[Federal Register Volume 69, Number 189 (Thursday, September 30, 2004)]
[Notices]
[Page 58578]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-21910]


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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 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 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 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. Application for Help with Medicare Prescription Drug Plan 
Costs--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 help with premium, deductible, and/or co-payment costs. 
Form SSA-1020, the Application for Help with Medicare Prescription Drug 
Plan Costs, collects information about an applicant's resources and is 
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.


    Note: Since publishing the 60-day Federal Register Notice (69 FR 
45879), SSA has decided to conduct a pilot test of form SSA-1020 in 
March 2005. This test is intended to assist SSA in: (1) determining 
how eligible individuals will respond to its Part D Subsidy 
application outreach (scheduled to begin in June 2005) and (2) 
testing its systems processing of the SSA-1020 application. SSA will 
use the information to make actual subsidy eligibility 
determinations. The Agency will conduct the test with approximately 
2,000 beneficiaries potentially eligible for Part D cost-sharing 
subsidies by providing them with copies of form SSA-1020.


    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. Appeal of Determination for Help with Medicare Prescription Drug 
Plan Costs--0960-NEW. The Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (Public Law 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 help with premium, deductible, and/or co-payment costs. 
Form SSA-1021, the Appeal of Determination for Help with Medicare 
Prescription Drug Plan Costs, 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: 75,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 12,500 hours.

    Dated: September 24, 2004.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 04-21910 Filed 9-29-04; 8:45 am]
BILLING CODE 4191-02-P