[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.
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Average
Number of Frequency of burden per Estimated
Collection format respondents responses response annual burden
(hours) (hours)
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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)...
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[[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:
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Average
Section No. Number of Frequency of response burden Estimated
responses (hours) annual (hours)
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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
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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
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SSA
SSA 5062 L5063
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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]
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