[Federal Register Volume 62, Number 107 (Wednesday, June 4, 1997)]
[Notices]
[Pages 30653-30655]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-14542]


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SOCIAL SECURITY ADMINISTRATION


Information Collection Activities: Proposed Collection Requests 
and Comment Requests

    This notice lists information collection packages that will require 
submission to the Office of Management and Budget (OMB), as well as 
information collection packages submitted to OMB for clearance, in 
compliance with P.L. 104-13 effective October 1, 1995, The Paperwork 
Reduction Act of 1995.
    I. The information collection(s) listed below require(s) 
extension(s) of the current OMB approval(s) or are proposed new 
collection(s):
    1. Employer Report of Special Wage Payments--0960-0565. The 
information collected on form SSA-131 will be used to verify wage 
information in order to prevent earnings-related overpayments or to 
avoid erroneous withholding of benefits. Only a small segment of 
employers, estimated at about 1,000, will need to complete the entire 
form. For these employers, the estimated average burden to complete a 
single form is 22 minutes. It will take an estimated average burden of 
20 minutes to complete a single form for the majority of the employers. 
The respondents are employers who need to report an event which 
requires special wage payment verification.
    Number of Respondents: 100,000.
    Frequency of Response: 1.
    Average Burden Per Response: 20-22 Minutes.
    Estimated Annual Burden: 33,367.
    2. Social Security Tax and Benefit Statement Survey--0960-New. 
Public Law 104-121 requires SSA to conduct and report to Congress on a 
pilot study of the efficacy of providing beneficiaries with information 
about their Social Security benefits, earnings and taxes paid on those 
earnings. SSA will conduct a one-time survey to solicit beneficiaries' 
reactions to such a statement and to determine whether the statement 
promotes better understanding of their contributions and benefits under 
the Social Security programs. The respondents are a sample of Social 
Security beneficiaries who are randomly selected and agree to 
participate in the survey.
    Number of Respondents: 1,600.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 267 hours.
    3. Subpart T--State Supplementation Provisions; Agreement; 
Payments, 20 CFR 416.2099--0960-0240. Section 1618 of the Social 
Security Act contains pass-along provisions of the Social Security 
amendments. These provisions require that States which supplement the 
Federal SSI benefit pass along Federal cost-of-living increases to 
individuals who are eligible for State supplementary payments. If a 
State fails to keep payments at the required level, it becomes 
ineligible for Medicaid reimbursement under title XIX of the Social 
Security Act. Regulations at 20 CFR 416.2099 require States to report 
mandatory minimum and optional supplementary payment data to SSA. The 
information is used to determine compliance with laws and regulations. 
The respondents are States which supplement Federal SSI payments.
    Number of Respondents: 26.
    Frequency of Response: 15 States report quarterly, 11 States report 
annually.
    Average Burden Per Response: 1 hour.
    Estimated Annual Burden: 71 hours.
    4. Work Activity Report--Employee--0960-0059. The form SSA-821-BK 
is used by the Social Security Administration to obtain information on 
work activity. The information is needed to determine if disabled 
individuals are performing substantial gainful activity and, if so, 
whether they continue to meet the disability criteria

[[Page 30654]]

of the law. The respondents are Social Security and SSI disability 
applicants and recipients.
    Number of Respondents: 300,000.
    Frequency of Response: On occasion.
    Average Burden Per Response: 45 minutes.
    Estimated Annual Burden: 225,000 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: 
Nicholas E. Tagliareni, 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 information collection(s) listed below have been submitted 
to OMB:
    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: 1.
    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-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 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: 76,375 hours.
    6. 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.
    7. 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.
    8. 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.
    9. Third Party Liability Information Statement--0960-0323. 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. The 
respondents are third-party insurers other than Medicare or Medicaid.
    Number of Respondents: 1,500,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 125,000 hours.
    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:

[[Page 30655]]

(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: Nicholas E. Tagliareni, 1-
A-21 Operations Bldg., 6401 Security Blvd., Baltimore, MD 21235

    To receive a copy of any of the forms or clearance packages, call 
the SSA Reports Clearance Officer on (410) 965-4125 or write to him at 
the address listed above.
Nicholas E. Tagliareni,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 97-14542 Filed 6-3-97; 8:45 am]
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