[Federal Register Volume 66, Number 23 (Friday, February 2, 2001)]
[Notices]
[Pages 8834-8836]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-2797]


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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.

(SSA Address)
    Social Security Administration, DCFAM, Attn: Frederick W. 
Brickenkamp, 1-A-21 Operations Bldg., 6401 Security Blvd., 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

    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. Function Report--Adult--0960-0603. Form SSA-3373-TEST is used by 
the Social Security Administration (SSA) to record the claimant's 
description of his or her impairment-related limitations and ability to 
function. The respondents are Applicants for Title II (Old-Age, 
Survivors and Disability Insurance) and Title XVI (Supplemental 
Security Income) benefits.
    Number of Respondents: 7,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30.
    Estimated Annual Burden: 3,500.
    1. Physical Residual Functional Capacity Assessment; Mental 
Residual Functional Capacity Assessment--0960-0431. The information 
collected on form SSA-4734 is needed by SSA to assist in the 
adjudication of disability claims involving physical and/or mental 
impairments. The form assists the State DDS to evaluate impairment(s) 
by providing a standardized data collection format to present findings 
in a clear, concise and consistent manner. The respondents are State 
DDSs administering title II and title XVI disability programs.
    Number of Responses: 1,130,772.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 376,924 hours.
    3. Modified Benefit Formula Questionnaire-Foreign Pension--960-
0561. The information collected on form SSA-308 is used by SSA to 
determine exactly how much (if any) of the foreign pension may be used 
to reduce the amount of the Social Security retirement or disability 
benefit under the modified benefit formula. The respondents are 
applicants for Social security retirement/disability benefits.
    Number of Responses: 50,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 8,333 hours.
    II. The information collections listed below have been submitted to 
OMB for

[[Page 8835]]

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. Application for Benefits Under The Federal Mine And Safety And 
Health Act Of 1977, as Amended (Widow's Claim, Child's Claim And 
Dependent's Claim)--0960-0118. Section 402(g) and Section 412(a) of the 
Federal Mine Safety and Health Act provide that those widows, surviving 
children and dependents (parents, and brothers or sisters) who are not 
currently receiving benefits on the deceased miner's account must file 
the appropriate application within 6 months of the deceased miner's 
death. Forms SSA-47-F4, SSA-48-F4, and SSA-49-F3 are used by the Social 
Security Administration (SSA) to determine eligibility. The respondents 
are widows, surviving children and dependents (parents, brothers or 
sisters) who are not currently receiving Black Lung benefits on the 
deceased miner's account.

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                                                                  SSA-47-F4        SSA-48-F4        SSA-49-F3
----------------------------------------------------------------------------------------------------------------
Number of Respondents........................................              600              600              600
Frequency of Response........................................                1                1                1
Average Burden Per Response (minutes)........................               11               11               11
Estimated Annual Burden (hours)..............................              110              110              110
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    2. Representative Payee Report of Benefits and Dedicated Account--
0960-0576. Form SSA-6233 is 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 
individuals and organizational representative payees required by law to 
establish a separate (``dedicated'') account in a financial institution 
for certain past-due SSI benefits.
    Number of Respondents: 30,000.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 10,000 hours.
    3. Physician's/Medical Officer's Statement of Patient's Capability 
to Manage Benefits--0960-0024. SSA uses the information collected on 
Form SSA-787 to determine an individual's capability, or lack thereof, 
to handle his or her own benefits. The information also provides SSA 
with leads to follow in selecting a representative payee, if needed. 
The respondents are physicians of these beneficiaries.
    Number of Respondents: 120,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 20,000 hours.
    4. Certificate of Responsibility for Welfare and Care of Child Not 
in Applicant's Custody--0960-0019. SSA uses the information collected 
on form SSA-781 to decide if ``in care'' requirements are met by non-
custodial parent(s), who is filing for benefits based on having a child 
in care. The respondents are non-custodial wage earners whose 
entitlement to benefits depends upon having an entitled child in care.
    Number of Respondents: 14,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 2,333 hours.
    5. 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 Supplemental Security Income (SSI) 
payments. The respondents are individuals who apply for SSI benefits 
for a disabled child.
    Number of Respondents: 272,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 136,000 hours.
    6. Application for a Social Security Card--0960-0066. The 
information collected is needed to assign a Social Security Number 
(SSN) and issue a card. The form SS-5 is one method of collecting the 
information and is available in paper and on the Internet. The 
applicant can print the SS-5 from the Internet but must still complete, 
sign and return it to SSA with the required documentation as is 
currently required for the paper SS-5. An individual can also provide 
the information through an in-person interview, or through the 
Enumeration at Birth (EAB) process. In the EAB process, the State 
Bureaus of Vital Statistics electronically transmit the birth data to 
SSA. The data is then uploaded to the SSA mainframe and the newborn is 
assigned an SSN.
    SSA screens its records to make sure applicants for original SSN 
cards don't already have SSNs before assigning an original number. SSA 
also uses the information to ensure that replacement SSN cards are 
issued to the correct number holder. Use of SSNs enables SSA 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 Retirement, 
Survivors and Disability Insurance programs, the SSI program and other 
programs administered by the Federal government including Black Lung, 
Medicare and veterans compensation and pension programs. The Internal 
Revenue Service uses the SSN as a taxpayer identification number for 
the administration of tax benefits based on support or residence of 
children. The respondents are applicants for original, duplicate or 
corrected Social Security cards and State Bureaus of Vital Statistics.

Public Reporting Burden for the SS-5

    Number of Respondents: 14,000,000.
    Frequency of Response: 1.
    Average Burden Per Response: 8\1/2\-9 minutes.
    Estimated Annual Burden: 1,991,667 hours.

Public Reporting Burden for the State Bureaus of Vital Statistics

    Please note that this notice corrects a previous notice (Vol. 65, 
No. 250, page 82442, 12/28/2000) that contained erroneous information 
on the public reporting burden for the EAB process. Following is the 
correct information: The respondent Bureaus of Vital Statistics are 
reimbursed by SSA at the imputed cost of approximately $1.83 per record 
for approximately 4,026,800 records. The total cost is $7,376,339.


[[Page 8836]]


    Dated: January 29, 2001.
Frederick W. Brickenkamp,
Reports Clearance Officer.
[FR Doc. 01-2797 Filed 2-1-01; 8:45 am]
BILLING CODE 4191-02-U