[Federal Register Volume 69, Number 176 (Monday, September 13, 2004)]
[Notices]
[Pages 55206-55208]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-20589]


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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 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 collections 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

[[Page 55207]]

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. RS/DI Quality Review Case Analysis: Sampled Number Holder, 
Auxiliaries/Survivors, Parents: Stewardship Annual Earnings Test 
Workbook--0960-0189. SSA uses the information collected by forms SSA-
2930, SSA-2931, and SSA-2932 to establish a national payment accuracy 
rate for all cases in payment status; to measure the accuracy rate for 
newly adjudicated claims for beneficiaries receiving old-age, 
survivors, or disability insurance; and to serve as a source of 
information regarding problem areas in the RSI/DI programs. Form SSA-
4569 is used to evaluate and determine the effectiveness of the annual 
earnings test and to use the results to develop ongoing improvements in 
the process. The respondents are beneficiaries and representative 
payees for beneficiaries receiving old age, survivors, or disability 
insurance.
    Type of Request: Extension of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                               Average burden       Estimated
                                              Number of       Frequency of      per response      annual burden
                                             Respondents        response          (minutes)          (hours)
----------------------------------------------------------------------------------------------------------------
SSA-2930................................             3,000                 1                30             1,500
SSA-2931................................             1,500                 1                30               750
SSA-2932................................               650                 1                20               217
SSA-4659................................               325                 1                10                54
                                         -------------------
    Totals..............................             5,475  ................  ................             2,521
----------------------------------------------------------------------------------------------------------------

    Estimated Annual Burden: 2,521 hours.
    2. Request for Hearing by Administrative Law Judge--20 CFR 404.933 
and 416.1433, 42 CFR 405.722--0960-0269. The information collected by 
form HA-501 is used by SSA to process a request for a hearing on an 
unfavorable determination of entitlement or eligibility to benefits 
administered by SSA. The respondents are individuals whose claims for 
benefits are denied and who request a hearing to appeal the denial.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 667,236.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 111,206 hours.
    3. Acknowledgement of Receipt (Notice of Hearing)--20 CFR 404.938 
and 416.1438--0960-0671. The information collected by form HA-504 is 
used by SSA to process requests for hearings about unfavorable 
determinations of entitlement or eligibility to disability payments. 
Specifically, this form is used to acknowledge receipt of the notice of 
hearing issued by an Administrative Law Judge. The respondents are 
applicants for SSA disability payments who want to have a hearing to 
appeal an unfavorable entitlement or eligibility decision.
    Type of Request: Extension of OMB-approved information collection.
    Number of Respondents: 670,000.
    Frequency of Response: 1.
    Average Burden Per Response: 1 minute.
    Estimated Annual Burden: 11,167 hours.
    4. Medical Report (Individual with Childhood Impairment)--20 CFR 
404.1512, .1514-.1515, and 416.912-.915--0960-0102. The information 
collected on Form SSA-3827 is needed to determine the claimant's 
physical and mental status prior to making a childhood disability 
determination. The respondents are medical sources.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 12,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 6,000 hours.
    5. Disability Hearing Officer's Report of Disability Hearing (DC)--
20 CFR 416.1407--0906-0507. The information collected on form SSA-1204-
BK is used by the Disability Hearing Officer (DHO) to conduct and 
document disability hearings, and to provide a structured format that 
covers all conceivable issues relating to SSI claims for disabled 
children. The completed SSA-1204-BK will aid the DHO in preparing the 
disability decision and will provide a record of what transpired in the 
hearing. The respondents are DHOs in the State Disability Determination 
Services.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 35,000.
    Frequency of Response: 1.
    Average Burden Per Response: 60 minutes.
    Estimated Annual Burden: 35,000 hours.
    6. Employer Report of Special Wage Payments--20 CFR 404.428-.429--
0960-0565. SSA gathers the information on Form SSA-131 to prevent 
earnings-related overpayments to employees, and to avoid erroneous 
withholding of benefits. The respondents are employers who provide 
special wage payment verification.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 30,000.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 10,000 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. 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.

[[Page 55208]]

    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 8,333 hours.
    2. Plan for Achieving Self-Support--20 CFR 416.1180-1182 and 
416.1225--0960-0559. The information collected by form SSA-545 is used 
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 an OMB-approved information 
collection.
    Number of Respondents: 7,000.
    Frequency of Response: 1.
    Average Burden Per Response: 2 hours.
    Estimated Annual Burden: 14,000 hours.
    3. 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 SSA 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.

    Dated: September 7, 2004.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 04-20589 Filed 9-10-04; 8:45 am]
BILLING CODE 4191-02-P