[Federal Register Volume 69, Number 92 (Wednesday, May 12, 2004)]
[Notices]
[Pages 26426-26428]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-10713]


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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. Request for Change in Time/Place of Disability Hearing--20 CFR 
404.914(c)(2) and 416.1414(c)(2)--0960-0348. The information on Form 
SSA-769 is used by SSA and the State Disability Determination Services 
(DDSs) to provide claimants with a structured format to exercise their 
right to request a change in the time or place of a scheduled 
disability hearing. The information is to be used as a basis for 
granting or denying requests for changes and for rescheduling hearings. 
The respondents are claimants who wish to request a change in the time 
or place of their disability hearing.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 7,483.
    Frequency of Response: 1.
    Average Burden Per Response: 8 minutes.
    Estimated Annual Burden: 998 hours.
    2. Disability Hearing Officer's Report of Disability Hearing--20 
CFR 416.1407, 404.917, and 416.1417--0960-0440. The information on Form 
SSA-1205-BK is used by the Disability Hearing Officers (DHOs) at the 
Social Security Administration (SSA) as a guide to conducting and 
recording disability hearings. It ensures that all of the pertinent 
issues are considered. The respondents are DHOs in the State Disability 
Determination Services and Federal DHOs.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 100,000.
    Frequency of Response: 1.
    Average Burden Per Response: 60 minutes.
    Estimated Annual Burden: 100,000 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. 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 26427]]

    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.
    Estimated Annual Burden: 7,917 hours.
    2. Supplemental Statement Regarding Farming Activities of Person 
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.
    3. Subpoena-Disability Hearing--20 CFR 404.916(b)(1) and 
416.1416(b)(1)--0960-0428. The information on Form SSA-1272-U4 is used 
by SSA to subpoena evidence or testimony needed at disability hearings. 
The respondents are comprised of officers from Federal and State 
Disability Determination Services (DDSs).
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 36.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 18 hours.
    4. Request for Earnings and Benefit Estimate Statement--20 CFR 
404.810--0960-0466. Form SSA-7004 is used by members of the public to 
request information about their Social Security earnings records and to 
get an estimate of their potential benefits. SSA provides information, 
in response to the request, from the individual's personal Social 
Security record. The respondents are Social Security number holders who 
have covered earnings on record.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 800,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 66,667 hours.
    5. Employer Verification of Earnings after Death--20 CFR 404.821 
and 404.822--0960-0472. The information collected on Form SSA-L4112 is 
used by SSA to determine whether wages reported by an employer are 
correct, when SSA records indicate that the wage earner is deceased. 
The respondents are employers who report wages for a deceased employee.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 50,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 8,333 hours.
    6. 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 database 
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.

------------------------------------------------------------------------
                                     SSA-3820      i3820         EDCS
------------------------------------------------------------------------
Number of Respondents............      366,000        2,500      157,000
Average Burden per Response                  1            2            1
 (hours).........................
Total Burden (hours).............      366,000        5,000      157,000
    Total Estimated Annual
     Burden: 528,000 hours.
------------------------------------------------------------------------

    7. Work History Report--20 CFR 404.1512 and 416.912--0960-0578. The 
information collected on form SSA-3369 is needed to determine 
disability by the State Disability Determination Services (DDSs). The 
information will be used to document an individual's past work history. 
The respondents are applicants for disability payments.
    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.
    8. 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: 88,000.
    Frequency of Response: 1.
    Average Burden Per Response: 2.5 hours.
    Estimated Annual Burden: 220,000 hours.
    9. 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-

[[Page 26428]]

4513 and SSA-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 Information Collection: 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
----------------------------------------------------------------------------------------------------------------

    10. 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.
    11. 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.

    Dated: May 6, 2004.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 04-10713 Filed 5-11-04; 8:45 am]
BILLING CODE 4191-02-P