[Federal Register Volume 72, Number 230 (Friday, November 30, 2007)]
[Notices]
[Pages 67776-67778]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E7-23253]


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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, faxed or emailed 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].
(SSA), Social Security Administration, DCBFM, 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. Request for Review of Hearing Decision/Order--20 CFR 404.967-
404.981, 416.1467-416.1481--0960-0277. The HA-520 is needed in order to 
afford claimants their statutory right under the Social Security Act 
and implementing regulations to request review of an Administrative Law 
Judge's (ALJ) hearing decision or dismissal of a hearing request on 
title II and title XVI claims. An individual may request Appeals 
Council review by filing a written request. A completed HA-520 ensures 
that SSA receives the information necessary to establish that the 
claimant filed the request for review within the prescribed time, and 
that the claimant has completed the requisite steps to permit review by 
the Appeals Council. The Appeals Council also uses the information to 
document the claimant's reason(s) for disagreeing with the ALJ' s 
decision or dismissal, to determine whether the claimant has additional 
evidence to submit, and to determine whether the claimant has a 
representative or wants to appoint one. The respondents are claimants 
requesting review of an ALJ's decision or dismissal of hearing on 
Social Security.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 100,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 16,667 hours.
    2. Epidemiological Research Report--20 CFR 401.165--0960-0701. 
Section 311 of the Social Security Independence and Program 
Improvements Act of 1994 directed SSA to provide support to health 
researchers involved in epidemiological research. Specifically, when a 
study is determined to contribute to a national health interest, SSA 
will furnish information to determine whether a study subject is shown 
on the SSA administrative records as being alive or deceased (vital 
status). SSA will recoup all expenses incurred in providing this 
information. Web-posted questions solicit the information SSA needs to 
provide the data and to collect the fees. The requestors are scientific 
researchers who are applying to receive vital status information about 
individuals from Social Security administrative data records.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 30.
    Frequency of Response: 1.
    Average Burden Per Response: 120 minutes.
    Estimated Annual Burden: 60 hours.
    3. Work Activity Report (Self-Employed Person)--20 CFR 404.1520(b), 
404.1571-404.1576, 404.1584-404.1593, and 416.971-416.976--0960-0598. 
The information on Form SSA-820-F4 is used by SSA to determine initial 
or continuing eligibility for Supplemental Security Income (SSI) or 
Social Security disability benefits. Under titles II and XVI of the 
Act, applicants for disability

[[Page 67777]]

benefits must prove an inability to perform any kind of Substantial 
Gainful Activity (SGA) generally available in the national economy for 
which they might be expected to qualify on the basis of age, education, 
and work experience. SSA needs to secure information about this work in 
order to ascertain whether the applicant was (or is) engaging in SGA. 
Work after a claimant becomes entitled can cause the cessation of 
disability benefits. The information obtained from form SSA-820-F4 is 
needed to determine if a cessation of benefits should occur. The 
respondents are applicants and claimants for SSI or Social Security 
disability benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 100,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 50,000 hours
    4. Student Reporting Form--20 CFR 404.352(b)(2), 404.368, 404.415, 
404.434, 422.135--0960-0088. The information collected by form SSA-1383 
is used by SSA to determine the impact of reported events on Social 
Security student beneficiaries' continuing entitlement to these 
benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 75,000.
    Frequency of Response: 1.
    Average Burden Per Response: 6 minutes.
    Estimated Annual Burden: 7,500 hours.
    5. Electronic Death Registration (EDR)--20 CFR 404.301; 404.310-
311; 404.316; 404.330-341;404.350-352; and 404.371; 416.912--0960-0700. 
SSA has contracted with the States to obtain death certificate 
information in order to compare it to SSA's payment files. This match 
ensures the accuracy of our payment files by detecting unreported or 
inaccurate dates of deaths of beneficiaries. Entitlement to retirement, 
disability, wife's, husband's or parent's benefits under the provisions 
of the Social Security Act terminates when the beneficiary dies.
    Type of Request: Extension of an OMB-approved information 
collection.

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                                                                                   Average cost      Estimated
           Collection format               Number of     Frequency of responses     per record      annual cost
                                          respondents                                 request         burden
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State Death Match--Manual Process.....              35  50,000 per State........           $0.72      $1,260,000
State Death Match--Electronic Death                 18  50,000 per State........            2.58       2,322,000
 Registration (EDR).
                                       -------------------------------------------------------------------------
    Totals............................              53  ........................  ..............       3,582,000
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    Estimated Annual Cost for all respondents:
    **Please note that both of these data matching processes are 
entirely electronic and there is no hourly burden for the respondent to 
provide this information. The cost burdens are based on the four cost 
components incurred by the respondents:

--software
--hardware
--average annual salaries of database management personnel
--average annual salaries of support personnel
    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. Request for Evidence from Doctor or Hospital--20 CFR 404 Subpart 
I and 20 CFR 416 Subpart P--0960-0722. Claimants are required to 
provide medical evidence of their impairment(s) in pursuing a 
disability claim under titles II and XVI of the Social Security Act. 
The HA-66 and HA-67 will be used by adjudicators of the Office of 
Disability Adjudication and Review (ODAR), the component of the Social 
Security Administration (SSA) that oversees the Administrative Law 
Judge (ALJ) hearing level. The letters will be used to request medical 
evidence from medical and other sources the claimant identifies as 
having information relative to his or her impairments or ability to do 
work-related activities. The respondents are doctors and hospitals 
where the claimant has been evaluated.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                  Average burden     Estimated
                    Form type                        Number of     Frequency of    per response    annual burden
                                                    respondents      response        (minutes)        (hours)
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Request for Evidence from a Doctor (HA-66)......          10,000              20              15          50,000
Request for Evidence from a Hospital (HA-67)....          10,000              20              15          50,000
                                                 ---------------------------------------------------------------
    Totals......................................          20,000  ..............  ..............         100,000
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    2. Development for Participation in a Vocational Rehabilitation or 
Similar Program--20 CFR 404.316(c), 404.337(c), 404.352(d), 
404.1586(g), 404.1596, 404.1597(a), 404.327, 404.328, and 416.1338(c) 
and (d) 416.1320(d), 416.1331(a)-(b), and 416.1338-0960-0282. State 
Disability Determination Services must determine if a recipient of 
disability benefits whose disability has ceased but who is enrolled in 
a vocational rehabilitation program can continue to receive SSA 
benefits. To do this, information is needed about the beneficiary, the 
type of program he/she is enrolled in, and the types of services the 
beneficiary is receiving under the auspices of that program. Form SSA-
4290 is used to collect this information. The respondents are State 
employment networks, vocational rehabilitation agencies, or other 
providers of education/job training services.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 3,000.
    Frequency of Response: 1
    Average Burden Per Response: 15 minutes.

[[Page 67778]]

    Estimated Annual Burden: 750 hours.
    3. Medical Report (Individual with Childhood Impairment)--20 CFR 
404.1512-.1515 and 416.912-.915 & 20 CFR 422.125--0960-0102. The 
information collected on form SSA-3827 is used by SSA to determine the 
childhood claimant's physical status prior to making a disability 
determination and to document the childhood disability claims folder 
with the medical evidence. The respondents are members of the medical 
community, and include physicians, hospital directors, medical records 
librarians, and other medical personnel.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 12,000.
    Frequency of Response: 1.
    Average Burden per Response: 30 minutes.
    Estimated Annual Burden: 6,000 hours.
    4. Disability Hearing Officer's Report of Disability Hearing (DC)--
SSA-1204-BK--0906-0507. The information collected on form SSA-1204-BK 
is used by the Disability Hearing Officer (DHO) to conduct and document 
disability hearings, and to provide a structured format that covers all 
conceivable issues relating to SSI claims for disabled children. The 
completed SSA-1204-BK will aid the DHO in preparing the disability 
decision and will provide a record of what transpired in the hearing. 
The respondents are DHO's in the State Disability Determination 
Services.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 2,000.
    Frequency of Response: 1.
    Average Burden per Response: 60 minutes.
    Estimated Annual Burden: 2,000 hours.
    5. Application for Help with Medicare Prescription Drug Plan 
Costs--20 CFR 418.3101--0960-0696. Medicare Part D, codified in 20 CFR 
418, provides voluntary prescription drug coverage of premium, 
deductible, and co-payment costs for certain low-income individuals. As 
per 20 CFR 418.3101, beneficiaries who meet eligibility criteria may 
receive help with these Medicare Part D costs. The Social Security 
Administration, which helps to administer the subsidy program, uses 
form SSA-1020 (the Application for Help with Medicare Prescription Drug 
Plan Costs) and its online equivalent, the i1020, to collect 
information that will be used to make Medicare Part D subsidy 
determinations. The respondents are eligible beneficiaries who want to 
apply for help with Medicare Part D costs.
    Type of Request: Extension of an OMB-approved information 
collection.

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                                                                                  Average burden     Estimated
                                                     Number of     Frequency of    per response    annual burden
                                                    respondents      response        (minutes)        (hours)
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SSA-1020 (paper application form)...............       2,545,716               1              35       1,485,001
i1020 (online equivalent).......................         380,394               1              45         285,296
 
    Totals......................................       2,926,110  ..............  ..............       1,770,297
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    Notes: (1) When SSA published the 60-day Notice for this 
collection on September 14, 2007 at 72 FR 52594, we described this 
as a revision. However, since that time OMB has determined that our 
proposed revisions were non-substantive in nature and has approved 
them. We are therefore now listing this collection as an extension. 
A list of the non-substantive changes SSA made are available if the 
public requests them. (2) The number of respondents completing the 
i1020 is greater and the number of respondents using the paper SSA-
1020 is less than the numbers reported in the 60-day Federal 
Register Notice for this collection. The reason for this change is 
that SSA received updated data on the percentage of respondents 
using the i1020 since the 60-day Federal Register Notice published.

    6. Appeal of Determination for Help with Medicare Prescription Drug 
Plan Costs--0960-0695. The Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (Pub. L. 108-173; MMA) established a new 
Medicare Part D program for voluntary prescription drug coverage for 
premium, deductible and cost-sharing subsidies for certain low-income 
individuals. The MMA stipulates that subsidies must be available for 
individuals who are eligible for the program and who meet eligibility 
criteria for help with premium, deductible, and/or co-payment costs. 
Form SSA-1021, the Appeal of Determination for Help with Medicare 
Prescription Drug Plan Costs, was developed to obtain information from 
individuals who appeal SSA's decisions regarding eligibility or 
continuing eligibility for a Medicare Part D subsidy. The respondents 
are applicants who are appealing SSA's eligibility or continuing 
eligibility decisions.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 75,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 12,500 hours.

    Dated: November 26, 2007.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. E7-23253 Filed 11-29-07; 8:45 am]
BILLING CODE 4191-02-P