[Federal Register Volume 69, Number 146 (Friday, July 30, 2004)]
[Notices]
[Pages 45879-45880]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-17353]


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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 new 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.

[[Page 45880]]

    (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. Application for Medicare Prescription Drug Cost-Sharing 
Subsidy--0960-NEW. The Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (Pub. L. 108-173; MMA) establishes a new 
Medicare Part D program for voluntary prescription drug coverage for 
premium, deductible and cost-sharing subsidies for certain low-income 
individuals. The MMA stipulates that subsidies must be available for 
individuals who are eligible for the program and who meet eligibility 
criteria for subsidization of premium, deductible, and/or co-payment 
costs. Form SSA-1020, the Application for Medicare Prescription Drug 
Cost-Sharing Subsidy, collects information about an applicant's income 
and assets and is thus used by SSA to determine eligibility for this 
assistance. The respondents are individuals who are eligible for 
enrollment in the new program and are requesting assistance with the 
related costs.
    Type of Request: New information collection.
    Number of Respondents: 5,000,000.
    Frequency of Response: 1.
    Average Burden Per Response: 35 minutes.
    Estimated Annual Burden: 2,916,667 hours.
    2. Request for Appeal of Medicare Part D Subsidy Determination--
0960-NEW. The Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (Pub. L. 108-173; MMA) establishes a new 
Medicare Part D program for voluntary prescription drug coverage and 
provides for premium, deductible, and cost-sharing subsidies for 
certain low-income individuals. An individual must be entitled to 
benefits under Medicare Part A or be enrolled in Medicare Part B to 
qualify for subsidization. SSA will make subsidy eligibility 
determinations and appeal decisions for voluntary Medicare prescription 
drug coverage. Form SSA-1021, the Request for Appeal of Medicare Part D 
Subsidy Determinations, was developed to obtain information from 
individuals who appeal SSA's decisions regarding eligibility or 
continuing eligibility for a Medicare Part D subsidy. The respondents 
are applicants who are appealing SSA's eligibility or continuing 
eligibility decisions.
    Type of Request: New information collection.
    Number of Respondents: 37,500.
    Frequency of Response: 1.
    Average Burden Per Response: 8 minutes.
    Estimated Annual Burden: 5,000 hours.

    Dated: July 26, 2004.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 04-17353 Filed 7-29-04; 8:45 am]
BILLING CODE 4191-02-P