[Federal Register Volume 68, Number 104 (Friday, May 30, 2003)]
[Notices]
[Pages 32563-32566]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-13532]


=======================================================================
-----------------------------------------------------------------------

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, approval of existing 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, 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. Certification by Religious Group--20 CFR, Subpart K, 404.1075-
0960-0093. The data collected on Form SSA-1458 will be used to 
determine if a religious group meets the qualifications set out in 
Section 1402(g) of the Internal Revenue Code, which permits its members 
to be exempt from the payment of self-employment taxes. The respondents 
are spokespersons for a religious group or sect.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 180.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 45 hours.
    2. Statement of Care and Responsibility for Beneficiary--20 CFR, 
Subpart U, 404.2020-.2025 & Subpart F, 416.620-.625--0960-0109. Form 
SSA-788 is used to obtain information from the beneficiary's custodian 
about the representative payee applicant's concern and responsibility 
for the beneficiary. The respondents are individuals who have custody 
of a beneficiary, where someone else has filed to be the beneficiary's 
payee.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 130,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 21,667 hours.
    3. Request for Reconsideration--Disability Cessation--20 CFR, 
Subpart J, 404.909 & Subpart N, 416.1409--0960-0349. Form SSA-789 is 
used by SSA to schedule disability hearings and to develop additional 
evidence/information for claimants whose disability is found to have 
ceased, not to have existed, or to no longer be disabling. The 
information will also be used to determine if an interpreter is needed 
for the disability hearing. The respondents are claimants under Title 
II & XVI of the Social Security Act who wish to request reconsideration 
of disability cessation.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 49,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10--13.5 minutes.
    Estimated Annual Burden: 10,045 hours.

[[Page 32564]]

    4. Psychiatric Review Technique--20 CFR, Subpart P, 404.1520(a) 
Subpart I 416.920(a)-0960-0413. Form SSA-2506-BK assists the Disability 
Determination Services (DDS) in evaluating mental impairments by 
helping to (1) identify the need for additional evidence for impairment 
severity; (2) consider aspects of the mental impairment relevant to the 
individual's ability to perform work-related mental functions, and (3) 
organize and present the findings in a clear, concise and consistent 
manner. The respondents are 54 State DDSs administering Title II and 
title XVI disability programs.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Responses: 1,253,703.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 313,426 hours.
    5. Request for Reconsideration--20 CFR, Subpart J, 404.907-.921 and 
Subpart N, 416.1407-.1421--0960-0622. The information collected on Form 
SSA-561 is used by SSA to document and initiate the reconsideration 
process for determining entitlement to Social Security benefits (Title 
II), Supplemental Security Income payments (Title XVI), and Special 
Veterans benefits (Title VIII). The respondents are individuals filing 
for such reconsideration.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 1,455,000.
    Frequency of Response: 1.
    Average Burden Per Response: 8 minutes.
    Estimated Annual Burden: 194,000 hours.
    6. Request for Withdrawal of Application--20 CFR, Subpart E, 
404.460--0960-0015. Form SSA-521 is completed by SSA when an individual 
wishes to withdraw his or her application for Social Security benefits. 
The respondents are individuals who wish to withdraw their applications 
for benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 100,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 8,333 hours.
    7. Collection of SSI Overpayments from Special Benefits for Certain 
WWII Veterans; 20 CFR, Subpart E, 416.570 & .572.--0960-0653. The 
information collection requirement in 20 CFR 416.570 allows for an 
individual to request to withhold a title XVI overpayment from Title 
II/VIII benefits. The information collection requirement in 20 CFR 
416.572 allows for an individual to elect a higher or lower rate of 
withholding for recovery of an SSI overpayment. The information 
collected will be used to determine the proper rate of withholding of 
benefits to recover program overpayments. The respondents are Title II 
or Title VIII beneficiaries who were overpaid title XVI benefits and 
who request a higher rate of recovery than specified in 20 CFR 416.571.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 2,500.
    Frequency of Response: 1.
    Average Burden Per Response: 1 hour.
    Estimated Annual Burden: 2,500 hours.
    8. Medical or Psychological Consultant's Review of Childhood 
Disability Evaluation Form--20 CFR, Subpart J, 416.1040, .1043, .1045--
0960-NEW. Form SSA-536 is used by SSA medical or psychological 
consultants to document their review and assessment of the Childhood 
Disability Evaluation Form, SSA-538, prepared by State DDS employees. A 
childhood disability evaluation is required in each SSI childhood 
disability case. Therefore, the consultants must prepare an assessment 
form SSA-536 for each childhood disability case that is reviewed. The 
respondents are 256 SSA medical and psychological consultants.
    Type of Request: Approval of an existing information collection.
    Number of Responses: 17,000.
    Frequency of Response: 1.
    Average Burden Per Response: 12 minutes.
    Estimated Annual Burden: 3,400 hours.
    9. Individuals or Agents Seeking Information or Testimony in Non-
Social Security Administration Cases--20 CFR 403.120--0960-0619. 20 CFR 
403.120 establishes a procedure whereby an individual, organization or 
governmental entity may request testimony of an agency employee in a 
legal proceeding to which the agency is not a party. The request, which 
must be in writing to the Commissioner, must fully explain the nature 
and the relevance of the sought testimony and include the time, date, 
and place where the testimony will be given. Respondents are 
individuals or their representatives who require testimony from Social 
Security Administration employees in a legal proceeding to which the 
Social Security Administration is not a party.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 40.
    Frequency of Response: 1.
    Average Burden Per Response: 60 minutes.
    Estimated Annual Burden: 40 hours.
    10. Medical Consultant's Review of Mental Functional Capacity 
Assessment--20 CFR, Subpart O, 404.1520(a); Subpart Q, 404.1640, 
404.1643, 404.1645; and Subpart I 416.920(a)--0960-NEW. Form SSA-392-
SUP is used by SSA's medical/psychological consultants to document 
their review and assessment of the Mental Residual Functional Capacity 
Form or SSA 4734-F4-SUP. The SSA-392-SUP documents whether the reviewer 
agrees or disagrees with the manner in which the SSA 4734-F4-SUP was 
completed. The SSA 392-SUP is required for each SSA 4734-F4-SUP form 
completed. The respondents are the 256 SSA medical/psychological 
consultants.
    Type of Request: Approval of an existing information collection.
    Number of Responses: 45,000.
    Frequency of Response: 1.
    Average Burden Per Response: 12 minutes.
    Estimated Annual Burden: 9,000 hours.
    11. Medical Consultant's Review of Physical Functional Capacity 
Assessment; 20 CFR Subpart O 404.1520(a), Subpart Q 404.1640, 404.1645, 
404.1643, and 416.920(a), Subpart I--0960-NEW. SSA-392 is used by SSA's 
medical consultants to document their review and assessment of the 
Physical Residual Functional Capacity Form, the SSA-4734, prepared by 
State DDS offices. The SSA-392 is required for each SSA-4734 form 
completed. The respondents are the 256 SSA medical consultants.
    Type of Request: Approval of an Existing Information
    Collection.
    Number of Responses: 92,000.
    Frequency of Response: 1.
    Average Burden Per Response: 12 minutes.
    Estimated Annual Burden: 18,400 hours.
    12. Medical Consultant's Review of Psychiatric Review Technique; 20 
CFR Subpart O 404.1520(a), Subpart Q 404.1640, 404.1643, 404.1645--
0960-NEW. SSA measures the performance of DDSs in the area of quality 
of documentation and determinations on claims. In mental claims, a 
Psychiatric Review Technique Form (PRTF) is completed by DDS employees. 
SSA medical/psychological consultants use Form SSA-3023 to document 
their

[[Page 32565]]

review and assessment of the information on the PRTF. The SSA 
consultant completes an SSA-3023 for each PRTF in the claims file. The 
respondents are the 256 medical/psychological consultants.
    Type of Request: Approval of an existing information collection.
    Number of Responses: 68,000.
    Frequency of Response: 1.
    Average Burden Per Response: 12 minutes.
    Estimated Annual Burden: 13,600 hours.
    13. Request for Withdrawal of Application-- 20 CFR 404.460--0960-
0015. Form SSA-521 is completed by SSA when an individual wishes to 
withdraw his or her application for Social Security benefits. The 
respondents are individuals who wish to withdraw their applications for 
benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 100,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 8,333 hours.
    14. Privacy and Disclosure of Official Records and Information: 
Availability of Information and Records to the Public--20 CFR 401 and 
402--0960-0566. The information collected is needed (a) to identify 
individuals who request access to their records; (b) designate an 
individual to receive and review sensitive medical records; (c) correct 
or amend records; (d) obtain consent from an individual to release his/
her records to others; (e) facilitate the release of information under 
the Freedom of Information Act; and (f) to grant a waiver or reduction 
of fees for records. The respondents are individuals requesting access 
to their SSA records, correction of their SSA records and disclosure of 
SSA records. The reporting burden is shown below:
    (a) Number of Respondents: 10,000.
    Frequency of Response: On Occasion.
    Average Burden Per Response: 11 minutes.
    Estimated Annual Burden: 1,833 hours.
    (b) Number of Respondents: 3,000.
    Frequency of Response: On Occasion.
    Average Burden Per Response: 2 hours.
    Estimated Annual Burden: 6,000 hours.
    (c) Number of Respondents: 100.
    Frequency of Response: On Occasion.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 17 hours.
    (d) Number of Respondents: 200,000.
    Frequency of Response: On Occasion.
    Average Burden Per Response: 3 minutes.
    Estimated Annual Burden: 10,000 hours.
    (e) Number of Respondents: 15,000.
    Frequency of Response: On Occasion.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 1,250 hours.
    (f) Number of Respondents: 400.
    Frequency of Response: On Occasion.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 33 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. 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.
    2. Third Party Liability Information Statement--42 CFR 
433.136-.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 SSI 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.
    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. Request for Workers' Compensation/Public Disability 
Information--20 CFR, Subpart E, 404.408--0960-0098. SSA uses form SSA-
1709 to request and/or verify information about workers' compensation 
or public disability benefits given to Social Security disability 
recipients so that the proper adjustment is made to their monthly 
benefits. The respondents are Federal, State, and local agencies 
administering workers' compensation or public disability benefits, 
private workers, insurance carriers and public or private self-insured 
companies.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 140,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 35,000 hours.
    5. Self-Employment/Corporate Officer Questionnaire--20 CFR 
404.435(e) 404.446--0960-0487. Form SSA-4184 is used to develop 
earnings data and corroborate the claimant's allegations of retirement 
when the claimant is self-employed or a corporate officer. The 
information collected is used to determine benefit amounts. The 
respondents are self-employed individuals and corporate officers.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 20,000.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 6,667 hours.
    6. Disability Report, Appeal--20 CFR 404.1512 and 416.912, 20 CFR 
404.916(c) and 416.1416(c)--0960-0144. SSA uses form SSA-3441 to secure 
updated resource and condition information from claimants seeking

[[Page 32566]]

reconsideration of denied disability benefits. The claimant also has 
the option of providing the information during a personal interview or 
through SSA's Internet application. This information assists the State 
DDS and Administrative Law Judges (ALJ) in preparing for appeals and 
hearings and in issuing a decision on whether or not an individual is 
entitled to or continues to be entitled to disability benefits. SSA 
requests completion of the SSA-3441 when individuals appeal denial of 
Social Security Disability Income (SSDI) and SSI benefits following a 
previous denial. The respondents are applicants for reconsideration of 
initial denial of disability benefits or reconsideration of disability 
cessation and individuals requesting hearings before an ALJ.
    Type of Request: Revision of an OMB-approved information 
collection. SSA will collect this information using both the 
traditional paper format and electronic formats through SSA information 
gathering systems and an online Internet collection as follows:

----------------------------------------------------------------------------------------------------------------
                                                                                  Average burden     Estimated
                                                     Number of     Frequency of    per  response   annual burden
                                                    respondents      response      (in minutes)     (in hours)
----------------------------------------------------------------------------------------------------------------
SSA-3441 (Paper Form)...........................       1,079,338               1              30         539,669
Electronic Disability Collection System (EDCS)..          16,790               1              30           8,395
I3441 (Internet Form)...........................          16,690               1              60          16,690
                                                 -----------------
      Total respondents and burden hours........       1,112,818  ..............  ..............         564,754
----------------------------------------------------------------------------------------------------------------


    Dated: May 22, 2003.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 03-13532 Filed 5-29-03; 8:45 am]
BILLING CODE 4191-02-P