[Federal Register Volume 69, Number 129 (Wednesday, July 7, 2004)]
[Notices]
[Pages 41016-41017]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-15263]


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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 Public Law 
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 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. Payment of Certain Travel Expenses--20 CFR 404.999(d) and 
416.1499--0906-0434. This regulation mandates travel expense 
reimbursement by a State or Federal agency for claimants traveling to a 
consultative examination, or for claimants, their representatives, and 
non-subpoenaed witnesses who must travel over 75 miles to appear at a 
disability hearing. State and Federal personnel review the listing and 
the receipts to verify the amount of reimbursement. The respondents are 
claimants for Title II/XVI benefits and/or their representatives and 
non-subpoenaed witnesses.
    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.
    2. Request for Social Security Earnings Information--20 CFR 404.810 
and 401.100--0960-0525. The Social Security Act provides that a wage 
earner, or someone authorized by a wage earner, may request Social 
Security earnings information from the Social Security Administration, 
using form SSA-7050. SSA uses the information collected on the form to 
verify that the requestor is authorized to access the earnings record 
and to produce the earnings statement. The respondents are wage earners 
and organizations and legal representatives authorized by the wage 
earner.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 87,000.
    Frequency of Response: 1.
    Average Burden Per Response: 11 minutes.
    Estimated Annual Burden: 15,950 hours.
    3. Plan for Achieving Self-Support--20 CFR 416.1180-1182 and .1225-
1227--0960-0559. The information on form SSA-545 is collected by SSA 
when a Supplemental Security Income (SSI) applicant/recipient desires 
to use available income and resources to obtain education and/or 
training in order to become self-supporting. The information is used to 
evaluate the recipient's plan for achieving self-support to determine 
whether the plan may be approved under the provisions of the SSI 
program. The respondents are SSI applicants/recipients who are blind or 
disabled.
    Type of Request: Extension of OMB-approved information collection.

[[Page 41017]]

    Number of Respondents: 7,000.
    Frequency of Response: 1.
    Average Burden Per Response: 2 hours.
    Estimated Annual Burden: 14,000 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. Requests for Self-Employment Information, Employee Information, 
Employer Information--20 CFR, Subpart A, 422.120--0960-0508. SSA uses 
Forms SSA-L2765, SSA-L3365 and SSA-L4002 to request correct information 
when an employer, employee or self-employed person reports an 
individual's earnings without a Social Security Number (SSN) or with an 
incorrect name or SSN. The respondents are employers, employees or 
self-employed individuals who are requested to furnish additional 
identifying information.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 3,000,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 500,000 hours.
    2. Function Report-Child: Birth to 1st Birthday (SSA-3375), Age 1 
to 3rd Birthday (SSA-3376), Age 3 to 6th Birthday (SSA-3377), Age 6 to 
12th Birthday (SSA-3378), and Age 12 to 18th Birthday (SSA-3379)--20 
CFR 416.912--0960-0542. State Agency adjudicative teams use the 
information gathered by these forms in combination with other medical 
function evidence to form a complete picture of a child's ability to 
function. This information is used to help determine if a child is 
disabled, especially in cases in which disability cannot be found on 
medical grounds alone. The respondents are applicants for Title XVI 
childhood disability benefits and their caregivers.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 650,000.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 216,667 hours.
    3. Function Report-Third Party--20 CFR 404.1512 and 416.912--0960-
0635. The Social Security Act requires claimants to provide medical and 
other evidence to prove they are disabled. The Act also gives the 
Commissioner of Social Security the authority to make rules and 
regulations about the nature and extent of the evidence required to 
prove disability as well as the methods of obtaining this evidence. The 
information collected by form SSA-3380 is needed to determine 
disability under Title II (Old-Age, Survivors and Disability Insurance 
(OASDI) and/or Title XVI (SSI). The form records information about the 
disability applicant's illnesses, injuries, conditions, impairment-
related limitations, and ability to function. The respondents are 
individuals who are familiar with the disability applicant's 
impairment, limitations, and ability to function.

    Note: Please note the following burden data differ from that 
provided in the 60-day Federal Register notice, published April 5, 
2004. SSA inadvertently published the wrong burden data in the first 
notice.

    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 1,500,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 750,000 hours.
    4. 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.
    5. 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 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.
    6. 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.

    Dated: June 29, 2004.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 04-15263 Filed 7-6-04; 8:45 am]
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