[Federal Register Volume 69, Number 19 (Thursday, January 29, 2004)]
[Notices]
[Pages 4339-4341]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-1929]


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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

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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, Attn: Desk Officer for SSA, New 
Executive 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 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 SSA Reports Clearance Officer at 410-965-
0454 or by writing to the address listed above.
    1. Certification of Contents of Document(s) or Record(s)--20 CFR 
404.715 Subpart H--0960-NEW. SSA must secure evidence necessary for 
individuals to establish rights to benefits. Some of the types of 
evidence needed are evidence of age, relationship, citizenship, 
marriage, death, and military service. Form SSA-704 allows SSA 
employees, state record custodians, and other custodians of evidentiary 
documents to record information from documents and records to establish 
these types of evidence. SSA employees use this form but it also is 
used by state record custodians and other custodians of evidentiary 
documents.
    Type of Request: Form in use without OMB clearance.
    Number of Respondents: 4,200.
    Average Burden Per Response: 10 minutes.
    Frequency of Response: 1.
    Estimated Annual Burden: 700.
    2. Modified Benefit Formula Questionnaire-Foreign Pension--0960-
0561. The information collected on form SSA-308 is used by SSA to 
determine exactly how much (if any) of the foreign pension may be used 
to reduce the amount of the Social Security retirement or disability 
benefit under the modified benefit formula. The respondents are 
applicants for Social Security retirement/disability benefits.
    Type of Request: Extension of OMB-approved information collection.
    Number of Responses: 50,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 8,333 hours.
    3. Beneficiary Interview and Auditor's Observations Form--0960-
0630. The information collected through the Beneficiary Interview and 
Auditor's Observation Form, SSA-322, will be used by the SSA Office of 
the Inspector General (OIG) to interview beneficiaries and/or their 
representative payees to determine whether the payees are complying 
with their duties and responsibilities. Respondents to this collection 
will be randomly selected Supplemental Security Income recipients and 
Social Security beneficiaries that have representative payees.
    Type of Request: Extension of an OMB-approved collection.
    Number of Respondents: 2,550.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 638.
    4. Questionnaire for Children Claiming SSI Benefits--0960-0499. The 
information collected on form SSA-3881-BK is used by SSA to evaluate 
disability in children who are appealing an unfavorable disability 
decision or whose continuing disability is being reviewed. The form 
requests the names and addresses of non-medical sources such as 
schools, counselors, agencies, organizations or therapists who would 
have information about a child's functioning. The respondents are 
children or their representatives who are appealing an unfavorable 
decision on their claim or whose continuing disability is being 
reviewed.
    Type of Request: Extension of OMB-approved collection.
    Number of Respondents: 272,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 136,000 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 addresses listed above.
    1. Child Relationship Statement--20 CFR 404.355 and 404.731--0960-
0116. SSA uses the information collected on Form SSA-2519 to help 
determine the entitlement of children to Social Security benefits under 
section 216(h)(3) of the Social Security Act (Deemed Child Provision). 
The respondents are persons providing information about the 
relationship between the worker and his/her alleged biological child, 
in connection with the child's application for benefits.
    Type of Request: Extension of an OMB-approved collection.
    Number of Respondents: 50,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 12,500 hours.
    2. 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.


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    Dated: January 22, 2004.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 04-1929 Filed 1-28-04; 8:45 am]
BILLING CODE 4191-02-P