[Federal Register Volume 65, Number 28 (Thursday, February 10, 2000)]
[Notices]
[Pages 6684-6685]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-3010]


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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, 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. Claimant's Medications--0960-0289. The Social Security 
Administration (SSA) uses Form HA-4632 to request that applicants for 
disability benefits provide information to facilitate processing their 
title II, Old-Age, Survivors and Disability Insurance (OASDI) and Title 
XVI, Supplemental Security Income (SSI) claims. The form elicits from 
the claimants an updated list of medications used by the claimants. It 
enables the Administrative Law Judge hearing the case to fully inquire 
into medical treatment the claimant is receiving and the effect of 
medications on the claimant's medical impairments. The respondents are 
applicants for OASDI and SSI benefits.
    Number of Respondents: 171,939.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 42,985 hours.
    2. Statement of Employer--0960-0030. The information collected on 
Form SSA-7011 is needed by SSA to substantiate allegations of wages 
paid to workers when those wages do not appear in SSA's records of 
earnings and the worker does not have proof that payment was made. This 
information is

[[Page 6685]]

used to process claims for social security benefits and to resolve 
discrepancies in earnings records. The respondents are certain 
employers who can verify allegations of wages made by the wage earner.
    Number of Respondents: 925,000.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 308,333 hours.
    3. Request for SSI Benefit Estimate--0960-0492. SSA uses Form SSA-
3716 for an SSI beneficiary who wishes to request a 5-month estimate of 
what their benefits would be if they should return to work in the 
future. The respondents are SSI recipients.
    Number of Respondents: 50,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 4,167 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 a copy of the OMB 
clearance packages by calling the SSA Reports Clearance Officer on 
(410) 965-4145, or by writing to him.
    1. Vocational Rehabilitation ``301'' Program Development--0960-
0282. The information on Form SSA-4290 is used by the Social Security 
Administration (SSA) to determine an individual's continued entitlement 
to disability benefits when that individual has medically recovered 
while allegedly participating in a State or alternate Vocational 
Rehabilitation (VR) program. The respondents are State or alternate VR 
agencies serving such beneficiaries.
    Number of Respondents: 8,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 2,000 hours.
    2. Certificate of Election for Reduced Spouse's Benefits--0960-
0398. SSA uses the information collected on Form SSA-25 to pay a 
qualified spouse who elects to receive a reduced benefit at an earlier 
age. The respondents are entitled spouses seeking reduced benefits.
    Number of Respondents: 30,000.
    Frequency of Response: 1.
    Average Burden Per Response: 2 minutes.
    Estimated Annual Burden: 1,000 hours.
    3. Statement of Funds You Provided to Another, Statement of Funds 
You Received-0960-0481. Forms SSA-2854 & SSA-2855 are used by SSA to 
collect information in situations where the SSI claimant alleges that 
money was borrowed on an informal basis from a noncommercial lender, 
e.g., a relative or friend, etc. These statements are completed by the 
borrower/claimant and the lender and are required to determine whether 
the proceeds from the transaction are/are not income to the borrower/
claimant. If the transaction constitutes a bona fide loan, the proceeds 
are not income to the SSI borrower/claimant. The respondents are 
applicants for and recipients of SSI payments who borrow money on an 
informal (noncommercial) basis and individuals who lend money 
informally to SSI applicants and recipients.
    Number of Respondents: 40,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 6,667 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: Desk 
Officer for SSA, New Executive Office Building, Room 10230, 725 17th 
St., NW, Washington, DC 20503

    Dated: February 3, 2000.
Frederick W. Brickenkamp,
Reports Clearance Office, Social Security Administration.
[FR Doc. 00-3010 Filed 2-9-00; 8:45 am]
BILLING CODE 4191-02-P