[Federal Register Volume 69, Number 44 (Friday, March 5, 2004)]
[Notices]
[Pages 10494-10497]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-4889]


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SOCIAL SECURITY ADMINISTRATION


Agency Information Collection Activities: Emergency Request, 
Proposed Request, Comment Request and Notice of OMB Approval

    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.

[[Page 10495]]

    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. SSA is requesting emergency consideration within 2 weeks of 
publication of the information collection listed below.
    Youth Transition Process Demonstration Evaluation Data Collection--
0960-NEW. To further the President's New Freedom Initiative goal of 
increasing employment of individuals with disabilities, SSA has awarded 
seven cooperative agreements for the purpose of developing service 
delivery systems to assist youth with disabilities to successfully 
transition from school to work. SSA is funding two coordinated 
contracts to provide (1) technical assistance and (2) an evaluation. 
SSA will work with the Evaluation Contractor to use the results to 
conduct a net outcome evaluation to determine the long-term 
effectiveness of the interventions, impacts and benefits of the 
demonstration. Evaluation data will be used by the projects to improve 
the efficiency of the project's operations; use of staff; linkages 
between the project and the agencies through which comprehensive 
services are arranged; and specific aspects of service delivery to 
better meet the needs of the targeted population. This type of project 
is authorized by sections 1110 and 234 of the Social Security Act. The 
respondents will be youth with disabilities who have enrolled in the 
project.
    Type of Request: New Collection.
    Number of Respondents: 5,000.
    Frequency of Response: 4.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 5,000 hours.
    II. 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. Supplemental Statement Regarding Farming Activities of Persons 
Living Outside the U.S.A.--0960-0103. Form SSA-7163A-F4 is used by SSA 
to collect needed information whenever a Social Security beneficiary or 
claimant reports work on a farm outside the U.S. The information is 
used to make a determination for work deduction purposes. The 
respondents are Social Security beneficiaries or claimants who are 
engaged in farming activities outside the U.S.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 1,000.
    Frequency of Response: 1.
    Average Burden Per Response: 60 minutes.
    Estimated Annual Burden: 1,000 hours.
    2. Notice Regarding Substitution of Party Upon Death of Claimant-
Reconsideration of Disability Cessation--20 CFR 404.907-.921 and 
416.1407-.1421--0960-0351. SSA uses form SSA-770 to obtain information 
from substitute parties regarding their intention to pursue the appeals 
process for an individual who has died. The respondents are such 
parties.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 1,200.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 100 hours.
    3. Disability Hearing Officer's Decision--20 CFR 404.917 and 
416.1417--0960-0441. The Social Security Act requires that SSA provide 
an evidentiary hearing at the reconsideration level of appeal for 
claimants who have received an initial or revised determination that a 
disability did not exist or has ceased. Based on the hearing, the 
disability hearing officer (DHO) completes form SSA-1207 and all 
applicable supplementary forms (which vary depending on the type of 
claim). The DHO uses the information in documenting and preparing the 
disability decision. The form will aid the DHO in addressing the 
crucial elements of the case in a sequential and logical fashion. The 
respondents are DHOs in the State Disability Determination Services 
(DDS).
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 100,000.
    Frequency of Response: 1.
    Average Burden Per Response: 45 minutes.
    Estimated Annual Burden: 75,000 hours.
    4. Work History Report--20 CFR 404.1512 and 416.912--0960-0578. The 
information collected by form SSA-3369 is needed to determine 
disability by the State DDS. The information will be used to document 
an individual's past work history. The respondents are applicants for 
disability benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 1,000,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 500,000 hours.
    5. Medical History and Disability Report, Disabled Child--20 CFR 
416.912--0960-0577. The Social Security Act requires claimants to 
furnish medical and other evidence to prove they are disabled. Form 
SSA-3820 is used to obtain various types of information about a child's 
condition, his/her treating sources and/or other medical sources of 
evidence. The i3820 allows the claimant for disability benefits to go 
online and furnish the same information. The Electronic Disability 
Collect System (EDCS) is an internal collection process. Using EDCS, 
Field Office (FO) employees key information provided by applicants or 
their representatives onto EDCS screens, which establish a data base 
that the adjudicating component can access. Both the i3820 and EDCS 
screens have been designed to capture the same information as the 
revised paper version of the SSA-3820. The information collected on the 
SSA-3820 is needed for the determination of disability by the State 
DDSs. The respondents are applicants for Title XVI (SSI) child 
disability benefits.
    Type of Request: Extension of an OMB-approved information 
collection.

[[Page 10496]]



----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Frequency of     burden per       Estimated
                                                    respondents      response        response     annual  burden
                                                                                      (hours)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3820........................................         366,000               1               1         366,000
i3820...........................................           2,500               1               2           5,000
EDCS............................................         157,000               1               1         157,000
----------------------------------------------------------------------------------------------------------------

    Total Estimated Annual Burden: 528,000 hours.
    6. Annual Registration Statement Identifying Separated Participants 
with Deferred Benefits, Schedule SSA--0960-0606. Schedule SSA is a form 
filed annually as part of a series of pension plan documents required 
by section 6057 of the IRS Code. Administrators of pension benefit 
plans are required to report specific information on future plan 
benefits for those participants who left plan coverage during the year. 
SSA maintains the information until a claim for Social Security 
benefits has been approved. At that time, SSA notifies the beneficiary 
of his/her potential eligibility for payments from the private pension 
plan. The respondents are administrators of pension benefit plans, or 
their service providers employed to prepare the Schedule SSA on behalf 
of the pension benefit plan. Below are the estimates of the cost and 
hour burdens for completing and filing Schedule SSA(s). We have used an 
average to estimate the hour burden. However, the burden may be greater 
or smaller depending on whether the respondent is a large or small 
pension benefit plan and how many Schedule SSA's are filed in a given 
year.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 1.
    Average Burden Per Response: 2.5 hours.
    Estimated Annual Burden: 220,000 hours.
    Estimated Annual Cost Burden for All Respondents: $12,194,400.
    7. State Agency Report of Obligations for SSA Disability Programs 
and Addendum, SSA-4513; Time Report of Personnel Services for 
Disability Determination Services, SSA-4514; and State Agency Schedule 
of Equipment Purchased for SSA Disability Programs, SSA-871--0960-0421. 
SSA uses the information collected by forms SSA-4513 and 4514 to 
conduct a detailed analysis and evaluation of the costs incurred by the 
State Disability Determination Services (DDSs) in making the disability 
determination for SSA. The data is also used to determine funding 
levels for each DDS. SSA uses the information collected by form SSA-871 
to budget and account for expenditures of funds for equipment purchases 
by the State DDSs that administer the disability determination program. 
The respondents are DDSs that have the responsibility for making 
disability determinations for SSA.
    Type of Request: Extension of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Frequency of     burden per       Estimated
                                                    respondents      response        response     annual  burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4513........................................              52               4              90             312
SSA-4514........................................              52               4              90             312
SSA-871.........................................              52               4              30             104
----------------------------------------------------------------------------------------------------------------

    Total Estimated Annual Burden: 728 hours.
    8. Summary of Evidence--20 CFR 416.1407--0960-0430. Form SSA-887 is 
used by the State Disability Determination Services (DDS) to provide 
claimants with a list of medical/vocational reports pertaining to their 
disability. The form will aid claimants in reviewing the evidence in 
their folders and will also be used by hearing officers in preparing 
for and conducting hearings. The respondents are State DDSs that make 
disability determinations.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 49,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 12,250 hours.
    9. Wage Reports and Pension Information--20 CFR 422.122(b)--0960-
0547. The information collected by form OR-418P is used by SSA to 
identify the requester of pension plan information and to confirm that 
the individual is entitled to the data SSA provides. The respondents 
are requesters of pension plan information.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 600.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 300 hours.
    III. 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. 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.

[[Page 10497]]

    2. Medical Permit Parking Application--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.

IV. Notice of OMB Approval

    As required by the Paperwork Reduction Act of 1995 (44 U.S.C. 
3507), the Social Security Administration (SSA) is providing notice of 
OMB's approval of the information collections contained in 20 CFR 
404.610, 404.611, and 422.505, Filing of Applications and Related 
Forms. In compliance with the Paperwork Reduction Act, persons are not 
required to respond to an information collection unless it displays a 
valid Office of Management and Budget control number. The OMB number is 
0960-0685, which expires February 28, 2007.

    Dated: March 1, 2004.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 04-4889 Filed 3-4-04; 8:45 am]
BILLING CODE 4191-02-P