[Federal Register Volume 64, Number 10 (Friday, January 15, 1999)]
[Notices]
[Pages 2695-2696]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-555]


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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 Pub. 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. Inquiry to File an SSI Child's Application--0960-0557. The 
information collected on Form SSA-293 is used by the Social Security 
Administration (SSA) to document the earliest possible filing date and 
to determine potential eligibility for SSI child's benefits. The 
respondents are individuals, such as hospital social workers, who 
inquire about SSI eligibility for low birth weight babies.

Number of Respondents: 2,100
Frequency of Response: 1
Average Burden Per Response: 10 minutes
Estimated Average Burden: 350 hours

    2. Request for Workers' Compensation/Public Disability 
Information--0960-0098. Form SSA-1709 is used by SSA to request and/or 
to verify information about worker's compensation or public disability 
benefits given to Social Security disability insurance benefit 
recipients so that their monthly benefit adjustments are properly made. 
The respondents are State and local governments and/or businesses that 
administer workers' compensation or other disability benefits.

Number of Respondents: 140,000
Frequency of Response: 1
Average Burden Per Response: 15 minutes
Estimated Average Burden: 35,000 hours

    3. Individuals Who Inquire About SSI Eligibility for Themselves--
0960-0140. Form SSA-3462 is completed by SSA personnel, via telephone 
or personal interview, and it may be used to determine potential 
eligibility for SSI benefits. The respondents are individuals who 
inquire about SSI eligibility for themselves or someone else.
Number of Respondents: 2,134,100
Frequency of Response: 1
Average Burden Per Response: 5 minutes
Estimated Average Burden: 177,842 hours

    4. State Mental Institution Policy Review--0960-0110. The 
information collected on form SSA-9584 is used by the Social Security 
Administration to determine whether an institution's policies and 
practices conform with

[[Page 2696]]

SSA's regulations in the use of benefits, and whether the institution 
is performing other duties and responsibilities required of a 
representative payee. The information also provides the basis for 
conducting the actual onsite review and is used in the preparation of 
the subsequent report of findings and recommendations which is provided 
to the institution. The respondents are state mental institutions which 
serve as representative payees for Social Security beneficiaries.

Number of Respondents: 183
Frequency of Response: 1
Average Burden Per Response: 1 hour
Estimated Average Burden: 183 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: 
Frederick W. Brickenkamp, 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. Application for U.S. Benefits Under the Canada-U.S. 
International Agreement--0960-0371. The information collected on Form 
SSA-1294 is used to determine entitlement to benefits. The respondents 
are individuals who live in Canada and file for U.S. Social Security 
Benefits.

Number of Respondents: 1,000
Frequency of Response: 1
Average Burden Per Response: 15 minutes
Estimated Annual Burden: 250 hours

    2. Quarterly Statistical Report on Recipients and Payments Under 
State-Administered Assistance Programs for Aged, Blind and Disabled 
(Individuals and Couples) Recipients--0960-0130. The information 
collected on Form SSA-9741 is used to provide statistical data on 
recipients and assistance payments under the SSI State-administered 
State supplementation program. These data collections are needed to 
complement the information available for the Federally administered 
programs under SSA, and to more fully explain the impact of the public 
income support programs on the needy, aged, blind and disabled. The 
respondents are state agencies who administer supplementary payment 
programs under SSI.

Number of Respondents: 30
Frequency of Response: 4 times annually
Average Burden Per Response: 1 hour
Estimated Annual Burden: 120 hours

    3. Statement of Death by Funeral Director--0960-0142. SSA uses the 
information collected on Form SSA-721 to verify the death of an 
individual insured under the Social Security Act and to determine if 
there is a survivor eligible for a lump-sum death payment. The 
respondents are funeral directors with knowledge of the death of a 
person insured for Social Security benefits.

Number of Respondents: 900,000
Frequency of Response: 1
Average Burden Per Response: 3.5 minutes
Estimated Average Burden: 52,500 hours

    4. Statement Regarding Marriage--0960-0017. SSA uses the 
information collected on Form SSA-753 to make determinations regarding 
entitlement to spouse's benefits when a common-law marriage is alleged. 
The respondents are third parties who can supply evidence concerning 
the existence of a common-law marriage.

Number of Respondents: 40,000
Frequency of Response: 1
Average Burden Per Response: 9 minutes
    Estimated Average Burden: 6,000 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: Lori Schack, New 
Executive Office Building, Room 10230, 725 17th St., NW, Washington, 
D.C. 20503
(SSA), Social Security Administration, DCFAM, Attn: Frederick W. 
Brickenkamp, 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) 965-4145 or write to him at 
the address listed above.

    Date: January 6, 1999.
Frederick W. Brickenkamp,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 99-555 Filed 1-14-99; 8:45 am]
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