[Federal Register Volume 71, Number 34 (Tuesday, February 21, 2006)]
[Notices]
[Pages 8880-8882]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E6-2397]


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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. 
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. Letter to Employer Requesting Wage Information--20 CFR 404.726--
0960-0138. The information collected on Form SSA-L4201 is used by SSA 
to collect wage information from employers to establish and/or verify 
wage information for Supplemental Security Income (SSI) claimants and 
beneficiaries. Form SSA-L4201 is also used to determine eligibility and 
proper payment for SSI applicants/recipients. The respondents are 
employers of applicants and recipients of SSI payments.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 133,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 66,500 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

[[Page 8881]]

410-965-0454, or by writing to the address listed above.
    1. 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.
    2. 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.
    Estimated Annual Burden: 3,000 hours.
    6. Supplemental Security System (SSI) 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.
    7. 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.
    8. 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 Social Security 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: 70,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 5,833 hours.
    9. 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.

[[Page 8882]]



                                       Beneficiary Survey Data Collection
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                                                                                          Average       Total
                       Survey activity                        Respondents   Frequency       time        burden
                                                                           of response   (minutes)      hours
----------------------------------------------------------------------------------------------------------------
National Beneficiary Sample.................................        2,400  ...........           45        1,800
TTW Participant Sample (Baseline)...........................        2,000  ...........           55        1,833
TTW Participant Sample (Follow-up)..........................        1,772  ...........           45        1,329
                                                             --------------
    Total for Survey Data...................................        6,172  ...........  ...........        4,962
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                                     Service Provider Qualitative Collection
----------------------------------------------------------------------------------------------------------------
Site Visits.................................................           10  ...........            6           60
Focus Groups................................................           12  ...........           40          480
Phone Interviews............................................          130  ...........            2          260
                                                             --------------
    Total for Qualitative Data..............................          152  ...........  ...........          800
                                                             ==============
    Total Burden Hours for all Collection Activities........  ...........  ...........  ...........        5,762
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    Dated: February 14, 2006.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. E6-2397 Filed 2-17-06; 8:45 am]
BILLING CODE 4191-02-P