[Federal Register Volume 67, Number 213 (Monday, November 4, 2002)]
[Notices]
[Pages 67232-67233]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-27974]


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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 P.L. 104-13 
effective October 1, 1995, The Paperwork Reduction Act of 1995. The 
information collection packages that may be included in this notice are 
for new information collections, revisions to OMB-approved information 
collections and extensions (no change) of OMB-approved information 
collections.
    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

[[Page 67233]]

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. The information can be mailed and/or faxed to the individuals 
at the addresses and fax numbers listed below:

(OMB) Office of Management and Budget, Attn: Desk Officer for SSA, New 
Executive Office Building, Room 10235, 725 17th St., NW., Washington, 
DC 20503, Fax: 202-395-6974;
(SSA) Social Security Administration, DCFAM, Attn: Reports Clearance 
Officer, 1-A-21 Operations Bldg., 6401 Security Blvd., Baltimore, MD 
21235, Fax: 410-965-6400.

    I. The information collections listed below are pending at SSA and 
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-
0454, or by writing to the address listed above.
    1. Statement of Funds You Provided to Another, Statement of Funds 
You Received--20 CFR 416.1103(f)--0960-0481. Supplemental Security 
Income (SSI) entitlement, and the amount of the SSI payment, is 
affected by any other income the applicant has. Forms SSA-2854 and SSA-
2855 are used by SSA to collect information in situations where the SSI 
applicant alleges that money was borrowed on an informal basis from a 
noncommercial lender, e.g., a relative or friend, etc. These statements 
are completed by the borrower/claimant and by the lender and are 
required to determine whether the proceeds from the transaction are/are 
not income to the borrower/claimant. If the transaction constitutes a 
bona fide loan, the proceeds are not income to the SSI borrower/
claimant. The respondents are applicants for SSI payments who borrow 
money on an informal (noncommercial) basis and by individuals who lend 
money informally to SSI applicants.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 40,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 6,667 hours.
    II. The information collection listed below has 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 package 
by calling the SSA Reports Clearance Officer at 410-965-0454, or by 
writing to the address listed above.
    1. The Internet Social Security Benefits Application (ISBA)--20 CFR 
Subpart D, 404.310-404.311 and 20 CFR Subpart F, 404.601-404.603--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 SSA's Internet site, is one method that an individual can choose to 
file an application for benefits. Individuals can use ISBA to apply for 
retirement insurance benefits (RIB), disability insurance benefits 
(DIB) and spouse's insurance benefits based on age. SSA gathers only 
information relevant to the individual applicant's circumstances and 
will use the information collected by ISBA to entitle individuals to 
RIB, DIB and/or spouses benefits. The respondents are applicants for 
RIB, DIB and/or spouses benefits. Below is an estimate of the public 
reporting burden:
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 169,000.
    Frequency of Response: 1.
    Average Burden Per Response: 21.4 minutes.
    Estimated Annual Burden: 60,277 hours.
    2. Application for Disability Insurance Benefits--20 CFR Subpart 
P--404.1501-1512 and Subpart D--404.315-404.322--0960-0060. Section 223 
of the Social Security Act allows payment of disability insurance 
benefits to any individual who is insured for disability benefits by 
virtue of covered employment under Social Security; has not attained 
full retirement age; has filed an application for disability insurance 
benefits; and is under a disability as defined by the Act. Form SSA-16-
F6 obtains the information necessary to determine whether the 
provisions of the Act have been satisfied with respect to an applicant 
for disability benefits and detects whether the applicant has 
dependents who would qualify for benefits on his or her earnings 
record. The information collected on form SSA-16 helps to determine 
eligibility for social security disability benefits. The respondents 
are applicants for Social Security disability benefits.
    Type of Request: Revision of an OMB-Approved Information 
Collection.
    Number of Respondents: 1,513,677.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 504,559 hours.
    3. Worker's Compensation/Public Disability Benefit Questionnaire--
20 CFR Subpart E, 404.408--0960-0247. Section 224 of the Social 
Security Act provides for the reduction of disability insurance 
benefits (DIB) when the combination of DIB benefits and any worker's 
compensation (WC) and/or certain Federal, State or Local public 
disability benefits (PDB) exceeds 80% of the worker's predisability 
earnings. SSA-546 collects the information to determine whether or not 
the worker's receipt of WC/PDB payments will cause a reduction of DIB. 
The respondents are applicants for title II DIB.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 100,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 25,000 hours.
    4. Medical Report on Adult with Allegation of Human Immune 
Deficiency Virus Infection and Medical Report on Child with Allegation 
of Human Immune Deficiency Virus Infection--20 CFR Subpart I, 416.933--
0960-0500. The information collected on forms SSA-4814-F5 and SSA-4815-
F6 assist the field offices/disability determination services to make 
findings of presumptive disability that confirms the claimants' disease 
manifestations meet the severity of listing-level criteria for Human 
Immunodeficency Virus (HIV) infection. The respondents are medical 
sources of claimants for title XVI disability payments based on HIV 
infection.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 59,100.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 9,850 hours.

    Dated: October 29, 2002.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 02-27974 Filed 11-1-02; 8:45 am]
BILLING CODE 4191-02-P