[Federal Register Volume 68, Number 48 (Wednesday, March 12, 2003)]
[Notices]
[Pages 11883-11885]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-5789]


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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. 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 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:


[[Page 11884]]


(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, 1338 Annex 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 Employer--20 CFR 404.801-404.803-0960-0030. The 
information collected by SSA on form SSA-7011 is needed to substantiate 
allegations of wages paid to workers when those wages do not appear in 
SSA's records of earnings and the worker does not have proof that 
payment was made. This information is used to process claims for social 
security benefits and to resolve discrepancies in earnings records. The 
respondents are certain employers who can verify allegations of wages 
made by the wage earner.
    Type of Request: Extension of an OMB-approved Information 
Collection.
    Number of Respondents: 925,000.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 308,333 hours.

    2. Request to be Selected as Payee--20 CFR 404.2010-404.2025; 20 
CFR 416.601-416.665-0960-0014. The information collected by SSA on form 
SSA-11-BK is used to determine the proper payee for a Social Security 
beneficiary, and it is designed to aid in the investigation of a payee 
applicant. The form will establish the applicant's relationship to the 
beneficiary, the justification of the need for a payee, the concern for 
the beneficiary and the manner in which the benefits will be used. The 
respondents are applicants for selection as representative payee for 
Old Age, Survivors and Disability Insurance, Supplemental Security 
Income (SSI), and title-VIII Special Veterans Benefits.
    Type of Request: Extension of an OMB-approved Information 
Collection.
    Number of Respondents: 2,121,686.
    Frequency of Response: 1.
    Average Burden Per Response: 10.5 minutes.
    Estimated Annual Burden: 371,295 hours.

    3. Appointment of Representation--20 CFR 404.1707, 410.684, and 
416.1507-0960-0527. The information collected by SSA on form SSA-1696-
U4 is used to verify the applicant's appointment of a representative. 
It allows SSA to inform the representative of items which affect the 
applicant's claim. The affected public consists of applicants who 
notify SSA that they have appointed a person to represent them in their 
dealings with SSA when claiming a right to benefits.
    Type of Request: Extension of an OMB-approved Information 
Collection.
    Number of Respondents: 551,520.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 91,920.

    4. Application for Special Benefits for World War II Veterans--20 
CFR, Subpart C, 408-0960-0615. Form SSA-2000-F6 is used by SSA to 
elicit information necessary to determine the entitlement of an 
individual to a monthly benefit under title VIII of the Social Security 
Act. The respondents are persons outside the U.S. applying for benefits 
for themselves (or for someone else) under title VIII of the Act.
    Type of Request: Extension of an OMB-approved Information 
Collection.
    Number of Respondents: 400.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 133 hours.

    5. Third Party Liability Information Statement--42 CFR 433.136-
433.139--0960-0323. SSA obtains third party liability information for 
States under the terms of an agreement with the Centers for Medicare 
and Medicaid Services, which oversees administration of the Medicaid 
program. Medicaid State agencies use the information that SSA gathers 
on Form SSA-8019-U2 to bill third parties liable for medical care, 
support, or services to insure that Medicaid remains the payer of last 
resort. The respondents are Supplemental Security Income applicants and 
beneficiaries.
    Type of Request: Extension of an OMB-approved Information 
Collection.
    Number of Respondents: 95,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 7,917 hours.
    6. Prohibition of Payments of SSI Benefits to Fugitive Felons and 
Parole/Probation Violators--20 CFR 416.708--0960-0617. Section 1611(e) 
of the Social Security Act provides that a person shall not be 
considered an eligible individual or eligible spouse for purposes of 
the SSI program for any month during which the person is fleeing to 
avoid prosecution for a crime, or an attempt to commit a crime, which 
is a felony under the laws of the place from which the person flees (or 
which, in the case of the State of New Jersey, is a high misdemeanor 
under the laws of the State); is fleeing to avoid custody or 
confinement after conviction for a crime, or an attempt to commit a 
crime, which is a felony under the laws of the place from which the 
person flees (or which, in the case of the State of New Jersey, is a 
high misdemeanor under the laws of the State); or is violating a 
condition of probation or parole imposed under Federal or State law. 20 
CFR 416.708 describes events which must be reported by an individual 
receiving SSI benefits, a representative payee for an SSI recipient, or 
an applicant awaiting a final decision on an application for SSI 
benefits. The information reported will be used by SSA to determine 
eligibility for SSI benefits or whether to suspend SSI benefit 
payments. The respondents are SSI applicants or recipients, or the 
representative payee of same, who are in violation of the above 
stipulations.
    Type of Request: Extension of an OMB-approved Information 
Collection.
    Number of Respondents: 1,000.
    Frequency of Response: 1.
    Average Burden Per Response: 1 minute.
    Estimated Annual Burden: 17 hours.
    7. Request for Internet Service--Authentication--20 CFR 401.45--
0960-0596. The Information collected on the electronic request for 
Internet Service, Authentication, is used by the Social Security 
Administration to identify its customers who are requesting Privacy Act 
protected information. The respondents are members of the public who 
request services from SSA through the Internet.
    Type of Request: Extension of an OMB-approved Information 
Collection.
    Number of Respondents: 21,000.
    Frequency of Response: 1.
    Average Burden Per Response: 1.5 minutes.
    Estimated Annual Burden: 525 hours.

    The information collection listed below has been submitted to OMB 
for clearance. Your comments on the information collection 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

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the OMB clearance package by calling the SSA Reports Clearance Officer 
at 410-965-0454 or by writing to the address listed above.
    Instructions for Completion of Federal Assistance Application--
0960-0184. The information on Form SSA-96 will be used to assist SSA in 
selecting grant proposals for funding based on their technical merits. 
The information will also assist in evaluating the soundness of the 
design of the proposed activities, the possibilities of obtaining 
productive results, the adequacy of resources to conduct the activities 
and the relationship to other similar activities that have been or are 
being conducted. The respondents are State and local governments, 
State-designated protection and advocacy groups, colleges and 
universities and profit and nonprofit private organizations.
    Type of Request: Extension of an OMB-approved Information 
Collection.
    Number of Respondents: 200.
    Frequency of Response: 8.
    Average Burden Per Response: 14 hours.
    Estimated Annual Burden: 22,400 hours.

    Dated: March 6, 2003.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 03-5789 Filed 3-11-03; 8:45 am]
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