[Federal Register Volume 66, Number 58 (Monday, March 26, 2001)]
[Notices]
[Pages 16511-16513]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-6939]


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SOCIAL SECURITY ADMINISTRATION


Agency Information Collection Activities: Proposed Request, 
Comment Request and Notice of OMB Approval of an Information Collection 
Contained in a Regulation

    The Social Security Administration (SSA) publishes a list of 
information collection packages that will require clearance by the 
Office of Management and Budget (OMB) in compliance with P.L. 104-13 
effective October 1, 1995, The Paperwork Reduction Act of 1995. 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. In addition, SSA is announcing 
OMB's approval of an information collection contained in regulation.
    Written comments and recommendations regarding the information 
collection(s) should be submitted to the OMB Desk Officer and the SSA 
Reports Clearance Officer at the following addresses:

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

    I. The information collections listed below will be submitted to 
OMB within 60 days from the date of this notice. Therefore, your 
comments should be submitted to SSA within 60 days from the date of 
this publication. You can obtain copies of the collection instruments 
by calling the SSA Reports Clearance Officer at 410-965-4145, or by 
writing to him at the address listed above.
    1. Waiver of Your Right to Personal Appearance before an 
Administrative Law Judge--0960-NEW. Each claimant has a statutory right 
to appear in person

[[Page 16512]]

(or through a representative) and present evidence about his/her claim 
at a hearing before an Administrative Law Judge (ALJ). If a claimant 
wishes to waive his/her statutory right to appear before an ALJ, he/she 
must complete a written request. The claimant may use Form HA-4608 for 
this request. The information collected is used to document an 
individual's claim to show that an oral hearing is not preferred in the 
appellate process. The respondents are applicants for Social Security 
and Supplemental Security Income benefits who request a hearing.
    Number of Respondents: 12,000.
    Frequency of Response: 1.
    Average Burden Per Response: 2 minutes.
    Estimated Annual Burden: 400 hours.
    2. Request for Hearing--0960-0269. The information collected on 
Form HA-501 is used by the Social Security Administration (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: 553,400.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 92,233 hours.
    3. Student's Statement Regarding Resumption of School Attendance-- 
0960-0143. The information on Form SSA-1386 is used by SSA to verify 
full-time attendance at educational institutions and to determine 
eligibility for student benefits. The respondents are student 
beneficiaries currently receiving SSA benefits.
    Number of Respondents: 133,000.
    Frequency of Response: 1.
    Average Burden Per Response: 6 minutes.
    Estimated Annual Burden: 13,300 hours.
    4. Subpoena--Disability Hearing--0960-0428. The information on Form 
SSA-1272-U4 is used by SSA to subpoena evidence or testimony needed at 
disability hearings. The respondents are comprised of officers from 
Federal and State DDSs.
    Number of Respondents: 36.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Average Burden: 18 hours.
    5. Notification of Projected Completion Date--0960-0429. Form SSA-
891 is used by SSA and State Disability Determination Services (DDS) to 
inform disability hearing units whenever a hearing case will not be 
completed and forwarded to the hearing unit as expected. This 
information is necessary to enable the hearing units to schedule 
hearings as promptly and efficiently as possible. The respondents are 
State DDS and SSA components that make disability determinations for 
the Agency.
    Number of Respondents: 100.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 8 hours.
    6. Real Property Current Market Value Estimate--0960-0471. This 
form is used to obtain current market value estimates of real property 
owned by applicants for, or beneficiaries of, Supplemental Security 
Income (SSI) benefits (or a person whose resources are deemed to such 
an individual). The value of an individual's resources, including non-
home real property is one of the eligibility requirements for SSI 
benefits. The respondents are individuals with knowledge of local real 
property values.
    Number of Respondents: 5,438.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 1,813 hours.
    7. Information about Joint Checking/Savings Account--0960-0461. 
Form SSA-2574 is used to collect information from the claimant and the 
other account holder(s) when a Supplemental Security Income (SSI) 
applicant/recipient objects to the assumption that he/she owns all or 
part of the funds in a joint account bearing his or her name. These 
statements of ownership are required to determine whether the account 
is a resource of the SSI claimant. The respondents are applicants for 
and recipients of SSI payments and individuals who are joint owners of 
financial accounts with SSI applicants.
    Number of Respondents: 200,000.
    Frequency of Response: 1.
    Average Burden Per Response: 7 minutes.
    Estimated Annual Burden: 23,333 hours.
    8. Response to Notice of Revised Determination--0960-0347. Form 
SSA-765 is used by claimants to request a disability hearing and/or to 
submit additional evidence before a revised reconsideration 
determination is issued. The respondents are claimants who file for a 
disability hearing in response to a notice of revised determination for 
disability insurance and/or SSI under titles II (Old-Age, Survivors and 
Disability Insurance) and XVI (Supplemental Security Income).
    Number of Respondents: 1,925.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 963 hours.
    9. Function Report, Child (Birth to 1st (form SSA-3375), Age 1 to 
3rd (form SSA-3376), Age 3 to 6th (form SSA-3377), Age 6 to 12th (form 
SSA-3378), Age 12 to 18th (form SSA-3379) Birthday)--0960-0542. State 
Agency adjudicative teams use the information gathered on the 
appropriate version of these forms, in connection with other medical 
function evidence, to form a complete picture of the child's ability to 
function. This information assists with determining whether a child is 
disabled, or each case in which disability cannot be found on medical 
grounds alone. The respondents are applicants for Title XVI childhood 
disability benefits, and child caregivers.
    Number of Respondents: 750,000.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 250,000 hours.
    II. The information collections listed below have been submitted to 
OMB for clearance. Your comments on the information collections would 
be most useful if received by OMB and SSA within 30 days from the date 
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 at the address listed above.
    1. Application for Retirement Insurance Benefits--0960-0007. In 
order to receive Social Security retirement insurance benefits, an 
individual must file an application with the Social Security 
Administration (SSA). The SSA-1 is one application that the 
Commissioner of Social Security prescribes to meet this requirement. 
The information that SSA collects will be used to determine entitlement 
to retirement benefits. The respondents are individuals who choose 
apply for Social Security retirement insurance.
    Number of Respondents: 1,460,692.
    Frequency of Response: 1.
    Average Burden Per Response: 10.5 minutes.
    Estimated Annual Burden: 255,621 hours.
    2. Notice Regarding Substitution of Party Upon Death of Claimant--
0960-0288. When a claimant for Social Security or Supplemental Security 
Income benefits dies while a request for a hearing is pending, the 
hearing will be dismissed unless an eligible individual makes a written 
request to SSA showing that he or she would be adversely

[[Page 16513]]

affected by the dismissal of the deceased's claim. An individual may 
satisfy this requirement by completing an HA-539. SSA uses the 
information collected to document the individual's request to be made a 
substitute party for a deceased claimant, and to make a decision on 
whom, if anyone, should become a substitute party for the deceased. The 
respondents are individuals requesting hearings on behalf of deceased 
claimants for Social Security benefits.
    Number of Respondents: 10,548.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 879 hours.
    3. Report by Former Representative Payee--0960-0112. When a State 
mental institution or agency terminates its representative payee 
services, SSA requires a closeout report on funds held on behalf of 
Social Security beneficiaries. SSA uses the information, which is 
collected on form SSA-625, to determine the proper disposition of any 
conserved funds held by the representative payee. The respondents are 
State mental institutions or agencies that served as representative 
payees for Social Security beneficiaries.
    Number of Respondents: 8,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 2,000.
    4. State Agency Report of Obligations for SSA Disability Programs 
and Addendum (form SSA-4513), Time Report of Personnel Services for 
Disability Determination Services (form SSA-4514), and State Agency 
Schedule of Equipment Purchased for SSA Disability Programs (form SSA-
871)--0960-0421. The Social Security Administration uses the 
information collected on forms SSA-4513 and 4514 to conduct detailed 
analysis and evaluation of the costs incurred by the State Disability 
Determination Services (DDS) in making disability determinations for 
SSA. The data is also used to determine funding levels for each DDS. 
SSA uses the information collected on form SSA-871 to budget and 
account for expenditures of funds for equipment purchases by the State 
DDS that administer the disability determination program. The 
respondents are DDSs that have the responsibility for making disability 
determinations for SSA.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                                   Frequency of     burden per       Estimated
                                                    Respondents      response        response     annual  burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4513........................................              54               4              90             324
SSA-4514........................................              54               4              90             324
SSA-871.........................................              54               4              30             108
                                                 ---------------------------------------------------------------
      Total burden..............................  ..............  ..............  ..............             756
----------------------------------------------------------------------------------------------------------------

    5. Request for Earning and Benefit Estimate Statement--0960-0466. 
Form SSA-7004 is used by members of the public to request information 
about their Social Security earning records and to get an estimate of 
their potential benefits. SSA provides information, in response to the 
request, from the individual's personal Social Security record. The 
respondents are Social Security numberholders who have covered earnings 
on record.
    Number of Respondents: 3,000,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 250,000 hours.
    6. Certificate of Support--0960-0001. The information collected by 
form SSA-760-F4 is used to determine whether the deceased worker 
provided one-half support required for entitlement to parent's or 
spouse's benefits. The information will also be used to determine 
whether the Government pension offset would apply to the applicant's 
benefit payments. The respondents are parents of deceased workers or 
spouses who may be subject to Government pension offset.
    Number of Respondents: 18,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 4,500 hours.
    7. Request for Waiver of Overpayment Recovery or Change in 
Repayment Notice--0960-0037. Form SSA-632 collects information on the 
circumstances surrounding overpayment of Social Security Benefits to 
recipients. SSA uses the information to determine whether recovery of 
an overpayment amount can be waived or must be repaid and, if repaid, 
how recovery will be made. The respondents are recipients of Social 
Security, Medicare, Black Lung or Supplemental Security Income 
overpayments.
    Number of Respondents: 500,000.
    Frequency of Response: 1.
    Average Burden Per Response: 120 minutes.
    Estimated Annual Burden: 1,000,000 hours.
    8. Reconsideration Report for Disability Cessation--0960-0350. Form 
SSA-782-BK is used by claimants and SSA field offices to document new 
developments on the claimant's condition (as perceived by the 
claimant), since the prior continuing disability interview was 
conducted. The form is also used by the SSA interviewer to provide his/
her observations of the claimant. The respondents are claimants for 
Old-Age, Survivors and Disability Insurance and Supplemental Security 
Income, who file a Request for Reconsideration--Disability Cessation.
    Number of Respondents: 100,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 50,000 hours.
    III. OMB has approved an information collection published as a 
final rule at 65 FR 66561. The OMB control number for this information 
collection is 0960-0501 and the expiration date is February 29, 2004.

    Dated: March 15, 2001.
Frederick W. Brickenkamp,
Reports Clearance Officer.
[FR Doc. 01-6939 Filed 3-23-01; 8:45 am]
BILLING CODE 4191-02-P