[Federal Register Volume 69, Number 221 (Wednesday, November 17, 2004)]
[Notices]
[Pages 67379-67380]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-25489]


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SOCIAL SECURITY ADMINISTRATION


Agency Information Collection Activities: Comment Request

    The Social Security Administration (SSA) publishes a list of 
information

[[Page 67380]]

collection packages that will require clearance by the Office of 
Management and Budget (OMB) in compliance with Public Law 104-13 
effective October 1, 1995, The Paperwork Reduction Act of 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 collection(s) should be 
submitted to the OMB Desk Officer and the SSA Reports Clearance 
Officer.

(OMB), Office of Management and Budget, Attn: Desk Officer for SSA, 
Fax: 202-395-6974.
(SSA), Social Security Administration, DCFAM, Attn: Reports Clearance 
Officer, Fax: 410-965-6400, E-mail: [email protected].

    The information collections listed below have been submitted to OMB 
for clearance. In order for your comments to be considered, you must 
send them by December 17, 2004. You can obtain a copy of the OMB 
clearance package by calling the SSA Reports Clearance Officer at 410-
965-0454, or by writing to the e-mail address listed above.

1. Application for Help With Medicare Prescription Drug Plan Costs--
0960-NEW

    SSA published a notice in the Federal Register on September 30 (69 
FR 58578) informing the public that OMB is reviewing form SSA-1020, the 
Application for Help with Medicare Prescription Drug Plan Costs. At the 
time this notice was published, SSA received public comments and 
withheld submission of the forms in order to evaluate these comments. 
As a result, SSA has revised form SSA-1020, submitted it to OMB for its 
review, and is republishing the Notice below. Comments must be received 
within 30 days of publication of this Notice in order to be considered.
    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

    SSA published a notice in the Federal Register on September 30 (69 
FR 58578) informing the public that OMB is reviewing form SSA-1021, 
Appeal of Determination for Help with Medicare Prescription Drug Plan 
Costs. At the time this notice was published, SSA received public 
comments and withheld submission of the form in order to evaluate the 
comments. As a result, SSA has revised form SSA-1021, submitted it to 
OMB for its review, and is republishing the Notice below. Comments must 
be received within 30 days of publication of this Notice in order to be 
considered.
    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-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: November 12, 2004.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 04-25489 Filed 11-16-04; 8:45 am]
BILLING CODE 4191-02-P