[Federal Register Volume 68, Number 121 (Tuesday, June 24, 2003)]
[Notices]
[Pages 37599-37601]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-15884]


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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, 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 sent to the individuals listed below:

(OMB), Office of Management and Budget, Attn: Desk Officer for SSA, 
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. Social Security Disability Report--20 CFR 404.1512 & 416.912--0960-
0579

    The Social Security Act requires applicants to furnish medical, 
work history and other evidence or information to prove they are 
disabled. The information on the Adult Disability Report, together with 
other evidence and information, will be used by State Disability 
Determination Services (DDS) to develop medical evidence, assess the 
alleged disability, and make a determination on whether or not the 
applicant is disabled under the Act. DDSs are State agencies that make 
disability determinations on behalf of SSA.
    In addition to the traditional paper application, claimants for 
disability benefits will have the option to complete the Disability 
Report through the Internet (i3368) or in an interview format with an 
SSA representative at an SSA field office using the Electronic 
Disability Collection System (EDCS). Both the i3368 and EDCS formats 
collect the same information as that contained on the paper SSA-3368, 
but include enhancements to guide the claimant or interviewer through 
the application process. For example, the i3368 provides applicants 
with self-help screens and propagates certain information. Both the 
i3368 and EDCS applications will, when needed, collect additional 
information on a claimant's work history. In the paper-based process, 
however, additional work history information is collected through 
another form, the SSA-3369, OMB control number 0960-0578. The 
respondents are applicants for title II and title XVI disability 
benefits.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                       Average
                                                        Number of     Frequency of    burden per     Estimated
                  Collection format                    respondents     responses       response    annual burden
                                                                                       (hours)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3368 (Paper Form)...............................     2,040,667                1            1       2,040,667
Electronic Disability Collection System (EDCS)......        10,000                1            1          10,000
I3368 (Internet) (Hour burden varies between 1\1/2\         66,000                1       2\1/2\         165,000
 hours and 3 hours based on information required)...
----------------------------------------------------------------------------------------------------------------


[[Page 37600]]

    Total estimated annual burden: 2,215,667.

2. Supplement to Claim of Person Outside the United States--20 CFR 
404.460, 422.505(b), 404.460, 404.463 and 42 CFR 407.27(c)--0960-0051

    The information collected on Form SSA-21 is used by SSA to 
determine continuing entitlement to Social Security benefits and the 
proper benefit amounts of alien beneficiaries living outside the United 
States (U.S.). It is also used to determine whether benefits are 
subject to withholding tax. The respondents are comprised of 
individuals entitled to Social Security benefits who are, will be, or 
have been residing outside the U.S.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 35,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 2,917.

3. Requests for Self-Employment Information, Employee Information, 
Employer Information--20 CFR, Subpart A, 422.120--0960-0508

    SSA uses Forms SSA-L2765, SSA-L3365 and SSA-L4002 to request 
correct information when an employer, employee or self-employed person 
reports an individual's earnings without a Social Security Number (SSN) 
or with an incorrect name or SSN. The respondents are employers, 
employees or self-employed individuals who are requested to furnish 
additional identifying information.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 3,000,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 500,000 hours.

4. Statement of Claimant or Other Person--20 CFR 404.702 & 416.570--
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 Supplementary Supplemental 
Security Income (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, insure 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).
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 305,500.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 76,375 hours.

5. Uniform Administrative Requirements for Grants and Agreements With 
Institutions of Higher Education, Hospitals, and Other Non-Profit 
Organizations--20 CFR Part 435-0960-0616

    These rules cover the basic administrative reporting and 
recordkeeping requirements for applicable recipients of grants and 
agreements. Because very specific requirements must be met, it is 
necessary that SSA collect significant information from the applicants 
and grantees to determine if they meet, or continue to meet, the 
conditions specified. The respondents are institutions of higher 
education, hospitals, and other non-profit and commercial 
organizations. SSA currently has a total of 17 grant recipients that 
are subject to the requirements of the proposed rule.
    Type of Requests: Extension of an OMB-approved information 
collection. The hourly burden as estimated for each of the reporting 
(Rpt) and recordkeeping (Reckp) requirements is reflected in the 
following table:

----------------------------------------------------------------------------------------------------------------
                                                                                       Average
             Section No.                 Number of        Frequency of response         burden       Estimated
                                         responses                                     (hours)    annual (hours)
----------------------------------------------------------------------------------------------------------------
435.21 Rec-..........................             1  N/A                                      40              40
435.23 Rec-..........................            94  Quarterly (4)                             1             376
435.25 Rpt...........................            14  Biannually                                4             112
435.33 Rpt...........................             1  Annually (1)                              1               1
435.44 Rpt...........................             1  Annually (1)                              2               2
435.51 Rpt...........................           150  Quarterly (4)                            12           7,200
435.53 Rec-..........................           150  Annually (1)                              8           1,200
435.81 Rpt...........................             1  Annually (1)                             16              16
435.82 Rpt...........................             1  Annually (1)                              8               8
----------------------------------------------------------------------------------------------------------------

    Total estimated annual burden: 8,955 hours.

6. State Mental Institution Policy Review--20 CFR, Subpart U, 404.2001-
2065, Subpart F, 416.601-416.665-0960-0110

    The Social Security Act provides that the Commissioner of Social 
Security shall establish a system of accountability monitoring for 
institutions in each state that serve as a representative payee for 
recipients of Social Security and SSI benefits. As part of this 
accountability process, SSA collects information on Form SSA-9584 to 
determine whether the institution policies and practices conform to 
SSA's regulations on the use of benefits and whether the institution is 
performing other duties and responsibilities required of a 
representative payee. The information also provides a basis for 
conducting an onsite review of the institution and is used in the 
preparation of the subsequent report of findings. The respondents are 
state mental institutions that serve as representative payees.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 125.
    Frequency of Response: 1.
    Average Burden Per Response: 60 minutes.
    Estimated Annual Burden: 125 hours.

[[Page 37601]]

7. Application for Search of Census Records for Proof of Age--20 CFR 
404.716-0960-0097

    The information collected on Form SSA-1535-U3 is required to 
provide the Census Bureau with sufficient identification information, 
which will allow an accurate search of census records to establish 
proof of age for an individual applying for Social Security Benefits. 
It is used for individuals who must establish age as a factor for 
entitlement. The respondents are individuals applying for Social 
Security benefits who need to document their date of birth.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 18,000.
    Number of Response: 1.
    Average Burden per Response: 12 minutes.
    Estimated Average Burden: 3,600.

8. Function Report--Adult--20 CFR 404.1512 and 416.912--0960-NEW

    Form SSA-3373 records information about the disability applicant's 
impairment-related limitations and ability to function. It documents 
the types of information specified in SSA regulations and provides 
disability inteviewers with a convenient means to record information 
about how the claimant's condition affects his or her ability to 
function. This information, together with medical evidence, forms the 
evidentiary basis upon which the initial disaiblity proces is founded. 
The respondents are title II and XVI benefits applicants.
    Type of Request: New information collection.
    Number of Respondents: 4,005,367.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 2,002,684.
    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. 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 recipeints. 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 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 organizatioanal representative payees designated to 
receive funds on behalf of Social Security beneficiaries and/or SSI 
recipients.
    Type of Request: Extensioin 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.

2. Employee Work Activity Questionnair--20 CFR, Subpart P, 404.1574 and 
404.1592--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 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.

3. Disability Hearing Officer's Decision Title XVI Disabled Child 
Continuing Disability Review--20 CFR 404 Subpart J and 20 CFR 416 
Subpart I&N--OMB No. 0960-0657

    Both federal and state disability hearing officers (DHOs) use the 
SSA-1209 in preparing the disability determination. The form provides 
the framework for addressing the crucial elements of the case in a 
sequential and logical fashion. The completed form will be the official 
document of the decision. A copy becomes the personalized portion of 
the notice to the claimant/representative. the respondents are both 
federal and state disability hearing officers.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 35,000.
    Frequency of Response: 1.
    Average Burden Per Response: 1 hour 25 minutes.
    Estimated Annual Burden: 49,583 hours.

4. Claimant's Statement About Loan of Food and Shelter (SSA-5062), and 
Statement About Food or Shelter Provided to Another (SSA-L5063)--20 CFR 
416.1130 through 416.1148--0950-0529

    Forms SSA-5062 and SSA-L5063 are used to obtain statements about 
food and/or shelter provided to an SSI claimant. SSA uses the 
information to determine whether food and/or shelter are a bona fide 
loan or should be counted as income. This determination can affect 
eligibility for SSI and the amount of SSI that is payable. The 
respondents are claimants for SSI benefits and individuals, who provide 
(loan) food or shelter to SSI claimants.
    Type of Request: Extension of an OMB-approved information 
collection

------------------------------------------------------------------------
                                                                   SSA
                                                      SSA 5062    L5063
------------------------------------------------------------------------
Number of respondents...............................    65,540    65,540
Frequency of Response...............................         1         1
Average Burden of Response..........................        10        10
Estimated Annual Burden.............................    10,923    10,923
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    Dated: June 8, 2003.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 03-15884 Filed 6-23-03; 8:45 am]
BILLING CODE 4191-02-M