[Federal Register Volume 70, Number 236 (Friday, December 9, 2005)]
[Notices]
[Pages 73319-73320]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E5-7111]


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SOCIAL SECURITY ADMINISTRATION


Agency Information Collection Activities: Proposed Request

    The Social Security Administration (SSA) publishes a list of 
information collection packages that requires 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 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 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 e-mailing or faxing your request to the above e-mail address and 
fax number.

Medicare Subsidy Quality Review Case Analysis Forms--20 CFR 418(b)(5)--
0960-0707

    Under the aegis of the Medicare Modernization Act of 2003, SSA will 
make Medicare Part D subsidy determinations for the Medicare 
Prescription Drug program for Medicare beneficiaries with limited 
income and resources. The subsidy determination is based on applicants' 
answers to questions about household size, income, and resources. 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 determination. In 
this system, SSA will conduct phone interviews with selected applicants 
and will confirm information such as household size, income, and 
resources. 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.


    Note: This Notice is for the permanent approval of this 
collection, which was cleared by OMB temporarily through February 
2006 as an emergency information collection.


    Type of Request: Extension of a currently approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                 Description  of     Number of     Frequency of     burden  per      Estimated
     Form number and name             form          respondents      response        response      annual burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-9301 (Medicare Subsidy      Telephone                 10,000               1              35           5,833
 Quality Review Case Analysis    questionnaire
 Questionnaire).                 which will be
                                 administered by
                                 SSA employees
                                 to applicants
                                 for Medicare
                                 Part D Subsidy.
                                 Includes
                                 questions about
                                 family size,
                                 marriage,
                                 income, assets,
                                 etc.

[[Page 73320]]

 
SSA-9302 (Notice of Quality     After receiving           10,000               1              15           2,500
 Review Acknowledgement Form     notice of the
 for those with Phones).         scheduled 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     Same as for SSA-           1,000               1              15             250
 Review Acknowledgement Form     9302, except
 for those without Phones).      used by
                                 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-9304 (Checklist of          This checklist,   ..............  ..............  ..............  ..............
 Required Information).          which
                                 accompanies
                                 forms SSA-9302
                                 and SSA-9303,
                                 is a list of
                                 the
                                 documentation
                                 respondents are
                                 supposed to
                                 have prepared
                                 when SSA calls
                                 them to conduct
                                 the Quality
                                 Review phone
                                 interview.
                                 Their burden is
                                 accounted for
                                 in the burdens
                                 for forms SSA-
                                 9302 and SSA-
                                 9303.
SSA-9308 (Request for           Form which SSA            20,000               1              15           5,000
 Information).                   will send to
                                 various third
                                 parties to
                                 obtain/confirm
                                 information
                                 reported by
                                 beneficiaries.
SSA-9310 (Request for           Following the             10,000               1               5             833
 Documents).                     phone
                                 interview, SSA
                                 sends this
                                 notice to the
                                 participants
                                 advising them
                                 of the
                                 documents they
                                 must return to
                                 SSA.
SSA-9309 (Life Insurance        Form completed             8,000               1              15           2,000
 Verification Form).             by insurance
                                 companies
                                 confirming
                                 type, face
                                 value, cash
                                 surrender value
                                 and dividends
                                 for insurance
                                 policies of
                                 applicants for
                                 Medicare Part D
                                 subsidy.
SSA-8510 (Authorization to the  Beneficiaries             10,000               1               5             833
 Social Security                 give their
 Administration to Obtain        permission for
 Personal Information).          SSA to contact
                                 third parties
                                 to obtain/
                                 confirm
                                 information.
                                                 -----------------
    Total.....................  ................          69,000  ..............  ..............          17,249
----------------------------------------------------------------------------------------------------------------

    Total Estimated Annual Burden: 17,249 hours.

    Dated: December 2, 2005.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
 [FR Doc. E5-7111 Filed 12-8-05; 8:45 am]
BILLING CODE 4191-02-P