[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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