[Federal Register Volume 68, Number 72 (Tuesday, April 15, 2003)]
[Notices]
[Pages 18318-18319]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-9085]


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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:

(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, 1300 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. Employee Work Activity Questionnaire--20 CFR, Subpart P, 
404.1574 and .1592--0960-0483. Form SSA-3033 is used to determine if 
the claimant meets the disability requirements of the law, when the 
claimant returns to work after the alleged or established onset date of 
disability. When a possible unsuccessful work attempt or nonspecific 
subsidy is involved, Form SSA-3033 will be used to request a 
description of the employee's work effort. The respondents are 
employers of Old-Age and Survivors Disability Insurance (OASDI) and 
Supplemental Security Income (SSI) disability applicants and 
beneficiaries.
    Type of Request: Extension of an OMB-approved Information 
Collection.
    Number of Respondents: 15,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 3,750 hours.
    2. Request for Internet Services Representative Payee Report--20 
CFR 401.45--0960-0668.

Background

    SSA is testing the Internet Representative Payee Report form (I623) 
that electronically reports on the use of benefit payments made on 
behalf of Social Security beneficiaries and SSI recipients. In support 
of this process, a proof of concept (POC) test limited to 40 
organizational representative payees use the I623 to complete and file 
the representative payee report instead of using the paper SSA-623. 
Initially SSA projected a 6-month POC test, but is planning to expand 
the POC to a full operational year.

The Collection

    Organizations participating in the POC will designate up to three 
employees that will be authenticated using SSA's existing Integrated 
Registration for Employers and Submitters (IRES) OMB control number 
0960-0626. Once authenticated, the employee will be required to enter a 
Personal Identification Number (PIN) and Password to gain access to the 
online I623 application. The PIN and

[[Page 18319]]

Password will serve as the electronic signature. SSA will use the 
information collected through the I623 to determine whether the 
payments provided to the representative payee have been used for the 
beneficiary's current maintenance and personal needs and whether the 
representative payee continues to be concerned with the beneficiary's 
welfare. The respondents are organizational representative payees 
designated to receive funds on behalf of Social Security beneficiaries 
and/or SSI recipients.
    Type of request: Extension of an OMB-approved Information 
Collection.
    Number of Respondents: 40 organizations.
    Frequency of Response: 117.5 per respondent.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 1,175 hours.
    3. Statement of Claimant or Other Person--0960-0045. In special 
situations, when there is no standard form or questionnaire, Form SSA-
795 is used by SSA to obtain information from claimants or other 
persons having knowledge of facts in connection with many aspects of 
the Social Security or SSI programs. The information requested on form 
SSA-795 must be of sufficient importance that a signed statement, 
including a penalty clause, is necessary. The information collected is 
used to process such issues as claims for benefits or continuing 
eligibility, benefit amount, insured status, use of funds by a 
representative payee or a myriad of other program-related matters. The 
most typical respondents are applicants for Social Security or SSI 
benefits or beneficiaries of these programs. However, respondents could 
also include friends and relatives of the involved parties, coworkers, 
neighbors, or anyone else in a position to provide information 
pertinent to the issue(s).
    Number of Respondents: 305,500.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 76,375 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 package 
by calling the SSA Reports Clearance Officer at 410-965-0454, or by 
writing to the address listed above.
    1. Claimant's Medications--20 CFR, Subpart P, 404.1512 and Subpart 
I, 416.912--0960-0289. The information on Form HA-4632 is used to 
process title II and title XVI disability claims. Claimants provide an 
updated list of medications using form HA-4632. This information 
enables the Administrative Law Judge who conducts the hearing to fully 
inquire into medical treatment the claimant is receiving and the effect 
of medications on the claimant?s medical treatment. The respondents are 
applicants for title II and title XVI benefits.
    Type of Request: Extension of an OMB-approved Information 
Collection.
    Number of Respondents: 171,939.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 42,985 hours.
    2. Letter to Employer Requesting Wage Information--0960-0138. Form 
SSA--L4201-U2 is used to collect wage data from employers to establish 
and/or verify wage information for SSI claimants, beneficiaries and 
deemors. SSA uses the data to determine if an individual is eligible 
for SSI and, if so, to determine the amount of the payment due. The 
respondents are employers of applicants for and recipients of SSI 
payments.
    Type of Request: Extension of an OMB-approved Information 
Collection.
    Number of Respondents: 133,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 66,500 hours.

    Dated: April 8, 2003.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 03-9085 Filed 4-14-03; 8:45 am]
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