Data Reporting
Form--0960-0384. The information collected on Form SSA-1461 is used by
the Social Security Administration (SSA) to analyze and evaluate the
costs incurred by the State Disability Determination Services (DDS) in
making determinations of disability for SSA. The data is also used in
determining funding levels. The respondents are the State DDS offices.
Number of Respondents: 52.
Frequency of Response: 4 per year.
Average Burden Per Response: 6 hours.
Estimated Annual Burden: 1,248 hours.
3. Claim for Amounts Due in the Case of a Deceased Beneficiary--
0960-0101. Section 204(d) of the Social Security Act provides that if a
beneficiary dies before payment of Social Security title II benefits
has been completed, the amount due will be paid to persons meeting
specified qualifications. The information collected on Form SSA-
[[Page 16209]]
1724 is used by the Social Security Administration to determine
whether an individual is entitled to the underpayment. The respondents
are applicants for the underpayment of a deceased beneficiary.
Number of Respondents: 300,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 50,000 hours.
4. Supplement to Claim of Person Outside the United States--0960-
0051. The information collected on Form SSA-21 is used to determine the
continuing entitlement to Social Security benefits and the proper
benefit amounts of alien beneficiaries living outside the United
States. It is also used to determine whether benefits are subject to
tax withholding. The respondents are individuals entitled to Social
Security benefits who are, will be, or have been residing outside the
United States.
Number of Respondents: 35,000.
Frequency of Response: 1.
Average Burden Per Response: 5 minutes.
Estimated Annual Burden: 2,917 hours.
5. Statement of Care and Responsibility for Beneficiary--0960-0109.
When an individual requests to act as representative payee for someone
not in their custody, the Social Security Administration must determine
if this individual is the most qualified to serve in the beneficiary's
best interests. The information collected on Form SSA-788 is used to
corroborate the statements of concern made by the representative payee
applicant and to identify other potential representative payees. The
respondents are individuals who have custody of the beneficiaries for
whom someone else has filed to be the representative payee.
Number of Respondents: 130,000.
Frequency of Response: 1.
Average Burden of Response: 10 minutes.
Estimated Annual Burden: 21,667 hours.
6. Statement of Claimant or Other Person--0960-0045. Form SSA-795
is completed by Social Security or SSI applicants when additional
information is needed and there is no standard form which collects the
information. The information is used by the Social Security
Administration to process claims for benefits. The respondents are
applicants for Social Security or SSI benefits.
Number of Respondents: 305,500.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 75,375 hours.
7. Application for Disability Insurance Benefits--0960-0060. The
information collected on Form SSA-16 by the Social Security
Administration is used to determine an applicant's entitlement to
Social Security disability benefits. The respondents are applicants for
Social Security disability benefits.
Number of Respondents: 1,000,000.
Frequency of Response: 1.
Average Burden Per Response: 20 minutes.
Estimated Annual Burden: 333,333.
8. Statement for Determining Continuing Eligibility for
Supplemental Security Income Payment--0960-0145. The information
collected on Form SSA-8202 is used by the Social Security
Administration to determine a beneficiary's continuing eligibility for
and the amount of their SSI payments. The information collected also
assists SSI recipients to obtain food stamps and is used by agencies
administering Medicaid programs in ascertaining the legal liability of
third parties to pay for care and services. The respondents are
recipients of SSI benefits.
Number of Respondents: 818,000.
Frequency of Response: 1.
Average Burden Per Response: 11 minutes.
Estimated Annual Burden: 149,967 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.
To receive a copy of any of the forms or clearance packages, call
the SSA Reports Clearance Officer on (410) 965-4123 or write to her at
the address listed above.
Dated: March 31, 1997.
Frederick W. Brickenkamp,
Forms Management Officer, Social Security Administration.
[FR Doc. 97-8564 Filed 4-3-97; 8:45 am]
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