[Federal Register Volume 69, Number 146 (Friday, July 30, 2004)]
[Notices]
[Pages 45877-45879]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-17333]


=======================================================================
-----------------------------------------------------------------------

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, 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. Employee Identification Statement--20 CFR 404.702--0960-0473. 
The information collected on Form SSA-4156 is needed in scrambled 
earnings situations when two or more individuals have used the same 
social security number (SSN), or when an employer (or employers) have 
reported earnings for two or more employees under the same SSN. The 
information on the form is used to help identify the individual (and 
the SSN) to whom the earnings belong. The respondents are employers who 
have reported erroneous wages.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 4,750.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Average Burden: 792 hours.
    2. The Census Bureau Survey of Income and Program Participation 
(SIPP) on Behalf of the Social Security Administration (SSA)--0960-NEW. 
SSA has requested the Census Bureau to include in its SIPP interviews 
scheduled for January 2005 a sample of social security disabled 
insurance beneficiaries and supplemental security income recipients. 
SSA will use these data to conduct statistical research of recipients 
of SSA-administered programs. The SIPP for SSA Beneficiaries is a 
household-based survey molded around a central ``core'' of labor force 
and income questions. The core is supplemented with questions designed 
to address specific needs, such as obtaining information about assets 
and liabilities, as well as

[[Page 45878]]

expenses related to work, health care, child support and real estate/
dependent care. These supplemental questions are included with the core 
and are referred to as ``topical modules.''
    The topical modules for the SIPP for SSA Beneficiaries collect 
information about:
     Medical Expenses and Utilization of Health Care (Adults 
and Children)
     Work-Related Expenses, Child Support Paid and Child Care 
Poverty
     Assets, Liabilities, and Eligibility
     Dependent Care.
    The survey will include approximately 2,000 households. We estimate 
that each household will average 2.1 people, yielding 4,200 interviews. 
On average interviews take 45 minutes. The survey interviews will be 
conducted from January 1, 2005 through January 31, 2005.
    Type of Request: New Information Collection.
    Number of Respondents: 4,200.
    Frequency of Response: 1.
    Average Burden Per Response: 45 minutes.
    Estimated Annual Burden: 3,150 hours.
    3. Request for Waiver of Special Veterans Benefits (SVB) 
Overpayment Recovery or Change in Repayment Rate--0960-NEW

Background

    Section 251 of the Foster Care Independence Act of 1999, P.L. 106-
169, added Title VIII to the Social Security Act (Special Benefits for 
Certain World War II veterans). Title VIII allows for the payments of 
monthly benefits to qualified World War II veterans who reside outside 
the United States. When an overpayment in SVB occurs, the beneficiary 
can request a waiver of recovery of the overpayment or a change in the 
overpayment rate.

The Information Collection

    Form SSA-2032-BK will be used by SSA to obtain the information 
necessary to determine whether the provisions of the Act regarding 
waiver of recovery of the overpayment are met. The information on the 
form is needed to determine a repayment rate if repayment cannot be 
waived. The information will be collected by personnel in SSA field 
offices, U.S. Embassies or consulates, or the Veterans Affairs Regional 
Office in the Philippines. Respondents to the SSA-2032 are 
beneficiaries who have overpayments on their Title VIII record and wish 
to file a claim for waiver of recovery or change in repayment rate.
    Type of Request: New Information Collection.
    Number of Respondents: 39.
    Frequency of Response: 1.
    Average Burden Per Response: 120 minutes.
    Estimated Annual Burden: 78 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. Representative Payee Evaluation Report--20 CFR 404.2065 and 
416.665--0960-0069. The information on form SSA-624 is used by SSA to 
accurately account for the use of Social Security benefits and 
Supplemental Security Income payments received by representative payees 
on behalf of an individual. The respondents are individuals and 
organizations who received form SSA-623 or SSA-6230 (Representative 
Payee Report) and failed to respond, provided unacceptable responses 
that could not be resolved or reported a change in custody.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 252,000.
    Frequency of Response: 1.
    Average Burden per Response: 30 minutes.
    Estimated Average Burden: 126,000 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.
    3. Waiver of Your Right to Personal Appearance Before an 
Administrative Law Judge--20 CFR 404.948(b)(l)(i) and 
416.1448(b)(l)(i)--0960-0284. Each claimant has a statutory right to 
appear in person (or through a representative) and present evidence 
about his/her claim at a hearing before an Administrative Law Judge 
(ALJ). If a claimant wishes to waive his/her statutory right to appear 
before an ALJ, he/she must complete a written request. The claimant may 
use Form HA-4608 for this request. The information collected is used to 
document an individual's claim to show that an oral hearing is not 
preferred in the appellate process. The respondents are applicants for 
Social Security and Supplemental Security Income benefits who request a 
hearing.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 12,000.
    Frequency of Response: 1.
    Average Burden Per Response: 2 minutes.
    Estimated Annual Burden: 400 hours.
    4. Beneficiary Recontact Report--20 CFR 404.703 and 404.705--0960-
0536. SSA collects the information on Form SSA-1587 to ensure that 
eligibility for benefits continues after entitlement is established. 
SSA asks representative payees of children ages 15-17 information about 
marital status to detect possible overpayments and avoid continuing 
payment to those no longer entitled. Studies show that the 
representative payees of children who marry often fail to report the 
marriage, which is a terminating event. The respondents are payees who 
receive Title II (Old-Age, Survivors and Disability Insurance) benefits 
on behalf of children ages 15-17.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 982,357.
    Frequency of Response: 1.
    Average Burden Per Response: 3 minutes.
    Annual Burden: 49,118.
    5. Request for Correction of Earnings Record--20 CFR 404.820 and 
422.125-0960-0029. Form SSA-7008 is used by individual wage earners to 
request SSA review, and if necessary correction of the Agency's master 
record of their earnings. The respondents are individuals who question 
SSA's record of their earnings. Note: Please note that the burden data 
listed below differ from those published in the 60-day advance Notice 
at 69 FR 31442. This discrepancy is due to the Agency receiving updated 
burden information since publication of the 60-day Notice.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 375,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 62,500 hours.
    6. Statement of Agricultural Employer (Years prior to 1988); 
Statement of

[[Page 45879]]

Agricultural Employer (1988 and later)--20 CFR 404.702, 404.802, and 
404.1056--0960-0036. The information on forms SSA-1002 and SSA-1003 is 
used by SSA to resolve discrepancies when farm workers allege their 
employers did not report their wages or reported them incorrectly. The 
respondents are agricultural employers.
    Type of Request: Extension of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                       SSA-1002                            SSA-1003
----------------------------------------------------------------------------------------------------------------
Number of Respondents...................  75,000............................  50,000
Frequency of Response...................  1.................................  1
Average Burden Per Response (minutes)...  10 minutes........................  30 minutes
Estimated Annual Burden (hours).........  12,500 hours......................  25,000 hours
----------------------------------------------------------------------------------------------------------------

    Total Estimated Annual Burden: 37,500 hours.
    7. Medical Report (General)--20 CFR 404.1512-.1515 and 
416.912-.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.
    8. 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 
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 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.
    9. Agency/Employer Government Pension Offset Questionnaire--20 CFR 
404-408a-0960-0470. The information collected by form SSA-L4163 
provides SSA with accurate information from the agency paying a 
claimant's pension. This form is only used when (1) the claimant does 
not have the necessary information and (2) the pension-paying agency 
has not cooperated with the claimant in providing this information. 
Respondents are Federal, State, or local government agencies that have 
information needed by SSA to determine whether the Government Pension 
Offset provisions apply and if so, what is the amount of the offset.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 1,000.
    Frequency of Response: 1.
    Average Burden Per Response: 3 minutes.
    Estimated Annual Burden: 50 hours.
    10. 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 by form SSA-L706 is used to assist a claimant 
in obtaining evidence necessary to establish a date of birth. The 
respondents are applicants for Social Security benefits.
    Type of Request: New information collection.
    Number of Respondents: 7,200.
    Frequency of Response: 1.
    Average Burden Per Response: 10
    Estimated Annual Burden: 1,200 hours.
    11. 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.

    Dated: July 23, 2004.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 04-17333 Filed 7-29-04; 8:45 am]
BILLING CODE 4191-02-P