[Federal Register Volume 67, Number 63 (Tuesday, April 2, 2002)]
[Notices]
[Pages 15654-15655]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-7936]


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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, 
NewExecutive Office Building, Room 10230, 72517th St., NW., Washington, 
DC 20503.
(SSA), Social Security Administration, DCFAM, Attn: SSA Reports 
Clearance Officer, 1-A-21 Operations Bldg., 6401 Security Blvd., 
Baltimore, MD 21235.

    I. The information collection 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 a copy of the collection instrument by 
calling the SSA Reports Clearance Officer at 410-965-0454, or by 
writing to her at the address listed above.
    1. Disability Hearing Officer's Decision--Title XVI Disabled Child 
Continuing Disability Review--0960-NEW. The information collected on 
form SSA-1209 will be used by State Disability Hearing Officers (DHO) 
to formalize disability decisions. The form will aid the DHO in 
addressing the crucial elements of the case in a sequential and logical 
fashion. The form is used as the official determination of the DHO's 
decision and the personalized portion of the notice to the claimant.
    Number of Respondents: 35,000.
    Frequency of Response: 1.
    Average Burden Per Response: 1 1/4 hours.
    Estimated Annual Burden: 43,750 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-
0454, or by writing to her at the address listed above.
    1. Statement Regarding the Inferred Death of an Individual By 
Reason of Continued and Unexplained Absence-0960-0002. The information 
collected on Form SSA-723-F4 is needed to determine if SSA may presume 
that a

[[Page 15655]]

missing wage earner is dead and, if so, to establish a date of presumed 
death. The respondents are people who have knowledge of the 
disappearance of the wage earner.
    Number of Respondents: 3,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 1,500 hours.
    2. Credit Card Payment Acknowledgement Form--0960-NEW. SSA will use 
the information collected on Form SSA-1414 to process payments from 
former employees and vendors who have outstanding debts owed to the 
agency. This form has been developed as a convenient method for 
respondents to satisfy such debts. The respondents are former employees 
and vendors who have debts owed to the agency.
    Number of Respondents: 150.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 13 hours.
    Please note: The SSA form number and the total number of 
respondents has been amended since the first FRN publication. This 
collection was previously published on December 31, 2001, as the SSA-
324. The form number has been changed as a result of an internal SSA 
forms management review. The total number of respondents was adjusted 
after further evaluation of management information.
    3. 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-1367-0960-0641.

Background

    Public Law (Pub. L.) 106-170, the Ticket to Work and Work 
Incentives Improvement Act of 1999, created a new Ticket to Work (TTW) 
program for providing work access services to Social Security 
disability 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, which 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 our beneficiaries under either the traditional VR 
reimbursement mechanism or the new TTW 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 Form 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 the 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.
    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 TTW 
program. The respondents are ENs under the TTW 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: March 26, 2002.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 02-7936 Filed 4-1-02; 8:45 am]
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