[Federal Register Volume 70, Number 241 (Friday, December 16, 2005)]
[Notices]
[Page 74861]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-24096]


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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 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. 
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 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.

Certification of Low Birth Weight for SSI Eligibility--20 CFR 416.931, 
416.926a (m) (7) & (8) and 416.924--0960-NEW

    Form SSA-3830 is designed to assist hospitals and claimants who 
file on behalf of low birth weight infants in providing local field 
offices (FOs) and Disability Determination Services (DDSs) with medical 
information for determining disability of low birth weight infants. FOs 
use the forms as protective filing statements, and the medical 
information for making presumptive disability findings, which allow 
expedited payment to eligible claimants. DDSs use the medical 
information to formally determine disability and to establish the most 
appropriate continuing disability review diaries. The respondents are 
hospitals that have information identifying low birth weight babies and 
medical conditions those babies may have. We estimate it will take 10 
to 15 minutes to complete the form. Below, we use the higher number for 
our public burden computation.
    Type of Request: New information collection.
    Number of Respondents: 24,000.
    Frequency of Response: 1
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 6,000 hours.

    Dated: December 8, 2005.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 05-24096 Filed 12-15-05; 8:45 am]
BILLING CODE 4191-02-P