[Federal Register Volume 68, Number 246 (Tuesday, December 23, 2003)]
[Notices]
[Pages 74277-74279]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-31521]


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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, the Paperwork Reduction Act of 1995, effective October 1, 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 (OMB), Attn: Desk Officer for SSA, New 
Executive Building, Room 10235, 725 17th St., NW, Washington, DC 20503, 
Fax: 202-395-6974.

Social Security Administration (SSA), DCFAM, Attn: Reports Clearance 
Officer, 1338 Annex Building, 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

[[Page 74278]]

SSA Reports Clearance Officer at (410)-965-0454 or by writing to the 
address listed above.
    1. Pain Report-Child--20 CFR 416.912 and 416.1512--0960-0540. The 
information collected by form SSA-3371-BK will be used to obtain the 
types of information specified in the regulations, and to provide 
disability interviewers (and applicants/claimants in self-help 
situations) with a convenient means of recording the information 
obtained. This information is used by the State disability 
determination services (DDS) adjudicators and administrative law judges 
to assess the effects of symptoms on functionality for determining 
disability under the Social Security Act. The respondents are 
applicants for Supplemental Security Income (SSI) benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 250,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 62,500 hours.
    2. Medical Permit Parking Application--41 CFR 101-20.104-2--0960-
0624. SSA issues medical parking assignments at SSA-owned and -leased 
facilities to individuals who have a medical condition which meets the 
criteria for medical parking. In order to issue a medical parking 
permit, SSA must obtain medical evidence from the applicant's 
physician. Form SSA-3192-F4 is used to collect this information. SSA 
then uses the information to determine whether the individual qualifies 
for a medical parking permit and whether or not to issue the permit. 
The respondents are physicians of applicants for medical parking 
permits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 144.
    Frequency of Response: 1.
    Average Burden Per Response: 60 minutes.
    Estimated Annual Burden: 144 hours.
    3. Certification of Prison Records by Prison Officials--20 CFR 
422.107--0960-NEW. When a valid agreement is in place, prison officials 
provide to SSA specific information to attest to the identity of 
certain incarcerated U.S. citizens who need replacement Social Security 
cards. The information the prison officials provide will be taken from 
the official prison files and will be used by SSA to establish the 
applicant's identity in the Social Security card process. The 
respondents are prison officials who certify identity of prisoners 
applying for replacement Social Security cards.
    Type of Request: New information collection.
    Number of Respondents: 1,000.
    Frequency of Response: 200.
    Average Burden Per Response: 3 minutes.
    Estimated Annual Burden: 10,000 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 
packages by calling the SSA Reports Clearance Officer at (410) 965-
0454, or by writing to the address listed above.
    1. Blood Donor Locator Service--20 CFR 401.200--0960-0501. Section 
1141(a) of the Social Security Act and 42 U.S.C. 1320b-11 require that 
participating State agencies provide the SSA Blood Donor Locator 
Service (BDLS) with specific information on blood donors who have 
tested positive for Human Immunodeficiency Virus (HIV). SSA uses the 
information to identify the donor and to locate the donor's address in 
SSA records for the purpose of notifying the states and assuring that 
states meet regulatory requirements to qualify for using the BDLS. SSA 
will retain no record of the request or the information after 
processing has been completed. The respondents are participating State 
agencies acting on behalf of authorized blood donor facilities.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 10.
    Frequency of Response: 5.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 13 hours.
    2. Discrimination Complaint Form--0960-0585. The information 
collected on form SSA-437 is used by SSA to investigate and formally 
resolve complaints of discrimination based on race, color, national 
origin, sex, age, religion, and retaliation in any program or activity 
conducted by SSA. A person who believes that he or she has been 
discriminated against on any of the above bases may file a written 
complaint of discrimination. The information will be used to identify 
the complainant; identify the alleged discriminatory act; ascertain the 
date of such alleged act; obtain the identity of the individual(s)/
facility/component that allegedly discriminated; and ascertain other 
relevant information that would assist in the investigation and 
resolution of the complaints. The respondents are individuals who 
allege discrimination on the grounds described above.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 98.
    Frequency of Response: 1.
    Average Burden Per Response: 60 minutes.
    Estimated Annual Burden: 98 hours.
    3. Pre-1957 Military Service Federal Benefit Questionnaire--20 CFR 
404.1301-1371--0960-0120. Form SSA-2512 collects data used in the 
claims adjudication process to grant gratuitous military wage credits, 
when applicable, and solicits sufficient information to make a 
determination of eligibility. The respondents are individuals who are 
applying for Social Security benefits on the record of a wage earner 
with pre-1957 military service.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 12,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Average Burden: 2,000 hours.
    4. Application for Supplemental Security Income--20 CFR 416.305-
335--0960-0229. The information collected using Form SSA-8000-BK (or 
during a personal interview) is needed and is used to determine 
eligibility for SSI and the amount of benefits payable to the 
applicant. The respondents are applicants for SSI payments.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 1,128,374.
    Frequency of Response: 1.
    Average Burden Per Response: 40 minutes.
    Estimated Annual Burden: 752,249 hours.
    5. Statement of Household Expenses and Contributions--20 CFR 
416.1130-1148--0960-0456. Eligibility for Supplemental Security Income 
(SSI) is based on need. A factor for determining need is whether an 
individual receives in-kind support and maintenance in the form of food 
and shelter provided by other persons. SSA collects information on form 
SSA-8011-F3 to determine the existence and amount of in-kind support 
and maintenance received by a claimant/beneficiary of SSI. SSA uses the 
information to determine eligibility and payment amount under this 
program. The respondents are members of SSI claimants'/beneficiaries' 
households.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 400,000.

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    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 100,000 hours.

    Dated: December 16, 2003.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 03-31521 Filed 12-22-03; 8:45 am]
BILLING CODE 4191-02-P