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