[Federal Register Volume 70, Number 162 (Tuesday, August 23, 2005)]
[Notices]
[Pages 49352-49354]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-16660]


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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, 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 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 on Individual with Mental Impairment--20 CFR 404.1513, 
416.913--0960-0058. Form SSA-824 is used by SSA to determine the 
claimant's medical status prior to making a disability determination. 
The respondents are physicians, medical directors, medical record 
librarians and other health professionals.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 50,000.
    Frequency of Response: 1.
    Average Burden Per Response: 36 minutes.
    Estimated Annual Burden: 30,000 hours
    2. Supplement to Claim of Person Outside the United States--20 CFR

[[Page 49353]]

404.460, 404.463, 422.505(b), 42 CFR 407.27(c)--0960-0051. The 
information collected on Form SSA-21 is used to determine the 
continuing entitlement to Social Security benefits and the proper 
benefit amounts of beneficiaries living outside the United States. It 
is also used to determine whether benefits are subject to withholding 
tax. The respondents are individuals entitled to Social Security 
benefits who are, will be, or have been residing outside the United 
States.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 35,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 5,833 hours.
    3. Claimant's Work Background--20 CFR 404.1565(b), 416.965(b)--
0960-0300. The information collected on Form HA-4633 is needed and used 
to afford claimants their statutory right to a hearing and decision 
under the Social Security Act (the Act). The information is used by the 
SSA in cases in which claimants for disability benefits have requested 
a hearing on the determination regarding their claim. A completed form 
provides an updated summary of a claimant's past relevant work and 
helps the administrative law judge to better decide whether or not the 
claimant is disabled. The respondents are claimants requesting hearings 
for benefits based on disability under Titles II and/or XVI of the Act.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 120,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 30,000 hours.
    4. Medical Report on Adult with Allegation of Human 
Immunodeficiency Virus (HIV) Infection; Medical Report on Child with 
Allegation of Human Immunodeficiency Virus (HIV) Infection--20 CFR 
416.993-416.994--0960-0500. Collection of the information on Forms SSA-
4814-F5 and SSA-4815-F6 is necessary for SSA to determine if an 
individual with Human Immunodeficiency Virus (HIV) infection meets the 
requirements for presumptive disability (PD) payments. The SSA Field 
Office (FO) will, generally, mail the appropriate form to the 
claimant's medical source for completion and return to the FO. The FO 
staff will use the information on the form to determine if a PD is 
warranted. The respondents are the medical sources of the applicants 
for Supplemental Security Income (SSI) disability payments.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 59,100.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 9,850 hours.
    5. Coverage of Employees of State and Local Governments--20 CFR 
404, Subpart M--0960-0425. States (and Interstate Instrumentalities) 
are required to provide wage information and deposit related 
contributions for pre-1987 periods to SSA. The regulations at 20 CFR 
404, Subpart M set forth the rules for States submitting reports of 
deposits and related recordkeeping. The respondents are State and Local 
Governments or Interstate Instrumentalities.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 52.
    Frequency of Response: 1.
    Average Burden Per Response: 1 hour.
    Estimated Annual Burden: 52 hours.
    6. Information Collection Requirements for Title VIII of the Social 
Security Act--20 CFR 408.202(d), 408.210, 408.230(a), 408.232(a), 
408.320, 408.305, 408.310, 408.315, 408.340, 408.345, 408.351(d) and 
(f), 408.355(a), 408.360(a), 408.404(c), 408.410, 408.412, 408.420(a) 
and (b), 408.430, 408.432, 408.435(a) and (b), 408.437(b), (c) and 
(d)--0960-0658. Section 251 of the ``Foster Care Independence Act of 
1999'' added Title VIII to the Social Security Act (Special Benefits 
for Certain World War II Veterans). Title VIII allows, under certain 
circumstances, the payment of a monthly benefit by Social Security to a 
qualified World War II veteran who resides outside the United States. 
The accompanying regulations set out the requirements an individual 
must meet in order to qualify for and become entitled to Special 
Veterans Benefits (SVB). The respondents are individuals who are 
applying for benefits under Title VIII of the Social Security Act.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 762.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 381 hours.
    7. SSI Notice of Interim Assistance Reimbursement (IAR)--0960-0546. 
Forms SSA-8125 and SSA-L8125-F6 are used by SSA to obtain the amount of 
Interim Assistance Reimbursement (IAR) a State is due before it can pay 
IAR to the State in various situations. These forms are used for that 
purpose, and to conduct audits of a State's accounting of IAR. 
Respondents are State IAR officers.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 50,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 8,333 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. Marriage Certification--20 CFR 404.725--0960-0009. When the 
worker and spouse are not filing concurrently, SSA uses Form SSA-3-F6 
to record any changes/additions to the worker's marital history since 
the worker's claim was adjudicated. The marital history of the 
claimant's wife or husband, when compared to the worker's marital 
history (as supplemented by Form SSA-3-F6), enables the fact finder to 
determine if the claimant has the necessary relationship to the worker. 
Where the spouse and worker were ceremonially married, the worker's 
statement on his/her marital history that he/she was ceremonially 
married to the claimant's spouse and the claimant's spouse statement 
that he/she was ceremonially married to the worker generally constitute 
evidence of a ceremonial marriage in lieu of obtaining a marriage 
certificate.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 180,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 15,000 hours.
    2. Request To Be Selected As Payee--0960-0014. The information 
collected on form SSA-11-BK is necessary to determine the proper payee 
for a Social Security beneficiary. The form is designed to aid the 
investigation of a payee applicant. The use of the form will establish 
the applicant's relationship to the beneficiary, his/her justification 
and his/her concern for the beneficiary, as well as the manner in which 
the benefits will be used.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 2,121,686.

[[Page 49354]]

    Frequency of Response: 1.
    Average Burden Per Response: 10.5 minutes.
    Estimated Annual Burden: 371,295 hours.
    3. Record of SSI Inquiry--20 CFR 416.345--0960-0140. Form SSA-3462 
is completed by SSA personnel via telephone or personal interview, and 
it is used to determine potential eligibility for SSI benefits. The 
respondents are individuals who inquire about SSI eligibility for 
themselves or someone else.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 2,134,100.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 177,842 hours.
    4. Statement for Determining Continuing Eligibility for 
Supplemental Security Income Payments--Adult, Form SSA-3988; Statement 
for Determining Continuing Eligibility for Supplemental Security Income 
Payments--Child, Form SSA-3989--20 CFR Subpart B--416.204-0960--NEW.

Background

    The Social Security Act mandates periodic redeterminations of non-
medical factors relating to SSI recipient's continuing eligibility for 
SSI payments. SSA studies have indicated that as many as two-thirds of 
these scheduled redeterminations, which are completed with the 
assistance of an SSA employee, do not result in any change in 
circumstances that affects the recipients payment. SSA has conducted 
extensive testing of both of the SSA-3988 and SSA-3989, under OMB 
Control Number 0960-0643, and has validated that these redetermination 
formats result in significant operational savings and a decrease in 
recipient inconvenience while still obtaining timely, accurate data to 
determine continuing eligibility through the process.

The Collection

    Forms SSA-3988 and SSA-3989 will be used to determine whether SSI 
recipients have met and continue to meet all statutory and regulatory 
non-medical requirements for SSI eligibility, and whether they have 
been and are still receiving the correct payment amount. The SSA-3988 
and SSA-3989 are designed as self-help forms that will be mailed to 
recipients or to their representative payees for completion and return 
to SSA. The respondents are recipients of SSI payments or their 
representatives.
    Type of Request: New information collection.

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                                                                               Average burden
                  Forms                      Respondents      Frequency of      per response    Estimated annual
                                                                response          (minutes)      burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3988................................           650,000                 1                26           281,667
SSA-3989................................            65,000                 1                26            28,167
----------------------------------------------------------------------------------------------------------------

    5. Denial of Title II Benefits to Fugitive Felons--0960-New. 
Specifically, Section 203 of the SSPA prohibits payment of title II 
benefits:
     To persons fleeing to avoid prosecution or custody or 
confinement after conviction, under the laws of the place from which 
the person flees, for a crime, or an attempt to commit a crime, which 
is a felony under the laws of the place from which the person flees; or
     In jurisdictions that do not define crimes as felonies, 
where the crime is punishable by death or imprisonment for a term 
exceeding 1 year regardless of the actual sentence imposed; and
     To persons violating a condition of probation or parole 
imposed under Federal or State law.
    To identify claimants who should not be receiving benefits, the 
Commissioner directed that we add specific questions to title II 
applications that solicit information about any outstanding felony 
warrants or warrants for parole/probation violations.
    In addition, SSA will collect supplemental information if a 
claimant responds affirmatively to either or both of the two fugitive 
felon questions on title II applications, thereby indicating that they 
have an unsatisfied warrant. Answers to these questions will be used to 
verify that a warrant is still outstanding. An SSA claims 
representative will contact beneficiaries by telephone to collect the 
information. Respondents will be claimants for benefits who indicated 
on their application that they have an unsatisfied warrant.
    Type of Request: New information collection.
    Number of Respondents: 10,000.
    Frequency of Response: 1.
    Average Burden Per Response: 8 minutes.
    Estimated Annual Burden: 1,333 hours.

    Dated: August 17, 2005.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 05-16660 Filed 8-22-05; 8:45 am]
BILLING CODE 4191-02-P