[Federal Register Volume 68, Number 143 (Friday, July 25, 2003)]
[Notices]
[Pages 44133-44135]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-18906]


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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, 
1338 Annex, 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. Application for Special Age 72-or-Over Monthly Payments--20 CFR, 
Subpart D, 404.380-.384--0960-0096. Form SSA-19-F6 is needed to 
determine if an individual is entitled to Special Age 72 payments. 
Eligibility requirements will be evaluated based on the data collected 
on this form. The respondents are individuals who attained age 72 
before 1972.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 10.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 3 hours.
    2. Statement of Self-Employment Income, CFR Subpart B, 404.101 and 
Subpart K, 404.1096--0960-0046. The information collected on Form SSA-
766 is used to determine if the individual will have at least the 
minimum amount of self-employment income needed for one or more 
quarters of coverage in the current year. Additional quarters of 
coverage may be credited on the basis of the information obtained, and 
benefit payments may be expedited where there are sufficient quarters 
of coverage to give the individual insured status. The respondents are 
self-employed persons applying for Social Security benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 5,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 417 hours.
    3. Childhood Disability Evaluation Form--20 CFR 416.924-0960-0568. 
SSA and State Disability Determination Services (DDS) use the 
information collected on Form SSA-538 to record medical and functional 
findings regarding the severity of impairments of the children who 
claim SSI benefits based on disability. The form is used for initial 
determinations of eligibility, in appeals, and in initial continuing 
disability reviews. The respondents are employees of DDS responsible 
for these determinations.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 750,000.
    Frequency of Response: 1.
    Average Burden Per Response: 25 minutes.
    Estimated Annual Burden: 312,500 hours.
    4. Subpart T--State Supplementation Provisions--20 CFR 416.2095-
2099--0960-0240. Section 1618 of the Social Security Act contains pass-
along provisions of the Social Security Amendments. These provisions 
require States that supplement the Federal SSI benefits pass along 
Federal cost-of-living increases to the individuals who are eligible 
for State Supplementary benefit payments. If the State fails to keep 
payments at the required level, it becomes ineligible for Medicaid 
reimbursement under Title XIX of the Social Security Act. Regulations 
at 20 CFR 416.2099 require the States to report mandatory minimum and 
optional supplementary payment data to SSA. The information is used to 
determine compliance with the law and regulations. The respondents are 
States that supplement Federal SSI payments.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 26.
    Frequency of Response: 15 states report quarterly; 11 states report 
annually.
    Average Burden per Response: 1 hour.
    Estimated Annual Burden: 71.
    5. Representative Payee Report-Special Veterans Benefits Form--
0960-0621. SSA needs the information collected on form SSA-2001 to 
determine whether payments certified to the representative payee have 
been used properly and whether the representative payee demonstrates 
concern for the beneficiary's best interest. The form will be completed 
annually by representative payees receiving Special Veterans Benefit 
payments on behalf of beneficiaries who are outside of the United 
States. It will also be required when SSA has reason to believe a 
representative payee could be misusing the payments. The respondents 
are representative payees for beneficiaries who are receiving Special 
Veterans Benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 100.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 17 hours.
    6. You Can Make Your Payment by Credit Card--0960-0462. SSA will 
use the information on Forms SSA-4588 and SSA-4589 to update the 
individual's social security record to reflect that a payment has been 
made on their overpayment and to effectuate payment through the 
appropriate credit card company. The respondents are Title II (Old-Age, 
Survivors and Disability Insurance) and Title XVI (Supplemental 
Security Income) debtors; and citizens requesting material through SSA.

[[Page 44134]]

    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 19,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 1,583 hours.
    II. The information collection listed below has 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. 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.
    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.
    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. 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.
    7. Medical Consultant's Review of Physical Functional Capacity 
Assessment--20 CFR 404.1520(a), 20 CFR 404.1640, 20 CFR 404.1645, 20 
CFR 404.1643, and 20 CFR 416.920(a) --OMB #0960-NEW. The SSA-392 is 
used by the Social Security Administration's regional review component 
to facilitate the medical consultant's review of the Physical Residual 
Functional Capacity Form, the SSA-4734. The SSA-392 records the 
reviewing medical consultant's assessment of the SSA-4734 that was 
prepared by the adjudicating component. The SSA-392 is required for 
each SSA-4734 form completed. The respondents are the medical/
psychological consultants responsible for reviewing the SSA-4734.
    Type of Request: Request for approval of new collection.
    Number of Respondents: 256.
    Frequency of Response: 359.
    Average Burden Per Response: 12 minutes.
    Estimated Annual Burden: 18,380 hours.
    8. Medical Consultant's Review of Mental/Functional Capacity 
Assessment Form, SSA 392 SUP.--20 CFR 404.1640, 20 CFR 404.1645, 20 CFR 
404.1643, 20 CFR 404.1520(a) and 20 CFR 416.920(a)--0960-NEW. Medical 
Consultant's Review of Mental Residual Functional Capacity Form, SSA-
392 SUP, is used by the Social Security Administration's regional 
review component to facilitate the medical/psychological consultant's 
review of the Mental Residual Functional Capacity Form or SSA-4734-SUP. 
The form records the reviewing medical/psychological consultant's 
assessment of the SSA-4734-SUP prepared by the adjudicating component 
and whether the reviewer agrees or disagrees with the manner in which 
the SSA-4734-SUP was completed. The SSA-392-SUP is required for each 
SSA-4734-SUP form completed. The respondents are the medical/
psychological consultants

[[Page 44135]]

responsible for reviewing the SSA-4734-SUP.
    Type of Request: Request for approval of new collection.
    Number of Respondents: 256.
    Frequency of Response: 359.
    Average Burden Per Response: 12 minutes.
    Estimated Annual Burden: 18,380.
    9. Request for Withdrawal of Application--20 CFR 404.460--0960-
0015. Request for Withdrawal of Application--0960-0015. Form SSA-521 is 
completed by the Social Security Administration (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.

    Dated: July 21, 2003.
Nicholas E. Tagliareni,
Acting Reports Clearance Officer, Social Security Administration.
[FR Doc. 03-18906 Filed 7-24-03; 8:45 am]
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