[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