[Federal Register Volume 66, Number 154 (Thursday, August 9, 2001)]
[Notices]
[Pages 41925-41927]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-20030]



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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, 
D.C. 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. Reporting Events, SSI-0960-0128. Supplemental Security Income 
(SSI) applicants, recipients and their representative payees use Form 
SSA-8150-EV (or the Spanish version) to report by mail changes in 
circumstances that could affect eligibility for SSI. The Social 
Security Administration uses the reported changes on the form to 
determine eligibility and correct payment amounts for SSI payments, 
which may include federally, administered State supplementary payments. 
The respondents are SSI applicants, recipients, and their 
representative payees.
    Number of Respondents: 33,200.
    Frequency of Response: 1.
    Average Burden Per Response: 5.
    Estimated Annual Burden: 2,767 hours.
    2. Disability Determination And Transmittal--0960-0437. The 
information collected on Form SSA-831-U3/C3 is used by SSA to document 
the State agency determination as to whether an individual who applies 
for disability benefits is eligible for those benefits based on his/her 
alleged disability. SSA also uses the form for program management and 
evaluation. The respondents are State Disability Determination Services 
(DDS) adjudicating Title II and Title XVI Disability claims.
    Number of Respondents: 2,860,859.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 715,215 hours.
    3. Cessation or Continuance of Disability or Blindness 
Determination--0960-0443. The information on Form SSA-832-U3/C3 is used 
by SSA to document determinations as to whether an individual's 
disability benefits should be terminated or continued on the basis of 
his/her impairment. The respondents are State DDS employees 
adjudicating Title XVI Disability claims.
    Number of Respondents: 600,758.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 300,379 hours.
    4. Cessation Or Continuance Of Disability Or Blindness 
Determination And Transmittal--0960-0442. The information on Form SSA-
833-U3/C3 is used by SSA to make determinations of whether individuals 
receiving title II disability benefits should continue to be unable to 
engage in substantial gainful activity and are still eligible to 
receive benefits. The respondents are State DDS employees.
    Number of Respondents: 466,124.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 233,062 hours.
    5. Modified Benefit Formula Questionnaire--0960-0395. The 
information collected on Form SSA-150 is needed by SSA to determine the 
correct formula to use in computing Social Security benefits for 
someone who also receives benefits from employment not covered by 
Social Security. The respondents consist of claimants for Social 
Security benefits who are also entitled to benefits not covered by 
Social Security.
    Number of Respondents: 90,000.
    Frequency of Response: 1.
    Average Burden Per Response: 8 minutes.
    Estimated Average Burden: 12,000 hours.
    6. Internet Disability Report--0960-NEW. The Social Security Act 
requires applicants to furnish medical and other evidence and 
information to prove they are disabled. Applicants for disability 
benefits will be given the option to provide information needed to help 
determine they are disabled through the Internet. The Internet 
Disability Report, which is similar to the form SSA-3368-BK, Disability 
Report-Adult, will collect allegations of disability and gather 
information about the disabling condition and sources of medical 
evidence. Collecting this information is critical to case development 
and adjudication. The information on the Disability Report, together 
with other evidence and information, will be used by State DDSs (who 
make disability decisions on behalf of SSA) to develop medical 
evidence, assess the alleged disability, and make a determination on 
whether or not the applicant is disabled under the Act. The respondents 
are applicants for title II and title XVI disability benefits.
    Number of Respondents: 66,000.
    Frequency of Response: 1.
    Average Burden Per Response: 2 hours.
    Estimated annual Burden: 132,000 hours.
    6. National Study of Health and Activity (NSHA)--0960-0609. The 
Social Security Administration is sponsoring the NSHA to serve as the 
cornerstone of SSA's future disability policy development and research 
agenda. NSHA is a national disability study that consists of gathering 
information from interviews, medical examinations and medical records 
to be used to make simulated Disability Determination Service 
disability decisions. A pilot study was conducted in 2000 and revisions 
were made to the study instruments and procedures based on the analysis 
of the pilot data. To test the usability of the revisions, a pretest of 
the survey instruments and procedures is necessary prior to beginning 
the main study. This pretest will be conducted on volunteers obtained 
from SSA disability rolls and nondisabled individuals recruited from 
the community. Pretesting activities will encompass all components of 
the study including screening, interviewing, medical examinations, 
collection of medical records, and assembling a folder of all data for 
the study's simulated disability decision process. Once the results 
from this pretest are available, the NSHA instruments and

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procedures will be further refined for the dress rehearsal and main 
study.
    Referencing the following table, SSA will screen up to 400 
individuals to obtain 140 volunteers to participate in activities (2) 
through (5). SSA will contact approximately 420 health care providers 
to obtain the medical records of the volunteers (item (6). The public 
reporting burden is as follows:

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                                                     Number of     Frequency of    Average hours     Estimated
        Information collection  activity            respondents      response      per response    annual burden
----------------------------------------------------------------------------------------------------------------
(1) Recruitment screening.......................             400               1             .17              68
(2) Household screener..........................             140               1             .33              46
(3) Sample person interview.....................             140               1            1.5              210
(4) Respondent medical exam information.........             140               1            2                280
(5) Comments on pretest materials...............             140               1             .25              35
(6) Collecting medical evidence of record from               420               1             .5              210
 healthcare provider............................
                                                 ---------------------------------------------------------------
    Total.......................................  ..............  ..............  ..............             849
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    7. The Internet Social Security Benefits Application (ISBA)--0960-
0618. One of the requirements for obtaining Social Security benefits is 
the filing of an application so that a determination may be made on the 
applicant's eligibility for monthly benefits. ISBA, which is available 
at the Social Security Administration's (SSA) Internet site, is one 
method that an individual can choose to file an application for 
benefits. In order to make a determination on eligibility for benefits, 
it is necessary to elicit from the applicant information about the date 
and place of birth, current and recent work, receipt of non-covered 
pensions etc. Currently, the ISBA can only be used to apply for 
retirement and spouse's benefits. SSA plans to expand ISBA to encompass 
Disability Insurance Benefits (DIB). SSA has used information collected 
by ISBA to entitle individuals to retirement insurance benefits and/or 
spouse's benefits. The information collected by the expanded ISBA will 
be used to entitle individuals to DIB as well. The respondents are 
applicants for retirement insurance benefits, spouse's benefits and 
disability benefits. Below is an estimate of the public reporting 
burden:

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                                                                                  Average burden     Estimated
                 Type of benefit                     Number of     Frequency of    per response    annual burden
                                                    respondents      response      (in minutes)     (in house)
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RIB.............................................         130,000               1              20          43,333
DIB.............................................          39,000               1           25-30          16,542
                                                 ---------------------------------------------------------------
    Total.......................................         169,000  ..............  ..............          59,875
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    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. 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/SSI) 
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.

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                                                                   Frequency of   Average burden     Estimated
                                                    Respondents      response      per response    annual burden
----------------------------------------------------------------------------------------------------------------
SSA-2930........................................           3,000               1              30           1,500

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SSA-2931........................................           1,500               1              30             750
SSA-2932........................................             650               1              20             217
SSA-4659........................................             325               1              10              54
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    Total burden................................  ..............  ..............  ..............           2,521
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    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 DDSs 
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 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.
    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 SSI 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 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 CFR 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. The claimant is required to submit an 
itemized list of actual travel expenses and supporting receipts which 
were incurred in order to attend a hearing or medical examination. 
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.

    Dated: August 6, 2001.
Frederick W. Brickenkamp,
Reports Clearance Officer.
[FR Doc. 01-20030 Filed 8-8-01; 8:45 am]
BILLING CODE 4191-02-P