[Federal Register Volume 62, Number 244 (Friday, December 19, 1997)]
[Notices]
[Pages 66712-66713]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-32967]
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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 PL. 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. Report by Former Representative Payee--0960-0112. The Social
Security Administration (SSA) collects the information on Form SSA-625
when a mental facility is terminating its payee services and a
successor payee is to be named. The information is needed to determine
the proper disposition of any conserved funds. The respondents are
State institutions or agencies which are no longer serving as
representative payee for beneficiaries who are incapable of managing
benefits.
Number of Respondents: 8,000.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Average Burden: 2,000 hours.
2. Pre-1957 Military Service Federal Benefit Questionnaire--0960-
0120. Form SSA-2512 is used by SSA to solicit sufficient information to
make a determination of eligibility for military wage credits. Sections
217(a) and (e) of the Social Security Act provide for crediting
military service to the wage earner's record and for using the data in
the claims adjudication process to grant gratuitous military wage
credits, when applicable. The respondents are individuals who are
applying for Social Security benefits on a record where the wage earner
has pre-1957 military service.
Number of Respondents: 56,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Average Burden: 9,333 hours.
3. Request for Earnings and Benefit Estimate Statement--0960-0466.
Form SSA-7004 is used by members of the public to request information
about their Social Security earnings records and to get an estimate of
their potential benefits. SSA provides information, in response to the
request, from the individual's personal Social Security record. The
respondents are Social Security numberholders who have covered earnings
on record.
Number of Respondents: 3,350,000.
Frequency of Response: 1.
Average Burden Per Response: 5 minutes.
Estimated Average Burden: 279,167 hours.
4. Certificate of Support--0960-0001. The information collected on
Form SSA-760-F4 is used to determine whether the deceased worker
provided one-half support required for entitlement to parent's or
spouse's benefits. The information will also be used to determine
whether the Government pension offset would apply to the applicant's
benefit payment. The respondents are parents of deceased workers or
spouses who may be subject to Government pension offset.
Number of Respondents: 18,000.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Average Burden: 4,500 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 to Resolve Questionable Quarters of Coverage (SSA-512);
Request for Quarters of Coverage History Based on Relationship (SSA-
513)--0960-0575. The Personal Responsibility and Work Opportunity
Reconciliation Act states that aliens admitted for lawful residence who
have worked and earned 40 qualifying quarters of coverage (QCs) for
Social Security purposes can generally receive State benefits. QCs can
also be allocated to a spouse and/or to a child under age 18, if needed
to obtain 40 qualifying QCs for the alien. Form SSA-512 is used by the
States to request clarification from SSA on questionable QCs. Form SSA-
513 is used by States to request QC information for an alien's spouse
or parent in cases where the spouse or parent does not sign a consent
form giving permission to access his/her social security records. The
respondents are State agencies which require QC information in order to
determine eligibility for benefits.
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SSA-512 SSA-513
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Number of Responses..................... 200,000.............................. 350,000.
Frequency of Response................... 1.................................... 1.
Average Burden Per Response............. 2 minutes............................ 2 minutes.
Estimated Annual Burden................. 6,667 hours.......................... 11,667 hours.
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2. Application for Retirement Insurance Benefits--0960-0007. The
information on Form SSA-1 is used by SSA to determine an individual's
entitlement to retirement insurance
[[Page 66713]]
benefits. The respondents are applicants for retirement benefits.
Number of Respondents: 1,600,000.
Frequency of Response: 1.
Average Burden Per Response: 10.5 minutes.
Estimated Annual Burden: 280,000 hours.
3. Physician's/Medical Officer's Statement, Patient's Capability to
Manage Benefits--0960-0024. SSA uses the information on Form SSA-787 to
determine whether an individual is capable of handling his/her
benefits. The information is also used for leads in selecting a
representative payee. The respondents are physicians of the
beneficiaries or medical officers of institutions where beneficiaries
reside.
Number of Respondents: 120,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 20,000 hours.
4. Claimant's Statement When Request for Hearing Is Filed and The
Issue Is Disability--0960-0316. SSA requires that applicants for
disability benefits provide the updated medical information requested
on Form HA-4486, to facilitate processing their Old Age, Survivors and
Disability Insurance (OASDI) and Supplemental Security Income (SSI)
claims. This information also enables the Administrative Law Judge
hearing the case to fully inquire into the claimant's medical
condition. The respondents are applicants for OASDI and SSI Benefits.
Number of Respondents: 283,460.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 70,865 hours.
5. Representative Payee Report of Benefits and Dedicated Account--
0960-0576. Form SSA-6233 is used by SSA to ensure that payment of SSI
benefits is made to a relative, another person, or an organization when
the best interests of the beneficiary would be served. The form is also
used to ensure that the representative payee is using the benefits
received for the beneficiary's current maintenance and personal needs
and that expenditures of funds from the dedicated account are in
compliance with the law. The respondents are individual and
organizational representative payees required by law to establish a
separate (``dedicated'') account in a financial institution for certain
past-due SSI monthly benefits.
Number of Respondents: 30,000.
Frequency of Response: 1.
Average Burden Per Response: 20 minutes.
Estimated Annual Burden: 10,000 hours.
6. Application for a Social Security Card--0960-0066. The
information collected by SSA on Form SS-5 is used to assign a Social
Security Number and issue a card. The Social Security Number is used to
keep an accurate record of each individual's earnings for the payment
of benefits and for administrative purposes as an identifier for
health-maintenance and income-maintenance programs, such as the OASDI
Programs, the SSI Program and other programs administered by the
Federal government including Black Lung, Medicare and veterans
compensation and pension programs. The Social Security Number is also
used by the Internal Revenue Service as a taxpayer identification
number for those individuals who are eligible to be assigned a Social
Security Number. The respondents are applicants for a Social Security
Card.
Number of Respondents: 16 million.
Frequency of Response: 1.
Average Burden Per Response: 8\1/2\ minutes-9 minutes.
Estimated Annual Burden: 2,275,000 hours.
7. Questionnaire for Children Claiming SSI Benefits--0960-0499. The
information collected on form SSA-3881 is used by SSA to evaluate
disability in children who apply for SSI payments. The respondents are
individuals who apply for SSI benefits for a disabled child.
Number of Respondents: 978,000.
Frequency of Response: 1.
Average Burden Per Response: 30 minutes.
Estimated Annual Burden: 489,000 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:
(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.
Dated: December 11, 1997.
Nicholas E. Tagliareni,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 97-32967 Filed 12-18-97; 8:45 am]
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