[Federal Register Volume 71, Number 26 (Wednesday, February 8, 2006)]
[Notices]
[Pages 6535-6537]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E6-1690]


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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 Pub. L. 104-
13, the Paperwork Reduction Act of 1995, effective October 1, 1995. The 
information collection package included in this notice is for approval 
of an existing OMB-approved information collection.
    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. E-mail: [email protected].
    The information collection listed below has been submitted to OMB 
for clearance. Your comments on the information collection 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 package by 
calling the SSA Reports Clearance Officer at 410-965-0454, or by 
writing to the address listed above.
    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 categories such as 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 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

[[Page 6536]]

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.

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                                                                                                                        Average  burden     Estimated
              Form number and name                        Description of form            Number of       Frequency of     per  response   annual burden
                                                                                        respondents        response        (minutes)         (hours)
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SSA-9301 (Medicare Subsidy Quality Review Case    Telephone questionnaire which will           10,000                1               35            5,833
 Analysis Questionnaire).                          be 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                10,000                1               15            2,500
 Acknowledgement Form 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 Review                Same as for SSA-9302, except used             1,000                1               15              250
 Acknowledgement Form for those without Phones).   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 Required Information)....  This checklist, 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 Information)..............  Form which SSA will send to                  20,000                1               15            5,000
                                                   various third parties to obtain/
                                                   confirm information reported by
                                                   beneficiaries.
SSA-9310 (Request for Documents)................  Following the phone interview, SSA           10,000                1                5              833
                                                   sends this notice to the
                                                   participants advising them of the
                                                   documents they must return to SSA.
SSA-9309 (Life Insurance Verification Form).....  Form completed by insurance                   8,000                1               15            2,000
                                                   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 Social Security    Beneficiaries give their                     10,000                1                5              833
 Administration to Obtain Personal Information).   permission for SSA to contact
                                                   third parties to obtain/confirm
                                                   information.
                                                                                     ------------------
    Total.......................................  ..................................           69,000  ...............  ...............           17,249
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[[Page 6537]]

    Dated: February 2, 2006.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
 [FR Doc. E6-1690 Filed 2-7-06; 8:45 am]
BILLING CODE 4191-02-P