[Federal Register Volume 70, Number 11 (Tuesday, January 18, 2005)]
[Notices]
[Pages 2918-2921]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-868]


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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 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, 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. Report of Death by Funeral Director--20 CFR 404.715, 404.720, 
416.635--0960-0142. SSA uses the information on form SSA-721 to make 
timely and accurate decisions based on

[[Page 2919]]

the report of death including: (1) Proving the death of an insured 
individual, (2) learning of the death of a beneficiary whose benefits 
should terminate, and (3) determining who is eligible for the Lump-Sum 
Death Payment (LSDP) or may be eligible for benefits. The respondents 
are funeral directors with knowledge of the fact of death.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 741,113.
    Frequency of Response: 1.
    Average Burden Per Response: 3.5 minutes.
    Estimated Annual Burden: 43,231 hours.

    2. Statement Regarding Contributions--20 CFR 360-366 and 404.736--
0960-0020. The determination of one-half support or contributions to 
support must be made to entitle certain child applicants to Social 
Security benefits. SSA uses form SSA-783 to collect the information 
necessary to make such a determination. The respondents are persons 
giving information about a child's sources of support for entitlement 
to child's benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 30,000.
    Frequency of Response: 1.
    Average Burden Per Response: 17 minutes.
    Estimated Annual Burden: 8,500 hours.

    3. Appointment of Representative--20 CFR 404.1707, 404.1720, 
404.1725, 410.684 and 416.1507--0960-0527. The information collected by 
SSA on form SSA-1696-U4 is used to verify the applicant's appointment 
of a representative. It allows SSA to inform the representative of 
items which affect the applicant's claim. The affected public consists 
of applicants who notify SSA that they have appointed a person to 
represent them in their dealings with SSA when claiming a right to 
benefits.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 551,520.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 91,920 hours.

    4. Employee Work Activity Questionnaire--20 CFR 404.1574, 
404.1592--0960-0483. When a possible unsuccessful work attempt or a 
subsidy is involved, as described in regulations 20 CFR 404.1574(a)(1), 
(2) and (3), form SSA-3033 is used to request a description of the 
employee's work effort. The data is evaluated to determine if the 
claimant meets the disability requirements of the law. The information 
is collected through form SSA-3033 or by telephone contact, only in 
cases where it cannot be obtained through electronic data matches with 
other Federal agencies and/or State agencies.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 15,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 3,750 hours.

    5. Petition To Obtain Approval of a Fee for Representing a Claimant 
Before the Social Security Administration--20 CFR Subpart R--404.1720, 
404.1725, Subpart F, 410.686b, Subpart O, 416.1520 and 416.1525--0960-
0104. A representative of a claimant for Social Security benefits must 
file either a fee petition or a fee agreement with SSA in order to 
charge a fee for representing a claimant in proceedings before SSA. The 
representative uses form SSA-1560 to petition SSA for authorization to 
charge and collect a fee. A claimant may also use the form to agree or 
disagree with the requested fee amount or other information the 
representative provides on the form. SSA uses the information to 
determine a reasonable fee that a representative may charge and collect 
for his or her services. The respondents are claimants, their attorneys 
and other persons representing them.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 34,624.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 17,312 hours.

    6. Authorization to Obtain Earnings Data From the Social Security 
Administration--0960-0602. The information collected on form SSA-581 is 
used to verify the authorization of the wage earner, or other party, to 
access the correct earnings record and disposition of the response. 
This access is required in order to produce an itemized statement for 
release to the proper third party. The respondents are individuals, and 
various private/public organizations/agencies needing detailed earnings 
information.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 60,000.
    Frequency of Response: 1.
    Average Burden Per Response: 2 minutes.
    Estimated Average Burden: 2,000 hours.

    7. Statement Regarding the Inferred Death of an Individual by 
Reason of Continued and Unexplained Absence--20 CFR 404.720 and 
404.721--0960-0002. SSA will use the information collected on form SSA-
723 in making its determination that the missing person may be presumed 
deceased and, if so, to establish a date of presumed death. The 
respondents are persons who have knowledge about the disappearance of 
the missing person.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 3,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 1,500 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 package 
by calling the SSA Reports Clearance Officer at 410-965-0454, or by 
writing to the address listed above.
    1. Reporting Events-SSI--20 CFR 416.701-.732--0960-0128. SSA 
administers Federal Supplemental Security Income (SSI) benefits under 
title XVI of the Social Security Act. SSI is a public assistance 
program that provides benefits to individuals who are disabled, blind, 
or aged and who have limited income and resources. To assure proper 
administration of SSI benefits, SSA periodically requests information 
from individuals to reevaluate their continuing SSI eligibility and 
payment amount using Form SSA-8150-EV. The form serves as a reminder to 
individuals as to what they need to report in order to retain their 
benefits. Form SSA-8150-EV provides individuals with a way to report 
changes in their circumstances in writing. SSA uses the reported 
changes to determine SSI eligibility and correct payment amounts.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 30,180.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 2,515 hours.

    2. Cessation or Continuance of Disability or Blindness 
Determination and Transmittal--20 CFR 404.1615, 20 CFR 404.1512, and 20 
CFR 404.1588-1599--0960-0442. Form SSA-833-C3/

[[Page 2920]]

U3 is used by Disability Determination Services (DDS) to prepare 
continuance and cessation determinations of disability or blindness on 
Title II claims. The information is used in the course of the Federal 
SSA quality review of the determination. Form SSA-833-C3/U3 is also 
used to provide for SSA input on automated systems controls, e.g. 
establish and/or cancel diary controls, to establish a permanent 
longitudinal history of the claim, and to supply a statistical base to 
provide aggregate program information to SSA administrators, Congress, 
and the President.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 303,564.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 151,782 hours.

    3. Application to Collect a Fee for Payee Services--0960-NEW. 
Information requested on form SSA-445 will be provided by the fee for 
payee services applicant. SSA will be the only user of this 
information. By using form SSA-445, SSA will be able to determine 
whether the applicant meets the requirements to become a fee for 
service organizational payee, and if the applicant has provided all the 
information and documentation required. Based on the information 
provided on form SSA-445, SSA will issue a determination authorizing or 
denying permission to collect fees for payee services.
    Type of Request: New information collection.
    Number of Respondents: 100.
    Frequency of Response: 1.
    Average Burden Per Response: 3 minutes.
    Estimated Annual Burden: 5 hours.

    4. Agreement to Sell Property--20 CFR 416.1240-1245--0960-0127. 
Individuals or couples who are otherwise eligible for SSI benefits, but 
who's resources exceed the allowable limit, may receive conditional 
payments if they agree to dispose of the excess non-liquid resources 
and make repayment. Form SSA-8060-U3 is used to document this agreement 
and to ensure that the individuals understand their obligations. 
Respondents are applicants and recipients of SSI benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 20,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 3,333 hours.

    5. Epidemiological Research Request--20 CFR 401.165--0960-NEW. 
Section 311 of the Social Security Independence and Program 
Improvements Act of 1994 directed SSA to provide support to health 
researchers involved in epidemiological research. Specifically, when 
the study is determined to contribute to a national health interest, 
SSA will furnish information regarding whether a study subject is shown 
on the SSA administrative records as being alive or deceased (vital 
status). SSA will recoup all expenses incurred in providing this 
information. SSA collects information from health researchers in order 
to provide the data required and to collect fees. Respondents are 
applicants for vital status information.
    Type of Request: Collection in use without OMB number.
    Number of Respondents: 25.
    Frequency of Response: 1.
    Average Burden Per Response: 120 minutes.
    Estimated Annual Burden: 50 hours.

    6. Student Reporting Form--20 CFR 404.367, 404.368, 404.415, 
404.434, 404.452(b)(2)--0960-0088. Form SSA-1383 is used by Social 
Security student beneficiaries to report events or changes that may 
affect continuing entitlement to these benefits. The respondents are 
Social Security student beneficiaries.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 75,000.
    Frequency of Response: 1.
    Average Burden Per Response: 6 minutes.
    Estimated Annual Burden: 7,500 hours.
    7. Electronic Benefit Verification Information--20 CFR 401.40--
0960-0595. SSA provides verification of benefits, when requested, to 
individuals receiving Title II and/or Title XVI benefits. In order to 
provide to the public an easy and convenient means of requesting 
benefit information, SSA has developed an electronic request form that 
will allow persons to request the information through the Internet. The 
information collected on the electronic screens will be used by SSA to 
process the request for a benefit verification statement. To ensure 
appropriate confidentiality, the statement will be mailed to the 
recipient/beneficiary address shown in SSA's records. The respondents 
are Title II and XVI recipients/beneficiaries who request benefit 
verification information using the Internet.
    Type of Request: Extension of an approved OMB information 
collection.
    Number of Respondents: 133,920.
    Frequency of Response: 1.
    Average Burden Per Response: \1/2\ minute.
    Estimated Annual Burden: 1,116 hours.

    8. Listing of Impairments--Part 404, Subpart P, Appendix I--0960-
0642.

Background

    The Listing of Impairments (the listings), part 404, subpart P, 
appendix I, describes for each of the major body systems, impairments 
which are severe enough to prevent an individual from doing any gainful 
activity. As part of the listings, we provide an introductory text, 
which identifies specific requirements that affect the body system, 
such as documentation requirements and other factors that must be 
considered when evaluating impairments within that body system. These 
can include requirements for medical and other evidence. This clearance 
request covers sections in the following listings that contain 
information collection requirements: The regulations for the 
musculoskeletal body system contain reporting requirements at sections 
1.00B, 1.00C, 1.00D, 1.00E, 1.00H, 1.00I, 1.00J, 1.00K, 1.00P, 14.09A, 
101.00B, 101.00C, 101.00D, 101.00E, 101.00H, 101.00I, 101.00J, 101.00P, 
and 114.09A. The regulations for the cardiovascular body system contain 
reporting requirements at sections 4.00B, 4.00C, 4.00D, 4.00E, 4.00F, 
4.00G, 4.02A, 104.00B, 104.00C, 104.00E, and 104.06. The regulations 
for the genitourinary body system contain reporting requirements at 
sections 6.00C, 6.00E, 6.00G, 106.00C, 106.00E, and 106.00G. The 
regulations for the skin body system contain reporting requirements at 
sections 8.00C, 8.00D, 108.00B, 108.00C, and 108.00D. The regulations 
for the multiple body system contain reporting requirements at sections 
10.00B, 10.00C, 110.00B, and 110.00C. The regulations for Amyotrophic 
Lateral Sclerosis (ALS) contain reporting requirements at sections 
11.00G and 11.10. The regulations for the malignant neoplastic diseases 
contain reporting requirements at 13.00B, 13.00D, 13.00E, 13.00G, 
13.00K, 113.00B, 113.00D, 113.00E, 113.00G, and 113.00K.

The Information Collection

    The medical evidence documentation described in the listings is 
used by State DDSs to assess the alleged disability. The information, 
together with other evidence, is used to determine if an individual 
claiming disability benefits has an impairment that meets severity and 
duration requirements. The

[[Page 2921]]

respondents are disability applicants and other sources of evidence. 
SSA uses various forms to collect the information specified in the 
regulations. The public reporting burden is accounted for in the 
Information Collection Requests for these forms. Consequently, we are 
assigning a placeholder of 1-hour to the specific reporting 
requirements in theses listings so that we do not duplicate the burden 
assigned to the forms.
    Type of Request: Extension of an OMB-approved information 
collection.

    9. Request for Review of Hearing Decision/Order--20 CFR 
404.967-.981, 20 CFR 416.1467-.1481--0960-0277. SSA collects the 
information on form HA-520 from each claimant for Social Security or 
SSI benefits who is dissatisfied with the hearing decision or the 
dismissal of a hearing request and wants to request review of the 
decision by the Appeals Council. An individual may request Appeals 
Council review by filing a written request; however, a completed HA-520 
ensures that SSA receives the information necessary to establish that 
the claimant filed the request for review within the prescribed time, 
that the claimant is a proper party, and that the claimant has 
completed the requisite steps to permit review by the Appeals Council. 
The Appeals Council also uses the information provided by the claimant 
to document the claimant's reason (s) for disagreeing with the ALJ 
decision or dismissal, to determine whether the claimant has additional 
evidence to submit, and to determine whether the claimant has a 
representative or wants to appoint one.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 107,485.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 17,914 hours.

    10. Non-Attorney Representative Demonstration Project Application--
0960-NEW.
    Section 303 of the Social Security Protection Act of 2004 (SSPA) 
provides for a 5-year demonstration project to be conducted by SSA 
under which the direct payment of SSA approved fees is extended to 
certain non-attorney claimant representatives. Under the SSPA, to be 
eligible for direct payment of fees, a non-attorney representative must 
fulfill the following statutory requirements: (1) Possess a bachelors 
degree or have equivalent qualifications derived from training and work 
experience; (2) pass an examination that tests knowledge of the 
relevant provisions of the Social Security Act; (3) secure professional 
liability insurance or equivalent insurance; (4) pass a criminal 
background check; and (5) demonstrate completion of relevant continuing 
education courses. Through the services of a private contractor, SSA 
must collect the requested information to determine if a non-attorney 
representative has met the statutory requirements to be eligible for 
direct payment of fees for his or her claimant representation services. 
The information collection is needed to comply with the legislation. 
The respondents are non-attorney representatives who apply for direct 
payment of fees.
    Type of Request: New information collection.
    Number of Respondents: 500.
    Frequency of Response: 1.
    Average Burden Per Response: 60 minutes.
    Estimated Annual Burden: 500 hours.

    11. Disability Determination and Transmittal--20 CFR 404.1615(e), 
416.1015(f)--0960-0437. The information collected on form SSA-831-C3/U3 
is used by SSA to document the State agency determination as to whether 
an individual who applies for disability benefits is eligible for those 
benefits based on his/her alleged disability. SSA also uses form SSA-
831-C3/U3 for program management and for evaluation. The respondents 
are State DDSs adjudicating Title II and Title XVI disability 
determinations for SSA.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 3,155,120.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Average Burden: 788,780 hours.

    12. State Mental Institution Policy Review--20 CFR 416 Subpart U, 
20 CFR 416 Subpart F, 20 CFR 404.2035 and .2065, 20 CFR 416.635 and 
.665--0960-0110. SSA sends form SSA-9584-BK to State mental 
institutions that participate in SSA's representative payee onsite 
review program. As a representative payee, the State mental institution 
has the responsibility to receive and administer payments to 
beneficiaries who have been determined by SSA to be incapable of 
managing benefits. SSA is required by law and regulations to monitor 
representative payees' use of benefits. Under the onsite review 
program, SSA conducts a triennial review of State mental institutions 
in order to determine whether the institutions; policies and practices 
conform with SSA's regulations in the use of benefits, and the other 
duties and responsibilities required of representative payees.
    The form obtains information needed by the SSA review team 
(comprised of representatives from SSA's regional and field offices), 
and provides a basis for conducting the actual onsite review. In 
addition, the information is used in the preparation of the subsequent 
report of findings and recommendations, which is issued to the 
institutions.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 100.
    Frequency of Response: 1.
    Average Burden Per Response: 60 minutes.
    Estimated Annual Burden: 100 hours.

    Dated: January 11, 2005.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 05-868 Filed 1-14-05; 8:45 am]
BILLING CODE 4191-02-P