[Federal Register Volume 64, Number 38 (Friday, February 26, 1999)]
[Notices]
[Pages 9553-9554]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-4747]


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SOCIAL SECURITY ADMINISTRATION


Agency Information Collection Activities: Comment Request

    In compliance with Public Law 104-13, the Paperwork Reduction Act 
of 1995, SSA is providing notice of its information collections that 
require submission to the Office of Management and Budget (OMB). SSA is 
soliciting comments on the accuracy of the agency's burden estimate; 
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.
    The information collections listed below have been submitted to OMB 
for clearance. Written comments and recommendations on the information 
collections would be most useful if received within 30 days from the 
date of this publication. Comments should be directed to the SSA 
Reports Clearance Officer and the OMB Desk Officer at the addresses 
listed after this publication. You can obtain a copy of the OMB 
clearance packages by calling the SSA Reports Clearance Officer on 
(410) 965-4145, or by writing to him.
    1. Function Report--Adult, SSA-3373-TEST; Function Report--Third 
Party, SSA-3380-TEST--0960-NEW. SSA will be testing new prototype 
disability forms. The information collected on the forms is needed for 
the determination of disability. The forms record information about the 
disability applicant's illnesses, injuries, conditions, impairment-
related limitations and ability to function. The respondents are Title 
II and Title XVI disability applicants or individuals who know about 
the applicant's impairment, limitations and ability to function.

 
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                                     Adult form        Third party form
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Number of Respondents..........  7,000.............  5,000.
Frequency of Response..........  1.................  1.
Average Burden Per Response....  30 minutes........  30 minutes.
Estimated Annual Burden........  3,500 hours.......  2,500 hours.
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    2. Symptoms Report--0960-NEW. SSA will be testing new prototype 
disability forms, including the SSA-3370-TEST. The information 
collected on the form is needed for the determination of disability. 
The form records information about the disability applicant's 
description of symptoms of his or her illness, injury or condition. The 
respondents are applicants for Title II and Title XVI disability 
benefits.

Number of Respondents: 7,500
Frequency of Response: 1
Average Burden Per Response: 25 minutes
Estimated Annual Burden: 3,125 hours

SSA Address: Social Security Administration, DCFAM, Attn: Frederick W. 
Brickenkamp, 6401 Security Blvd., 1-A-21 Operations Bldg., Baltimore, 
MD 21235.
OMB Address: Office of Management and Budget, OIRA, Attn: Lori Schack, 
New Executive Office Building, Room 10230, 725 17th St., NW, 
Washington, DC 20503.


[[Page 9554]]


    Dated: February 19, 1999.
Frederick W. Brickenkamp,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 99-4747 Filed 2-25-99; 8:45 am]
BILLING CODE 4190-29-P