[Federal Register Volume 66, Number 106 (Friday, June 1, 2001)]
[Notices]
[Pages 29850-29853]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-13623]


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SOCIAL SECURITY ADMINISTRATION


Agency Information Collection Activities: Proposed Request and 
Comment Request

    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 Pub. 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.
    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

    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. Contact with the Representative Payee and Contact with 
Beneficiary--0960-NEW. SSA will use the SSA-L4945, Contact with the 
Representative Payee, and SSA-L4947, Contact with Beneficiary, to 
inform respondents and conduct quality reviews of payments made under 
the titles II and XVI (Old-Age, Survivors and Disability Insurance/
Supplemental Security Income) programs. Cases for the review will be 
selected randomly and the information solicited will be used for 
verification of payment data on record in the claims folder and SSA's 
Master Beneficiary Record. Form SSA-L4945 will be used to notify 
Representative Payees who have the responsibility of managing payments 
for an SSA Beneficiary that the case has been selected for the review 
process and to request the required information. Form SSA-L4947 will be 
used to notify beneficiaries that their case has been selected for the 
review process and request the needed information. Both letters contain 
information that must be verified and returned to SSA under the review 
process. The respondents are beneficiaries and representative payees 
for beneficiaries receiving title II and title XVI benefits.
    Number of Respondents: 200.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 50 hours.
    2. RSI/DI Quality Review Case Analysis-Sampled Number Holder, 
Auxiliaries/Survivors-Parent, Stewardship AET Workbook--0960-0189. SSA 
uses the information collected on forms SSA-2930, 2931 and 2932 to 
establish a national payment accuracy rate for all cases in payment 
status; measure the accuracy rate for newly adjudicated claims for 
beneficiaries receiving old-age, survivors, or disability insurance; 
and to serve as a source of information regarding problem areas in the 
RSI/DI programs. Form SSA-4659 is used to evaluate and determine the 
effectiveness of the annual earnings test and to use the results in 
developing ongoing improvements in the process. The respondents are 
beneficiaries and representative payees for beneficiaries receiving old 
age, survivors, or disability insurance.

----------------------------------------------------------------------------------------------------------------
                                                                                                     Estimated
                                                    Respondents    Frequency of   Average burden   annual burden
                                                                     response      per response       (hours)
----------------------------------------------------------------------------------------------------------------
SSA-2930........................................           3,000               1              30           1,500
SSA-2931........................................           1,500               1              30             750
SSA-2932........................................             650               1              20             217
SSA-4659........................................             325               1              10              54
                                                                                                 ---------------
    Total Burden................................  ..............  ..............  ..............           2,521
----------------------------------------------------------------------------------------------------------------

    3. Request for Change in Time/Place of Disability Hearing--0960-
0348. The information on Form SSA-769 is used by SSA and the State 
Disability Determination Services to provide claimants with a 
structured format to exercise their right to request a change in the 
time or place of a scheduled disability hearing. The information is be 
used as a basis for granting or denying requests for changes and for 
rescheduling hearings. The respondents are claimants who wish to 
request a change in the time or place of their disability hearing.
    Number of Respondents: 7,483.
    Frequency of Response: 1.
    Average Burden Per Response: 8 minutes.
    Estimated Annual Burden: 998 hours.
    4. Request for Reconsideration--Disability Cessation--0960--0349. 
The information collected on form SSA-789 is used by SSA to schedule 
hearings, and to develop additional evidence for claimants who have 
received an initial or revised determination that a disability did not 
exist or has ceased. The collected information also indicates whether 
an interpreter is needed. The respondents are disability beneficiaries 
who file a claim for reconsideration.
    Number of Respondents: 49,000.
    Frequency of Response: 1.
    Average Burden Per Response: 12 minutes.

[[Page 29851]]

    Estimated Annual Burden: 9,800 hours.
    5. Agency/Employer Government Pension Offset Questionnaire--0960-
0470. The Information collected on Form SSA-L4163 will provide SSA with 
accurate information from the agency paying the pension, for purposes 
of applying the pension-offset provision. The form will only be used 
when (1) the claimant does not have the information and (2) the 
pension-paying agency has not cooperated with the claimant. The 
respondents are Federal, State, or local government agencies that have 
information needed by SSA to determine whether the Government Pension 
Offset provisions apply and the amount of offset.
    Number of Respondents: 1,000.
    Frequency of Response: 1.
    Average Burden Per Response: 3 minutes.
    Estimated Annual Burden: 50 hours.
    6. Child-Care Dropout Questionnaire--0960-0474. The information 
collected on Form SSA-4162 is used by SSA to determine whether an 
individual qualifies for a child care exclusion in computing the 
individual's disability benefit amount. The respondents are applicants 
for disability benefits.
    Number of Respondents: 2,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 167 hours.
    7. Authorization for the Social Security Administration to Obtain 
Account Records from a Financial Institution--0960-0293. Form SSA-4641-
U2 provides financial institutions with the customer's authorization to 
disclose records, as required by Public Law 95-630. Responses to the 
questions are used, in part, to determine whether resource requirements 
are met in the Supplemental Security Income program. The respondents 
are financial institutions (banks, savings and loans, credit unions, 
etc.).
    Number of Respondents: 500,000.
    Frequency of Response: 1.
    Average Burden Per Response: 6 minutes.
    Estimated Annual Burden: 50,000 hours.
    8. Request for Social Security Earnings Information--0960-0525. The 
Social Security Act provides that a wage earner, or someone authorized 
by a wage earner, may request Social Security earnings information from 
the Social Security Administration, using form SSA-7050. SSA uses the 
information collected on the form to verify that the requestor is 
authorized to access the earnings record and to produce the earnings 
statement. The respondents are wage earners and organizations and legal 
representatives authorized by the wage earner.
    Number of Respondents: 61,494.
    Frequency of Response: 1.
    Average Burden Per Response: 11 minutes.
    Estimated Annual Burden: 11,274 hours.
    9. Statement of Household Expenses and Contributions--0960-0456. 
Eligibility for Supplemental Security Income (SSI) is based on need. A 
factor for determining need is whether an individual receives in-kind 
support and maintenance in the form of food and shelter provided by 
other persons. SSA collects information on form SSA-8011-F3 to 
determine the existence and amount of in-kind support and maintenance 
received by a claimant/beneficiary of SSI. SSA uses the information to 
determine eligibility and payment amount under this program. The 
respondents are members of SSI claimants'/beneficiaries' households.
    Number of Respondents: 400,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 100,000 hours.
    10. Payment of Certain Travel Expenses--0960-0434. This regulation 
(20 C.F.R. 404.999(d) and 416.1499) provides for travel expense 
reimbursement by the State agency or Federal agency for claimants 
traveling to a consultative examination, or for claimants, their 
representative and unsubpoenaed witnesses traveling over 75 miles to 
appear at a disability hearing. State and Federal personnel review the 
listing and the receipts to verify the amount to be reimbursed to the 
claimant. The respondents are claimants for Title II/XVI benefits.
    Number of Respondents: 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 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. 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.
    2. 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 comprise officers from Federal and 
State DDSs.
    Number of Respondents: 36.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 18 hours.
    3. Quiz Show--Internet Edition--0960-NEW.

Background

    As stated in the 1997 Agency Strategic Plan, one of the SSA's five 
major goals is ``To Strengthen Public Understanding of the Social 
Security Programs'' so the public will understand what benefits are 
valuable to them personally. Accordingly, the public will be able to 
more effectively plan for retirement security. Under this goal, SSA 
established a strategic objective that, by 2005, 90% of the public will 
be knowledgeable about SSA programs. In establishing this goal SSA 
recognized the need to develop innovative methods to help educate and 
continually measure the public's knowledge of SSA programs.

The Collection--``Quiz Show''

    SSA intends to implement an online interactive educational game 
entitled ``Quiz Show--Internet Edition''. The purpose of Quiz Show is 
to help support the Agency's goal of increasing the public's 
understanding of Social Security programs.
    Quiz Show will consist of 10 questions, which are based on 8 key 
messages about SSA programs that the Agency wants the public to 
understand. Participation in the online game will be strictly 
voluntary. Data collected through each Quiz Show question will measure 
the overall responses for the purpose of gauging the public's knowledge 
of each key Social Security message.
    SSA will implement Quiz Show in stages, with the initial stage 
providing performance feedback to the user. However, eventually SSA 
will use Quiz Show to collect performance data and

[[Page 29852]]

demographic data. SSA will not require users to provide demographic 
data to play the game. Rather, users would be asked to provide this 
data voluntarily. Questions related to demographics are for the sole 
purpose of identifying audiences to whom specific key messages should 
be targeted to increase their knowledge. Respondents to Quiz Show will 
be individuals who visit SSA's website, Social Security Online, and 
elect to play the online game.
    Number of Respondents: 12,000.
    Frequency of Response: 1.
    Average Burden Per Response: 8 minutes.
    Estimated Annual Burden: 1,600 hours.
    4. Work History Report--0960-0578. The information collected on 
form SSA-3369 is needed to determine disability by the State DDSs. The 
information will be used to document an individual's past work history. 
The respondents are applicants for disability benefits.
    Number of Respondents: 1,000,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 500,000 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 and XVI.
    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, Age 1 to 3rd, Age 3 to 
6th, Age 6 to 12th, Age 12 to 18th Birthday)--0960-0542. State Agency 
adjudicative teams will 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.
    10. Wage Reports and Pension Information--0960-0547. The 
information obtained through regulation at 20 CFR, section 422.122(b) 
is used by SSA to identify the requester of pension plan information 
and to confirm that the individual is entitled to the data we provide. 
The respondents are requesters of pension plan information.
    Number of Respondents: 600.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 300 hours.
    11. Beneficiary Recontact Report--0960-0502. SSA uses the 
information collected on Form SSA-1588-OCR-SM to ensure that 
eligibility for benefits continues after entitlement. SSA asks mothers/
fathers information about their marital status and children in-care to 
detect overpayments and avoid continuing payment to those no longer 
entitled. The respondents are recipients of survivor mother/father 
Social Security Benefits.
    Number of Respondents: 133,400.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 11,117 hours.
    12. Waiver of Your Right to Personal Appearance before an 
Administrative Law Judge--0960-0284. Each claimant has a statutory 
right to appear in person (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 SSI 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.
    13. Function Report--Third Party, SSA-3380--0960-NEW. The Social 
Security Act provides that claimants must furnish medical and other 
evidence to prove they are disabled. The Social Security Act also gives 
the Commissioner authority to make rules and regulations on the nature 
and extent of evidence required as well as the methods of obtaining 
evidence. The information collected from third parties on the form SSA-
3380 is needed for the determination of disability under Title II and/
or Title XVI (SSI). The form records information about the disability 
applicant's illnesses, injuries, conditions, impairment-related 
limitations and ability to function. The respondents are individuals 
who know about the disability applicant's impairment, limitations and 
ability to function.
    Number of Respondents: 1,500,000.

[[Page 29853]]

    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 750,000 hours.
    14. Disability Hearing Officer's Decision--0960-0441. The Social 
Security Act requires that SSA provide an evidentiary hearing at the 
reconsideration level of appeal for claimants who have received an 
initial or revised determination that a disability did not exist or has 
ceased. Based on the hearing, the disability hearing officer (DHO) 
completes an SSA-1207 and applicable supplementary forms (which apply 
to the type of claim involved). The DHO uses the information in 
documenting and preparing the disability decision. The form aids the 
DHO in addressing the crucial elements of the case in a sequential and 
logical fashion. The respondents are DHOs in the State Disability 
Determination Services (DDS).
    Number of Respondents: 100,000.
    Frequency of Response: 1.
    Average Burden Per Response: 45 minutes.
    Estimated Annual Burden: 75,000 hours.
    15. Medical History and Disability Report, Disabled Child--0960-
0577. The Social Security Act requires claimants to furnish medical and 
other evidence to prove they are disabled. The form SSA-3820 is used to 
obtain various types of information about a child's condition, his/her 
treating sources and/or other medical sources of evidence. The 
information collected on the SSA-3820 is needed for the determination 
of disability by the State DDSs. The respondents are applicants for 
Title XVI (SSI) child disability benefits.
    Number of Respondents: 523,000.
    Frequency of Response: 1.
    Average Burden Per Response: 40 minutes.
    Estimated Annual Burden: 348,667 hours.
    16. Disability Report--Adult--0960-0579. The Social Security Act 
requires claimants to furnish medical and other evidence to prove they 
are disabled. Applicants for disability benefits will complete form 
SSA-3368. The information will be used, in conjunction with other 
evidence, by State DDSs to develop medical evidence, to assess the 
alleged disability, and to make a disability determination. The 
respondents are applicants for Title II and Title XVI (SSI) disability 
benefits.
    Number of Respondents: 2,116,667.
    Frequency of Response: 1.
    Average Burden Per Response: 60 minutes.
    Estimated annual Burden: 2,116,667 hours.

    Dated: May 24, 2001.
Frederick W. Brickenkamp,
Reports Clearance Officer.
[FR Doc. 01-13623 Filed 5-31-01; 8:45 am]
BILLING CODE 4191-02-U