[Federal Register Volume 70, Number 120 (Thursday, June 23, 2005)]
[Notices]
[Pages 36454-36455]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-12286]



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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 new information collections, approval of existing information 
collections, 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, 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, 1333 Annex Building, 6401 Security Blvd., Baltimore, 
MD 21235; Fax: 410-965-6400.
    I. The information collection listed below is 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 a copy of the collection 
instrument by calling the SSA Reports Clearance Officer at 410-965-0454 
or by writing to the address listed above.
    Credit Card Payment Acknowledgement Form--0960-0648. SSA will use 
the information collected on Form SSA-1414 to process payments from 
former employees and vendors who have outstanding debts owed to the 
agency. This form has been developed as a convenient method for 
respondents to satisfy such debts.
    The respondents are former employees and vendors who have debts 
still owed to the agency.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 500.
    Frequency of Response: 12.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 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 
packages by calling the SSA Reports Clearance Officer at 410-965-0454, 
or by writing to the address listed above.
    1. State Agency Ticket Assignment Form: Ticket to Work and Self 
Sufficiency Program--0960-0641. SSA uses the information collected on 
Form SSA-1365 to determine proper assignment under the Ticket to Work 
program and to monitor services. This will be done through the 
contracted Program Manager. The State Vocational Rehabilitation Agency 
(VRA) completes the form and the beneficiary reviews the data. The 
beneficiary will sign the Form to acknowledge the assignment of their 
ticket to that agency. Respondents are the State VRAs.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 82.
    Frequency of Response: 50.
    Average Burden Per Response: 3 minutes.
    Estimated Annual Burden: 205 hours.
    2. Farm Arrangement Questionnaire--20 CFR 404.1082(c)--0960-0064. 
SSA uses the information collected on the SSA-7157-F4 to determine if 
farm rental income may be considered self-employment income for Social 
Security benefits coverage purposes. The respondents are individuals 
alleging self-employment income for the renting of land for farming 
activities.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 38,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 19,000 hours.
    3. Application for Benefits under a U.S. International Social 
Security Agreement--20 CFR 404.1925--0960-0448. The information 
collected on the SSA-2490-BK is required to determine entitlement to 
old-age, survivors or disability benefits from the United States or 
from a country that has entered into a Social Security agreement with 
the United States. The respondents are individuals who are applying for 
benefits from the U.S. or from a totalization agreement country.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 23,200.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Average Burden: 11,600 hours.
    4. Letter to Landlord Requesting Rental Information--20 CFR 
416.1130(b)--0960-0454. Form SSA-L5061 provides a nationally uniform 
vehicle for collecting information from landlords for use in making 
rental subsidy determinations in the Supplemental Security Income (SSI) 
program. The information is used in deciding whether income limits are 
met for SSI eligibility. Respondents are landlords who provide 
subsidized rental arrangements to SSI applicants and recipients.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 49,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 8,167 hours.
    5. Plan for Achieving Self-Support--20 CFR 416.1180-1182, 416.1225-
1227, 416.110(e)--0960-0559. The information on form SSA-545 is 
collected by SSA when an 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: Revision 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.
    6. Disability Update Report--20 CFR 404.1589-404.1595, 20 CFR 
416.988-416.996-0960-0511. Forms SSA-455 and SSA-455-OCR-SM are used by 
SSA to collect information when the continuing disability review diary 
of a recipient of SSA-administered benefits, based on disability, has 
matured or there is an indication of possible medical improvement. The 
information

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collected from beneficiaries is reviewed by specialists in the 
evaluation of work and earnings and in disability adjudication. The 
respondents are recipients of benefits, based on disability, under 
title II and/or XVI of the Social Security Act.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 981,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 245,250 hours.

    Dated: June 16, 2005.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 05-12286 Filed 6-22-05; 8:45 am]
BILLING CODE 4191-02-P