[Federal Register Volume 71, Number 113 (Tuesday, June 13, 2006)]
[Notices]
[Pages 34184-34186]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E6-9148]


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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

[[Page 34185]]

SSA Reports Clearance Officer at 410-965-0454 or by writing to the 
address listed above.
    1. SSA Survey of Online Services Internet Panel-0960-New. SSA plans 
to conduct an online panel survey with pre-retirement individuals. The 
survey will ask a number of questions about participants' experiences 
with SSA's Internet-based services. The results of the survey will be 
used to assess awareness of SSA Internet-based services and to identify 
ways to increase awareness of these services in the pre-retirement 
population. The respondents are individuals ages 50-67 who are employed 
and who have agreed to be contacted via e-mail for online surveys.
    Type of Request: New information collection.
    Number of Respondents: 1,000,
    Frequency of Response: 1.
    Average Burden per Response: 15 minutes.
    Estimated Annual Burden: 250 hours.
    2. Authorization for the Social Security Administration to Obtain 
Account Records From a Financial Institution and Request for Records--
20 CFR 416.200, 416.203--0960-0293. The SSA-4641-U2 provides financial 
institutions with the applicant, recipient, or deemor's authorization 
to disclose records. Responses to the questions are used, in part, to 
determine whether the resources requirements are met in the 
Supplemental Security Income (SSI) program. The respondents are 
financial institutions used by SSI applicants, recipients and/or 
deemors.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 500,000.
    Frequency of Response: 1.
    Average Burden per Response: 6 minutes.
    Estimated Annual Burden: 50,000 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. Application for Special Age 72-or-Over Monthly Payments--20 CFR 
404.380-404.384--0960-0096. Form SSA-19-F6 collects the information 
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 
Disability Determination Services 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 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 selected for the Medicare Quality Review System (OMB No. 
0960-0707), 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 collection.
    Total Estimated Annual Burden: 834 hours.

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                                    Medicare Part D subsidy
                                           applicants          Financial institutions            Totals
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Number of respondents............  10,000...................  10,000..................  20,000.
Frequency of response............  1........................  1.......................  1.
Average burden per response......  1 minute.................  4 minutes...............  5 minutes.
(minutes)........................
Estimated annual burden (hours)..  167 hours................  667 hours...............  834 hours.
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[[Page 34186]]

    Dated: June 6, 2006.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. E6-9148 Filed 6-12-06; 8:45 am]
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