[Federal Register Volume 71, Number 66 (Thursday, April 6, 2006)]
[Notices]
[Pages 17549-17551]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E6-4913]


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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. Application for Special Age 72-or-Over Monthly Payments--20 CFR 
404.380-404.384--0960-0096. Form SSA-19-F6 collects the information

[[Page 17550]]

needed to determine whether a claimant can qualify for Special Age 72 
payments. Eligibility requirements will be evaluated based on the data 
collected on this form. The respondents are individuals who reached age 
72 before 1972.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 10.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 2 hours.
    2. Medical or Psychological Review of Childhood Disability 
Evaluation Form (SSA-538)--20 CFR 416.1040, 416.1043, 416.1045, 
416.924(g)--0960-0675. Form SSA-536 is used by SSA medical or 
psychological consultants to document their review and assessment of 
the Childhood Disability Evaluation Form, SSA-538, prepared by State 
DDS employees. A childhood disability evaluation is required in each 
SSI childhood disability case that is reviewed. The respondents are 256 
SSA medical and psychological consultants.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Responses: 17,000.
    Frequency of Response: 1.
    Average Burden Per Response: 12 minutes.
    Estimated Annual Burden: 3,400 hours.
    3. Claimant's Medication--20 CFR 404.1512, 416.912--0960-0289. The 
HA-4632, completed by applicants for disability benefits, provides an 
updated list of medications used by the claimant. This enables the 
Administrative Law Judge hearing the case to fully inquire into the 
medical treatment the claimant is receiving and the effect of 
medications on the claimant's impairments and functional capacity. The 
respondents are applicants for Old Age, Survivors and Disability 
Insurance (OASDI) benefits, and/or Supplemental Security income (SSI) 
payments.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 171,939.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 42,985 hours.
    4. Authorization for the Social Security Administration to Obtain 
Account Records from a Financial Institution and Request for Records 
(Medicare Low-Income Subsidy)--0960-NEW. Under the aegis of the 
Medicare Modernization Act of 2003, Medicare beneficiaries can apply 
for a subsidy for the Medicare Prescription Drug Plan (Part D) program. 
In some cases, SSA will need to verify the details of applicants' 
accounts at financial institutions to determine if they are eligible 
for the subsidy. Form SSA-4640 will give SSA the authority to contact 
financial institutions about beneficiaries' accounts. It will also be 
used by financial institutions to verify the information requested by 
SSA. The respondents are applicants for the Medicare Part D program 
subsidy and financial institutions where applicants have accounts.
    Type of Request: New information request.

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                                                                  Medicare  Part
                                                                     D subsidy       Financial        Totals
                                                                    applicants     institutions
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Number of Respondents...........................................          10,000          10,000         20,000.
Frequency of Response...........................................               1               1              1.
Average Burden Per Response (minutes)...........................               1               4              5.
Estimated Annual Burden (hours).................................             167             667            834.
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    Total Estimated Annual Burden: 834 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. Claimant's Recent Medical Treatment--20 CFR 404.1512 & 416.912--
0960-0292. The information collected on Form HA-4631 is used to 
facilitate processing an applicant's OASDI (Title II) and/or SSI (Title 
XVI) claim. The form elicits from the claimant an updated list of 
medical treatment. This enables the Administrative Law Judge hearing 
the case to fully inquire into past and current medical treatment the 
claimant received/receives and the effect on the claimant's physical 
and mental status. The respondents are applicants for OASDI benefits 
and/or SSI payments.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 320,000.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 53,333 hours.
    2. Statement of Funds You Provided to Another and Statement of 
Funds You Received--20 CFR 416.1103(f)--0960-0481. Forms SSA-2854 and 
SSA-2855 collect information in situations where the SSI recipient 
alleges that he or she borrowed funds informally from a non-commercial 
lender, e.g., a relative or a friend. The statements are required to 
determine whether the proceeds from the transaction are income to the 
borrower. If the transaction constitutes a bona fide loan, then the 
proceeds are not income to the borrower. The respondents are the 
borrower/recipient and the lender of the funds.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 40,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 6,667 hours.
    3. Quickstart Enrollment--31 CFR 209 and 210--0960-0564. Social 
Security beneficiaries and SSI recipients can enroll for direct 
deposit/electronic funds transfer through their financial institutions 
(FIs) using an automated enrollment process. SSA uses the information 
to facilitate electronic transmission of data for direct deposit of 
funds to a payee's account. The respondents are Social Security 
beneficiaries and SSI recipients requesting direct deposit to their 
financial institutions.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 3,950,000.
    Frequency of Response: 1.
    Average Burden Per Response: 3 minutes.
    Estimated Annual Burden: 197,500 hours.
    4. Certificate of Election for Reduced Spouse's Benefits--20 CFR 
404.421--0960-0398. SSA uses the information collected on Form SSA-25 
to pay a qualified spouse who elects to receive a reduced Social 
Security benefit.

[[Page 17551]]

Reduced benefits are not payable to an already entitled spouse, at 
least age 62 but under full retirement age, who no longer has a child 
in care, unless the spouse elects to receive reduced benefits. The 
respondents are entitled spouses seeking reduced Social Security 
benefits.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 30,000.
    Frequency of Response: 1.
    Average Burden Per Response: 2 minutes.
    Estimated Annual Burden: 1,000 hours.
    5. Voluntary Customer Satisfaction Surveys in Accordance with E.O. 
12862 for the Social Security Administration--0960-0526. Under the 
auspices of E.O. 12862, Setting Customer Service Standards, SSA 
conducts multiple customer satisfaction surveys each year. These 
voluntary customer satisfaction assessments include paper, Internet, 
and telephone surveys; mailed questionnaires; focus groups; and 
customer comment cards. The purpose of these surveys is to assess 
customer satisfaction with the timeliness, appropriateness, access, and 
overall quality of the services SSA provides. The respondents are 
direct recipients of SSA services and professionals and other 
individuals who work on behalf of SSA beneficiaries.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                           Fiscal year 2006         Fiscal year 2007         Fiscal year 2008
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Number of Respondents................  1,352,181..............  1,356,001..............  1,357,851.
Frequency of Response................  1......................  1......................  1.
Range of Response Times..............  Varies (5 minutes to     Varies (5 minutes to     Varies (5 minutes to
                                        1\1/2\ hours).           1\1/2\ hours).           1\1/2\ hours).
Estimated Annual Burden..............  119,646................  120,993................  121,191.
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    Note: Please note that the figures above differ slightly from 
those published in the 60-day advance Notice. The reason for this 
difference is that SSA obtained updated burden data since publishing 
the 60-day Federal Register Notice.


    Dated: March 30, 2006.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. E6-4913 Filed 4-5-06; 8:45 am]
BILLING CODE 4191-02-P