[Federal Register Volume 70, Number 243 (Tuesday, December 20, 2005)]
[Notices]
[Pages 75526-75527]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E5-7514]


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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, 
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. Reporting Changes that Affect Your Social Security Payment--20 
CFR 404.301-305, .310-311, .330-.333, .335-.341, .350-.352, .370-.371, 
.401-.402, .408(a), .421-.425, .428-.430, .434-.437, .439-.441, 
.446-.447, .450-.455, .468--0960-0073. SSA uses the information 
collected on Form SSA-1425 to determine continuing entitlement to Title 
II Social Security benefits and to determine the proper benefit amount. 
The respondents are Title II beneficiaries receiving SSA retirement, 
disability or survivor's auxiliary benefits who need to report an event 
that could affect payments.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 36,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 3,000 hours.
    2. Workers' Compensation/Public Disability Questionnaire--20 CFR 
404.408--0960-0247. Section 224 of the Social Security Act provides for 
the reduction of disability insurance benefits (DIB) when the 
combination of DIB and any workers' compensation (WC) and/or certain 
Federal, State or local public disability benefits (PDB) exceeds 80% of 
the worker's predisability earnings. Form SSA-546 is used to collect 
the data necessary to determine whether or not the worker's receipt of 
WC/PDB payments will cause a reduction of DIB. The respondents are 
applicants for the Title II DIB.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 100,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 25,000 hours.
    3. Medicaid Use Report--20 CFR 416.268--0960-0267. The information 
required by this regulation is used by SSA to determine if an 
individual is entitled to special Title XVI Supplemental Security 
Income (SSI) payments and, consequently, to Medicaid benefits. The 
respondents are SSI recipients whose payments were stopped based on 
earnings.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 60,000.
    Frequency of Response: 1.
    Average Burden Per Response: 3 minutes.

[[Page 75527]]

    Estimated Annual Burden: 3,000 hours.
    4. Supplemental Security Income Claim Information Notice--20 CFR 
416.210--0960-0324. Form SSA-L8050-U3 is used by SSA to ensure that all 
sources of potential income that can be used to provide for an SSI 
beneficiary's own support and maintenance are utilized. SSI is intended 
to supplement other income an individual has available. Respondents are 
businesses and applicants/recipients of SSI who may be eligible for 
benefits from public or private programs.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 7,500.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 1,250 hours.
    5. Application Statement for Child's Insurance Benefits--20 CFR 
404.350-0368, 404.603, and 416.350--0960-0010. Title II of the Social 
Security Act provides for the payment of monthly benefits to the 
children of an insured retired, disabled, or deceased worker, if 
certain conditions are met. Form SSA-4-BK is used by SSA to collect 
information needed to determine whether the child or children are 
entitled to benefits. The respondents are children of the worker or 
individuals who complete this form on their behalf.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 1,740,000.
    Frequency of Respondents: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 435,000 hours.
    6. National Employment Activity and Disability Survey--0960-0666

Background

    The Ticket to Work (TTW) program was established by the Ticket to 
Work and Work Incentives Improvement Act of 1999. The program will 
provide eligible Social Security Disability Insurance (SSDI) and SSI 
disability beneficiaries with a Ticket, which can be used to obtain 
vocational rehabilitation (VR) or employment services through 
participating providers, called Employment Networks (ENs). The goal of 
the TTW program is to assist participants in returning to work at a 
level above the Substantial Gainful Activity (SGA) level. The program 
is expected to increase beneficiary demand for employment-related 
services and activities. It is also expected to increase the number and 
diversity of providers in response to the less restrictive 
participation requirements and increased consumer demand for services.

The National Employment Activity and Disability Survey

    The National Employment Activity and Disability Survey will collect 
data on the work-related activities of SSI and SSDI beneficiaries as 
the TTW program, and other initiatives designed to improve beneficiary 
employment outcomes, are implemented. The TTW Survey is specifically 
designed to be a significant resource for the formal evaluation of TTW, 
but SSA anticipates that the survey will provide useful information for 
a variety of evaluation and policy analysis purposes, especially 
related to current efforts that attempt to improve return to work. The 
survey questionnaire focuses on information about beneficiaries and 
their work-related activities that cannot be obtained from SSA's 
administrative records. The survey will provide information about: (1) 
Beneficiaries who assign their Tickets to ENs, and their experience in 
the program; (2) beneficiaries who do not assign their Tickets, and the 
reasons why they do not, including involuntary non-participants; (3) 
the employment outcomes of Ticket users and other beneficiaries; and 
(4) the use of employment services by Ticket users and other 
beneficiaries. The respondents will be selected from SSI and SSDI 
disabled beneficiaries who meet the Ticket to Work program eligibility 
requirements.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 5,538.
    Frequency of Response: 1.
    Average Burden Per Response: 47 minutes.
    Estimated Annual Burden: 4,338 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. Private Printing and Modification of Prescribed Applications and 
Other Forms--20 CFR 422.527--0960-0663. This regulation mandates that 
non-government persons or organizations who wish to reproduce, 
duplicate, or privately print any application or other form owned by 
SSA must receive written authorization from the Agency to do so. The 
respondents are private persons or groups who wish to reproduce, 
duplicate, or privately print an SSA application or form.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 9.
    Frequency of Response: 36.
    Average Burden Per Response: 8 minutes.
    Estimated Annual Burden: 43 hours.
    2. Public Information Campaign--0960-0544. SSA sends public 
information materials (e.g.: public service announcements, news 
releases, educational tapes) to public broadcasting systems so these 
media sources can inform the general public about the Agency's various 
programs and activities. To track media usage of these materials, SSA 
conducts the Public Information Campaign, a bi-annual solicitation of 
feedback from the target public media sources via business reply cards. 
The respondents are public broadcasting systems who are sent 
information about various SSA programs to disseminate to the public. 
Note: Please note that this collection was accidentally allowed to 
expire by OMB.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 8,000.
    Frequency of Response: 2.
    Average Burden Per Response: 1 minute.
    Estimated Annual Burden: 267 hours.

    Dated: December 13, 2005.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
 [FR Doc. E5-7514 Filed 12-19-05; 8:45 am]
BILLING CODE 4191-02-P