[Federal Register Volume 66, Number 195 (Tuesday, October 9, 2001)]
[Notices]
[Pages 51488-51490]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-25303]


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SOCIAL SECURITY ADMINISTRATION


Agency Information Collection Activities: Comment Request and 
Emergency 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 and 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 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. 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. A major goal of the 
proposed pretest is to improve the content of the disability 
determination folder. Once the results from this pretest are available, 
the NSHA instruments and procedures will be further refined for the 
dress rehearsal and main study.
    SSA will screen up to 400 individuals to obtain 140 volunteers to 
participate in activities (2) through (5) below. SSA will contact 
approximately 420 health care providers to obtain the medical records 
of the volunteers (item (6) below). 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

[[Page 51489]]

 
(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
----------------------------------------------------------------------------------------------------------------

    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 for 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: 556,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 92,667 hours.
    3. Request for Review of Hearing Decision/Order--0960-0277. The 
information collected on form HA-520 is needed to afford claimants 
their statutory right under the Social Security Act to request review 
of a hearing decision. The data will be used to determine the course of 
action appropriate to resolve each issue. The respondents are claimants 
denied or dissatisfied with a decision made regarding their claim.
    Number of Respondents: 80,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Average Burden: 13,333 hours.
    4. 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.
    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.
    5. 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.
    6. 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.
    II. Agency Information Collection Activities: Emergency 
Consideration Request SSA is requesting emergency consideration under 
20 CFR 1320.13 (a) (2) (iii) from OMB by October 25, 2001, of the 
information collections listed below.
    1. State Agency Ticket Assignment Form, SSA-1365, State Vocational 
Rehabilitation Ticket to Work Information Sheet, SSA-1366 and 
Individual Work Plans (IWP) Information Sheet, SSA-1367-0960-NEW.

Background

    Public Law (Pub. L.) 106-170, the Ticket to Work and Work 
Incentives Improvement Act of 1999, creates a new Ticket to Work (TTW) 
program for providing work access services to SSA beneficiaries. The 
new program requires SSA to monitor the services provided under the 
Law. SSA has developed three data collection forms that request service 
provider and beneficiary information that is essential to SSA's 
administration of this new program. Employment networks (ENs) providing 
TTW services under contracts with SSA are required to submit to SSA the 
information listed in form SSA-1367. State vocational rehabilitation 
agencies (VRAs) that provide services to SSA beneficiaries under either 
the traditional VR reimbursement mechanism or the new Ticket to Work 
program are required to submit to SSA the information listed in forms 
SSA-1365 and SSA-1366. SSA does not require that ENs or VRAs use forms 
SSA-1366 and SSA-1367 per se, but does require that any alternative 
forms submitted in place of these SSA forms include the SSA listed 
information at a minimum. VRAs are required to submit from SSA-1365 in 
all cases as a means of assigning Tickets to VRAs.
    a. State Agency Ticket Assignment Form-SSA-1365. The information 
collected on this form will be used by SSA's contracted Program Manager 
(PM) to perform the task of assigning beneficiaries' tickets and 
monitoring the use of tickets under the Ticket to Work and Self-
Sufficiency Program. The State VRA answers the questions and the 
beneficiary reviews the data and if in agreement will sign the form 
acknowledging their Ticket assignment.
    The respondents are State VR agencies.
    Number of Respondents: 21.
    Frequency of Response: 4,048 annually per respondent.
    Average Burden Per Response: 3 minutes.

[[Page 51490]]

    Estimated Annual Burden: 4,250 hours.
    b. State Vocational Rehabilitation Ticket to Work Information 
Sheet-SSA-1366. The information collected on Form SSA-1366 will be used 
by SSA's contracted PM when a State VRA elects to participate in the 
Program as an EN. In this case, form SSA-1366, when combined with the 
SSA-1365, is intended to meet the minimum information requirements for 
IWPs and to monitor the appropriateness of the IWPs as required under 
the Pub. L. 106-107. The respondents are VRAs acting as ENs under the 
Ticket to Work Program.
    Number of Respondents: 21.
    Frequency of Response: 132 annually per respondent.
    Average Burden Per Response: 2 minutes.
    Estimated Annual Burden: 92 hours.

    Please Note: The Ticket to Work Program is being implemented in 
stages. The above represents the initial phase of the program with 
13 participating states that include 21 State VR agencies. As the 
program continues to be phased in, each initial program year will 
result in a larger number of new tickets for the participating State 
VRs because existing clients will also be brought into the program.

    c. Individual Work Plans (IWP) Information Sheet-SSA-1367. The 
information collected on Form SSA-1367 will be used to monitor the 
appropriateness of IWPs that have been assigned to ENs under the Ticket 
To Work Act. The respondents are ENs under the ticket to work program.
    Number of Respondents: 31,450.
    Frequency of Response: 1 annually per respondent.
    Average Burden Per Response: 3 minutes.
    Estimated Annual Burden: 1,573 hours.

    Dated: Octobert 2, 2001.
Frederick W. Brickenkamp,
Reports Clearance Officer.
[FR Doc. 01-25303 Filed 10-5-01; 8:45 am]
BILLING CODE 4191-02-U