[Federal Register Volume 72, Number 30 (Wednesday, February 14, 2007)]
[Notices]
[Pages 7107-7110]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E7-2418]


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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, faxed or e-mailed 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, E-mail address: [email protected].

[[Page 7108]]

(SSA), Social Security Administration, DCFAM, Attn: Reports Clearance 
Officer, 1333 Annex Building, 6401 Security Blvd., Baltimore, MD 21235, 
Fax: 410-965-6400, E-mail address: [email protected].

    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 Child's Insurance Benefits--20 CFR 404.350-
404.368, 404.603, and 416.350--0960-0010. SSA uses the information 
collected by the SSA-4-BK to entitle children of living and deceased 
workers to monthly Social Security payments. Respondents are guardians 
completing the form on behalf of the children of living or deceased 
workers, or the children of living or deceased workers.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 1,740,000.
    Estimated Annual Burden: 344,141 hours.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Frequency per    burden per       Estimated
                Type of  request                    respondents      response        response      annual burden
                                                                                     (minutes)
----------------------------------------------------------------------------------------------------------------
Life Claims.....................................          46,250               1              10           7,708
Life Claims--MCS................................         439,375               1              10          73,229
Life Claims--Signature Proxy....................         439,375               1               9          65,906
Death Claims....................................          40,750               1              15          10,188
Death Claims--MCS...............................         387,125               1              15          96,781
Death Claims--Signature Proxy...................         387,125               1              14          90,329
                                                 ---------------------------------------------------------------
    Totals......................................       1,740,000  ..............  ..............         344,141
----------------------------------------------------------------------------------------------------------------

    2. Physician's/Medical Officer's Statement of Patient's Capability 
to Manage Benefits--20 CFR 404.2015 and 416.615--0960-0024. The 
information collected on the SSA-787 is used to determine whether an 
individual is capable of handling his or her own benefits. This 
information is also used for leads in selecting a representative payee, 
if needed. The respondents are physicians of the beneficiaries or 
medical officers of the institution in which the beneficiaries reside.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 120,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 20,000 hours.
    3. Modified Benefit Formula Questionnaire--Foreign Pension--0960-
0561. The information collected on the SSA-308 is used to determine 
exactly how much (if any) of a foreign pension may be used to reduce 
the amount of Social Security retirement or disability benefits under 
the modified benefit formula. The respondents are applicants for Social 
Security retirement or disability benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 50,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 8,333 hours.
    4. Authorization to Release Medical Report to Physician--20 CFR 
401.55 & 401.100--0960-NEW. If the claimant, his or her court appointed 
representative, or a parent of a minor child wants the consultative 
examination (CE) report sent to the claimant's treating physician, he 
or she will complete the information requested on Form SSA-91 and send 
it to SSA for processing. SSA will use the information collected to 
send the CE report to the authorized physician. Respondents are 
applicants for disability claims.
    Type of Request: Collection in use without an OMB number.
    Number of Respondents: 7,922.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 660 hours.
    5. Claimant Travel Reimbursement Request--20 CFR 404.999a-d--0960-
NEW. The claimants have the right to be reimbursed for their travel 
expenses to and from a consultative examination (CE). In order to be 
reimbursed, the claimants must submit an itemized list of what they 
spent to travel round trip to the CE. The SSA-104 is sent to the 
claimants with the CE appointment notice. If the claimants want to be 
reimbursed for their travel expenses, they must complete, sign and 
return the SSA-104 to SSA. SSA uses the information collected on this 
form to determine the amount of reimbursement. Respondents are 
applicants for disability claims.
    Type of Request: Collection in use without an OMB number.
    Number of Respondents: 11,092.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 1,849 hours.
    6. Treating Physician Consultative Examination Interest Form--20 
CFR 404.1519g-i--0960-NEW. The individual's treating physician (TP) is 
the preferred source to perform a consultative examination (CE). SSA 
uses the SSA-84 to ascertain whether the TP is interested in performing 
the CE. This form is sent to the claimant's treating physician along 
with the medical evidence of record request letter. If the treating 
physician is interested in performing the CE, he or she indicates 
interest by completing the SSA-84 and returning it to SSA. If the form 
is not returned, SSA assumes that the TP is not interested in 
performing the CE. Respondents are the claimants' treating physicians.
    Type of Request: Collection in use without an OMB number.
    Number of Respondents: 168.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 14 hours.
    7. Electronic Records Express--0960-NEW. Electronic Records Express 
(ERE) is a new Internet-based platform which facilitates the electronic 
submission of medical and school records needed for the disability 
process. These records are currently mailed as hard paper copies to SSA 
and state Disability Determination Services (DDSs) under the aegis of 
OMB No. 0960-0555, the Clearance of Information Collections Conducted 
by State Disability Determination Services on Behalf of SSA. While SSA 
and the DDSs will continue to accept paper copies, ERE offers 
respondents the

[[Page 7109]]

opportunity to submit these records electronically. The revised burden 
for the actual document submission will continue to be covered under 
0960-0555; this new collection covers the ERE registration and user 
training process. The respondents are medical providers and school 
professionals who submit information to SSA on behalf of disability 
applicants or beneficiaries.
    Type of Request: New information collection.
    Number of Respondents: 20,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 1,667 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 of Circuit Court Law--20 CFR 404.985 & 416.1458--
0960-0581. Under SSA regulations, persons may request re-adjudication 
on the basis that the application of an acquiescence ruling (AR) would 
change a prior determination or decision. We will use the information 
provided to determine whether they are entitled to re-adjudication of 
their claims in accordance with these regulations. We will review the 
available information in the requests to determine whether the issue(s) 
stated in the AR pertains to the claimant's case. If re-adjudication is 
appropriate, we will consider only those issue(s) covered by the AR. 
Any new determination or decision will be subject to administrative or 
judicial review in accordance with our regulations. Individuals who 
request readjudication are claimants for Social Security benefits and 
Supplemental Security Income payments.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 10,000.
    Frequency of Response: 1.
    Average Burden Per Response: 17 minutes.
    Estimated Annual Burden: 2,833 hours.
    2. Physical Residual Functional Capacity Assessment and Mental 
Residual Functional Capacity Assessment--20 CFR 404.1545-404.1546 & 
416.945-416.946--0960-0431. The information collected on forms SSA-
4734-BK and SSA-4734-F4-SUP is needed by SSA to assist in the 
adjudication of disability claims involving physical and/or mental 
impairments. The forms assist the State DDS offices to evaluate the 
severity of impairments by providing standardized data collection 
forms. The use of these forms by the DDSs ensures nationally consistent 
evaluations presented in a concise, clear and readily understandable 
manner. The respondents are primarily doctors in DDSs funded and 
administered by SSA.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 2,397,646.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 799,215 hours.
    3. Substitution of Party Upon Death of Claimant--20 CFR 
404.957(c)(4) & 416.1457(c)(4)--0960-0288. The HA-539 is used to 
collect information from any individual who asks to be made a 
substitute party for a claimant for either Social Security benefits or 
Supplemental Security Income payments who dies while his or her request 
for a hearing is pending. This information is needed and used by SSA to 
afford these individuals their statutory right to a hearing and 
decision under the Social Security Act.
    Respondents are individuals requesting to proceed with hearings as 
substitute parties for deceased claimants for Social Security benefits 
or Supplemental Security Income payments.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 4,320.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 360 hours.
    4. Child Relationship Statement--20 CFR 404.355 & 404.731--0960-
0116. The information collected on the SSA-2519 is used to help 
determine the entitlement of children to Social Security benefits under 
section 216(h)(3) of the Social Security Act (deemed child provision). 
Respondents are persons with knowledge of the relationship between the 
number holder and his/her alleged biological child who is filing for 
benefits.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 50,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 12,500 hours.
    5. Application for Lump Sum Death Payment--20 CFR 404.390-404.392--
0960-0013. The Social Security Administration (SSA) needs the 
information collected on Form SSA-8-F4 to authorize payment of the lump 
sum death payment (LSDP) to a widow, widower, or children as defined in 
Section 202(i) of the Act. Respondents are applicants for LSDP.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 587,000.
    Estimated Annual Burden: 93,187.

----------------------------------------------------------------------------------------------------------------
                                                                                     Estimated
                                                                     Number of      completion
                       Collection  method                           respondents        time        Burden  hours
                                                                                     (minutes)
----------------------------------------------------------------------------------------------------------------
MCS.............................................................         278,825              10          46,471
MCS/Signature Proxy.............................................         278,825               9          41,824
Paper...........................................................          29,350              10           4,892
                                                                 -----------------------------------------------
    Totals......................................................         587,000  ..............          93,187
----------------------------------------------------------------------------------------------------------------

    6. Certificate of Support--20 CFR 404.370, 404.750, 404.408a--0960-
0001. The information collected on the SSA-760-F4 is used to determine 
whether the parent of a deceased worker or the spouse meets the one-
half support requirement specified in SSA regulations. Respondents are 
parents of deceased workers, or spouses who may qualify for an 
exception to Government Pension Offset.
    Type of Request: Revision of an OMB approved information 
collection.
    Number of Respondents: 18,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.

[[Page 7110]]

    Estimated Annual Burden: 4,500 hours.
    7. Request for Reinstatement (Title II)--20 CFR 404.1592b-
404.1592f--0960-NEW. Form SSA-371 is used by former beneficiaries for 
Title II benefits who wish to request Expedited Reinstatement (EXR) of 
their Title II disability benefits. SSA uses the SSA-371 to obtain a 
signed statement from the individual requesting EXR, and to verify that 
the applicant meets the EXR requirements. The form will be maintained 
in the disability folder of the applicant to demonstrate that the 
individual was aware of the EXR requirements and chose to request EXR. 
Respondents are applicants for EXR of Title II disability benefits.
    Type of Request: Collection in use without an OMB number.
    Number of Respondents: 10,000.
    Frequency of Response: 1.
    Average Burden per Response: 2 minutes.
    Estimated Annual Burden: 333 hours.
    8. Request for Reinstatement (Title XVI)--20 CFR 416.999-416.999d--
0960-NEW. Form SSA-372 is used by former SSI claimants who wish to 
request Expedited Reinstatement (EXR) of their Title XVI disability 
payments. SSA uses the SSA-372 to obtain a signed statement from the 
individual requesting EXR and to verify that the requestor meets the 
EXR requirements. The form will be maintained in the disability folder 
of the applicant to demonstrate that the individual was aware of the 
EXR requirements and chose to request EXR. Respondents are applicants 
for EXR of Title XVI disability payments.
    Type of Request: Collection in use without an OMB number.
    Number of Respondents: 2,000.
    Frequency of Response: 1.
    Average Burden per Response: 2 minutes.
    Estimated Annual Burden: 67 hours.
    9. Vendor List Registration Form--0960-NEW. SSA maintains an 
Employer Wage Reporting and Instructions Vendor Web site. On this site, 
relevant vendors are allowed to list their products and services free 
of charge. Vendors wishing to list their information on the site can 
submit these requests via a written registration form or through the 
Web site itself. The respondents are vendors who offer employer wage 
reporting services and who want SSA to list their information on the 
relevant Web site.
    Type of Request: New information collection.
    Number of Respondents: 500.
    Frequency of Response: 1.
    Average Burden Per Response: 8 minutes.
    Estimated Annual Burden: 67 hours.

    Dated: February 7, 2007.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. E7-2418 Filed 2-13-07; 8:45 am]
BILLING CODE 4191-02-P