[Federal Register Volume 70, Number 126 (Friday, July 1, 2005)]
[Notices]
[Pages 38235-38237]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-12980]


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SOCIAL SECURITY ADMINISTRATION


Agency Information Collection Activities: Emergency Consideration 
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.
    SSA is soliciting comments on the accuracy of the agency's burden

[[Page 38236]]

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.

    The information collections listed below have been submitted to OMB 
for expedited Emergency Clearance. SSA is requesting Emergency 
Consideration from OMB by 07/15/2005. Your comments on the information 
collections are requested by that date. 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. Medicare Subsidy Quality Review Case Analysis Forms--20 CFR Part 
418(b)(5)--0960--NEW. Under the aegis of the Medicare Modernization Act 
of 2003, SSA will make Medicare Part D subsidy determinations and will 
work with the Centers for Medicare and Medicaid Services to administer 
the subsidy. The subsidy determination is based on applicants' answers 
to questions about categories such as household size, income, and 
assets. This information is self-reported by applicants using form OMB 
No. 0960-0696 (SSA-1020), and thus, SSA needs a way to determine if 
this form is being completed accurately and completely and a way to 
validate its determination decisions. To this end, SSA will use the new 
Medicare Quality Review system to check the accuracy of the self-
reported information on form OMB No. 0960-0696. In this system, SSA 
will conduct phone interviews with selected applicants and will confirm 
information such as household size, income, and assets.
    A questionnaire and several other forms will be used as part of the 
Medicare Quality Review System. The collection instruments, their 
descriptions, and burden information are listed in the table below.

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                                                                                                                              Average
                                                                                             Number of     Frequency of     burden per       Estimated
              Form number and name                         Description of form              respondents      response        response      annual burden
                                                                                                                             (minutes)        (hours)
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SSA-9301 (Medicare Subsidy Quality Review Case   Telephone questionnaire which will be            10,000               1              35           5,833
 Analysis Questionnaire).                         administered by SSA employees to
                                                  applicants for Medicare Part D
                                                  Subsidy. Includes questions about
                                                  family size, marriage, income, assets,
                                                  etc..
SSA-9302 (Notice of Quality Review               After receiving notice of the scheduled          10,000               1              15           2,500
 Acknowledgement Form for those with Phones).     date/time of the telephone
                                                  questionnaire, Part D applicants will
                                                  return this form confirming their
                                                  availability for the interview and
                                                  making note of any special needs for
                                                  the call..
SSA-9303 (Notice of Quality Review               Same as for SSA-9302, except used by              1,000               1              15             250
 Acknowledgement Form for those without Phones).  participants without phones or whose
                                                  phone numbers are not known by SSA. On
                                                  form SSA-9303, however, participants
                                                  confirm receipt of the letter and are
                                                  asked to call SSA on a specified date..
SSA-9308 (Request for Information).............  Form which SSA will send to various              20,000               1              15           5,000
                                                  third parties to obtain/confirm
                                                  information reported by beneficiaries..
SSA-9309 (Life Insurance Verification Form)....  Form completed by insurance companies             8,000               1              15           2,000
                                                  confirming type, face value, cash
                                                  surrender value and dividends for
                                                  insurance policies of applicants for
                                                  Medicare Part D subsidy..
SSA-8510 (Authorization to the Social Security   Beneficiaries give their permission for          10,000               1               5             833
 Administration to Obtain Personal Information).  SSA to contact third parties to obtain/
                                                  confirm information..
                                                ------------------------------------------
    Total......................................  .......................................  ..............  ..............  ..............          16,416
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[[Page 38237]]

    Total Estimated Annual Burden: 16,416 hours.

    Dated: June 24, 2005.
Craig Hartson,
Acting Reports Clearance Officer, Social Security Administration.
[FR Doc. 05-12980 Filed 6-30-05; 8:45 am]
BILLING CODE 4191-02-P