[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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