[Federal Register Volume 69, Number 83 (Thursday, April 29, 2004)]
[Notices]
[Pages 23553-23555]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-9511]


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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, 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. Letter to Custodian of Birth Records/Letter to Custodian of 
School Records--20 CFR 404.704, 404.716, 416.802, and 422.107--0960-
NEW. The information collected on forms SSA-L-706 and SSA-L-106 is used 
by SSA to assist a claimant in obtaining evidence necessary to 
establish age. The respondents are applicants for Social Security 
benefits.
    Type of Request: Form in use without OMB Number.
    Number of Respondents: 7,200.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 1,200 hours.
    2. Medical Report (General)--20 CFR 404.1512-404.1515 and 416.912-
416.915--0960-0052. The information collected on form SSA-3826-F4 is 
used by SSA to determine a claimant's physical status prior to making a 
disability determination. This information is also placed in the 
claimant's disability claims folder to provide written medical evidence 
which is used in the disability determination decision. The respondents 
are physicians, hospitals, directors, and medical records librarians.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 750,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 375,000 hours.
    3. Certificate of Coverage Request Form--0960-0554. The United 
States (U.S.) has Social Security agreements with 20 countries. These 
agreements eliminate double Social Security coverage and taxation where 
a period of work would be subject to coverage and taxes in both 
countries. The individual agreements contain rules for determining the 
country under whose laws the period of work will be covered and to 
whose system taxes will be paid. The agreements further provide that 
upon the request of the worker or employer, the country under whose 
system the period of work is covered will issue a certificate of 
coverage. The certificate serves as proof of exemption from coverage 
and taxation under the system of the other country. The information 
collected is needed to determine if a period of work is covered by the 
U.S. system under an agreement and to issue a certificate of coverage. 
The respondents are workers and employers wishing to establish an 
exemption from foreign Social Security taxes.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 46,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 23,000 hours.
    4. Representative Payee Report--20 CFR 404.265, 416.665--0960-NEW. 
The information collected on Form SSA-6234 is sent to all 
organizational representative payees (i.e. institutions, agencies) to 
determine whether the payments received on behalf of the beneficiaries 
have been used for their current maintenance and personal needs; to 
ensure that the payee continues to be concerned about the beneficiary's 
welfare; and to ascertain if the beneficiary is being charged a fee 
appropriately and how much the fee is. The respondents are all 
organizational representative payees for beneficiaries receiving Social 
Security benefits or Supplemental Security Income (SSI) payments.
    Type of Request: New information collection.
    Number of Respondents: 750,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 187,500 hours.
    5. Farm Self-Employment Questionnaire--20 CFR 404.1095--0960-0061. 
Section 211(a) of the Social Security Act requires the existence of a 
trade or business as a prerequisite for determining whether an 
individual or partnership may have ``net earnings from self-
employment.'' Form SSA-7156 elicits the information necessary to 
determine the existence of an agricultural trade or business and 
subsequent covered earnings for Social Security entitlement purposes. 
The respondents are applicants for Social Security benefits, whose 
entitlement depends on whether the worker has covered earnings from 
self-employment as a farmer.

[[Page 23554]]

    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 47,500.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Total Estimated Annual Burden: 7,917 hours.
    6. Child-Care Dropout Questionnaire--20 CFR 404.211(e)(4)--0960-
0474. The information collected on Form SSA-4162 is used by SSA to 
determine whether an individual qualifies for child care exclusion in 
computing the individual's disability benefit amount. The respondents 
are applicants for disability benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 2,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 167 hours.
    7. Appointment of Representation--20 CFR 404.1707, 410.684, and 
416.1507--0960-0527. The information collected by SSA on form SSA-1696-
U4 is used to verify the applicant's appointment of a representative. 
It allows SSA to inform the representative of items which affect the 
applicant's claim. The affected public consists of applicants who 
notify SSA that they have appointed a person to represent them in their 
dealings with SSA when claiming a right to benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 551,520.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 91,920 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. Certificate of Responsibility for Welfare and Care of Child Not 
in Applicant's Custody--20 CFR 404.330 and 404.339--0960-0019. SSA uses 
the information collected on form SSA-781 to decide if ``in care'' 
requirements are met by non-custodial parent(s), who are filing for 
benefits based on having a child in care. The respondents are non-
custodial wage earners whose entitlement to benefits depends upon 
having an entitled child in care.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 14,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 2,333 hours.
    2. Response to Notice of Revised Determination--20 CFR 404.913-
404.914 and 992(b), 416.1413-416.1414 and 1492--0960-0347. Form SSA-765 
is used by claimants to request a disability hearing and/or to submit 
additional evidence before a revised reconsideration determination is 
issued. The respondents are claimants who file for a disability hearing 
in response to a notice of revised determination for disability 
insurance and/or SSI under Titles II (Old-Age, Survivors, and 
Disability Insurance) and XVI (SSI).
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 1,925.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 963 hours.
    3. Notice Regarding Substitution of Party Upon Death of Claimant--
Reconsideration of Disability Cessation--20 CFR 404.907-404.921 and 
416.1407-416.1421--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: 10 minutes.
    Estimated Annual Burden: 200 hours.
    4. 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: 65,000.
    Frequency of Response: 1.
    Average Burden Per Response: 45 minutes.
    Estimated Annual Burden: 48,750 hours.
    5. Information about Joint Checking/Savings Account--20 CFR 
416.1201 and 416.1208--0960-0461. Form SSA-2574 is used to collect 
information from the claimant and the other account holder(s) when a 
Supplemental Security Income (SSI) applicant/recipient objects to the 
assumption that he/she owns all or part of the funds in a joint account 
bearing his or her name. These statements of ownership are required to 
determine whether the account is a resource of the SSI claimant. The 
respondents are applicants for and recipients of SSI payments and 
individuals who are joint owners of financial accounts with SSI 
applicants.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 200,000.
    Frequency of Response: 1.
    Average Burden Per Response: 7 minutes.
    Estimated Annual Burden: 23,333 hours.
    6. Beneficiary Contact Report--20 CFR 404.703 and 404.705--0960-
0502. SSA uses the information collected by form SSA-1588-OCR-SM to 
ensure that eligibility for benefits continues after entitlement. SSA 
asks parents information about their marital status and children in-
care to detect overpayments and to avoid continuing payment to those 
who are no longer entitled. The respondents are recipients of survivor 
mother/father Title II (OASDI) benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 133,400.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 11,117 hours.
    7. Earnings Record Information--20 CFR 404.801-404.803 and 404.821-
404.822--0960-0505. The information collected by form SSA-L3231-C1 is 
used to ensure that the proper person is credited for working when 
earnings are reported for a minor under age seven years. The 
respondents are businesses reporting earnings for children under age 7.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 20,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 3,333 hours.

[[Page 23555]]

    8. Internet Direct Deposit Application--31 CFR part 210--0960-0634. 
SSA uses Direct Deposit/Electronic Funds Transfer (DD/EFT) enrollment 
information received from beneficiaries to facilitate DD/EFT of their 
Social Security benefits with a financial institution. Respondents are 
Social Security beneficiaries who use the Internet to enroll in DD/EFT.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 9,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 1,500 hours.
    9. Authorization to Disclose Information to the Social Security 
Administration--20 CFR Subpart O, 404.1512 and Subpart I, 416.912--
0960-0623. SSA must obtain sufficient medical evidence to make 
eligibility determinations for the Social Security disability benefits 
and SSI payments. For SSA to obtain medical evidence, an applicant must 
authorize his or her medical source(s) to release the information to 
SSA. The applicant may use form SSA-827 to provide consent for release 
of information. Generally, the State DDS completes the form(s) based on 
information provided by the applicant, and sends the form(s) to the 
designated medical source(s). The respondents are applicants for Social 
Security disability benefits and SSI payments.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 3,853,928.
    Frequency of Response: 4.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 2,569,285 hours.

    Dated: April 20, 2004.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 04-9511 Filed 4-28-04; 8:45 am]
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