[Federal Register Volume 64, Number 93 (Friday, May 14, 1999)]
[Notices]
[Pages 26472-26474]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-12172]


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SOCIAL SECURITY ADMINISTRATION


Agency Information Collection Activities: Proposed Request and 
Comment Request

    In compliance with Public Law 104-13, the Paperwork Reduction Act 
of 1995, the Social Security Administration (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.
    I. The information collections listed below will be submitted to 
OMB within 60 days from the date of this notice. Therefore, comments 
and recommendations regarding the information collections would be most 
useful if received by the Agency within 60 days from the date of this 
publication. Comments should be directed to the SSA Reports Clearance 
Officer at the address listed at the end of this publication. You can 
obtain a copy of the collection instruments by calling the SSA Reports 
Clearance Officer on (410) 965-4145, or by writing to him at the 
address listed at the end of this publication.
    1. Marriage Certification--0960-0009. Form SSA-3 is used by the 
Social Security Administration (SSA) to determine whether the spouse's 
claimant has the necessary relationship to the worker as required by 
section 216 (h)(1) of the Social Security Act (the Act). The 
respondents are applicants for Spouse's Benefits.
    Number of Respondents: 180,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 15,000 hours.
    2. Claimant's Work Background--0960-0300. The information collected 
on Form HA-4633 is used by SSA in

[[Page 26473]]

cases in which claimants for disability benefits have requested a 
hearing on the decision regarding their claim, which is a statutory 
right granted to claimants under the Act. A completed form provides an 
updated summary of a claimant's past relevant work and helps the 
Administrative Law Judge better decide whether or not the claimant is 
disabled. The respondents are claimants who request a hearing on 
entitlement to disability benefits, under titles II and/or XVI of the 
Act.
    Number of Respondents: 120,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 30,000 hours.
    3. Report on Individual with Childhood Impairment--0960-0084. Form 
SSA-1323 is used by SSA to determine the claimant's medical status 
prior to making disability determinations. The respondents are public 
and nonpublic schools and agencies who provide status reports on 
claimants applying for disability benefits.
    Number of Respondents: 7,000.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 2,333 hours.
    4. Medicare Buy-In Part B Screening Guide--0960-0601. Pub. L. 105-
277 authorizes SSA to conduct a Medicare buy-in demonstration project 
to evaluate means to promote the Medicare buy-in programs targeted to 
elderly and disabled individuals under titles XVIII and XIX of the 
Social Security Act. A lack of awareness about the Medicare buy-in 
programs appears to be one of the major obstacles to enrollments. Other 
obstacles to enrollment include the confusion of potential eligibles as 
to how to apply for these programs and a preference for dealing with 
SSA field offices rather than with local Medicaid offices.
    SSA will screen respondents voluntarily for potential Medicare Part 
B buy-in eligibility using a screening guide developed for this 
purpose. The screening guide will collect information from SSA 
beneficiaries regarding income, resources, marital status, and living 
arrangements and also ask questions about their awareness of Medicare 
Part B buy-in programs. SSA will gather this information to identify 
and overcome obstacles to Medicare Part B buy-in enrollments and to 
determine potential eligibility for Medicare Part B benefits. The 
screening guide will be in use from March 1, 1999 through December 31, 
1999.
    Number of Respondents: 130,000.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 43,334 hours.
    5. Supplemental Security Income Notice of Interim Assistance 
Reimbursement (two forms)--0960-0546. Please note that these forms were 
previously approved under 2 OMB numbers, form SSA-8125--0960-0546 and 
form SSA-L8125-F6--0960-0563. However, because these forms are 
interrelated, SSA is combining them under 0960-0546. Forms SSA-8125 and 
SSA-L8125-F6 collect interim assistance reimbursement (IAR) information 
from the States that provide such assistance. Form SSA-8125 is used in 
situations where IAR can be distributed directly to the recipient after 
the State has deducted the amount of assistance it provided. Form SSA-
L8125-F6 is used in situations where a recipient entitled to 
underpayments has received IAR from a state and SSA will control the 
benefit through the installment process. The respondents are states 
that provide IAR to Supplemental Security Income (SSI) claimants.

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                                                       SSA-8125                          SSA-L8125-F6
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Number of Respondents...................  50,000............................  50,000.
Frequency of Response...................  1.................................  1.
Average Burden Per Response.............  10 minutes........................  10 minutes.
Estimated Annual Burden.................  8,333 hours.......................  8,333 hours.
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    6. State Report of Incorrect Bendex Information--0960-0517. SSA 
uses the information collected on Form SSA-1086 to correct its master 
database and to facilitate the electronic exchange of data. The 
respondents are State agencies administering programs for Aid to 
Families with Dependent Children.
    Number of Respondents: 123.
    Frequency of Response: 2.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 41 hours.
    II. 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 at the end of this publication. You can obtain copies of the OMB 
clearance packages by calling the SSA Reports Clearance Officer on 
(410) 965-4145, or by writing to him.
    1. Request for Hearing--0960-0269. The information collected on 
form HA-501 is used by SSA to process a request for hearing on an 
unfavorable determination of entitlement or eligibility to benefits 
administered by SSA. The respondents are individuals whose claims for 
benefits are denied and who request a hearing on the denial.
    Number of Respondents: 554,100.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Average Burden: 92,350 hours.
    2. Petition to Obtain Approval of a Fee for Representing a Claimant 
Before The Social Security Administration--0960-0104. SSA uses form 
SSA-1560 if the representative files a fee petition to obtain approval 
of a fee for representing a claimant. The representative must file 
either a fee petition or a fee agreement with SSA in order to charge 
for representing a claimant in proceedings before the Agency. The 
information is reviewed by SSA to determine a reasonable fee for the 
representative's services. The respondents are attorneys and other 
persons representing Social Security claimants.
    Number of Respondents: 34,624.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Average Burden: 17,312 hours.
    3. Letter to Landlord Requesting Rental Information--0960-0454. 
Form SSA-L5061 is used by SSA to provide a nationally uniform vehicle 
for collecting information from landlords in making a rental subsidy 
determination in the SSI Program. The responses are used in deciding 
whether income limits are met. The respondents are landlords who 
provide subsidized rental arrangements to SSI applicants and 
recipients.

[[Page 26474]]

    Number of Respondents: 49,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Average Burden: 8,167 hours.
    4. Farm Arrangement Questionnaire--0960-0064. SSA needs the 
information collected on form SSA-7157-F4 to determine if farm rental 
income may be considered self-employment income for Social Security 
coverage purposes. The respondents are individuals alleging self-
employment income from renting land for farming activities.
    Number of Respondents: 38,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Average Burden: 19,000 hours.
    5. State Contribution Return--0960-0041. SSA uses the information 
on form SSA 3961 to identify and account for all contributions owed and 
paid, under section 218 of the Social Security Act. The data is used to 
balance each deposit made by a State and to allocate the deposited 
contributions by specific liability. The form is ultimately used to 
provide audit statements to State agencies and to perform Trust Fund 
accounting. The respondents are State Social Security agencies (one 
agency in each state, Puerto Rico, and the Virgin Islands) and each of 
approximately 65 interstate instrumentalities.
    Number of Respondents: 10,000.
    Frequency of Response: 1.
    Average Burden Per Response: 3 minutes.
    Estimated Average Burden: 500 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

    Dated: May 6, 1999.
Frederick W. Brickenkamp,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 99-12172 Filed 5-13-99; 8:45 am]
BILLING CODE 4190-29-P