[Federal Register Volume 74, Number 30 (Tuesday, February 17, 2009)]
[Notices]
[Pages 7506-7511]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-3171]


=======================================================================
-----------------------------------------------------------------------

SOCIAL SECURITY ADMINISTRATION


Agency Information Collection Activities: Proposed Request and 
Comment Request

    The Social Security Administration (SSA) publishes a list of 
information collection packages requiring clearance by the Office of 
Management and Budget (OMB) in compliance with Public Law (Pub. L.) 
104-13, the Paperwork Reduction Act of 1995, effective October 1, 1995. 
This notice includes revisions and extensions of OMB-approved 
Information Collections and a new collection.
    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 ways to minimize the 
burden on respondents, including the use of automated collection 
techniques or other forms of information technology. Mail, email, or 
fax your comments and recommendations on the information collection(s) 
to the OMB Desk Officer and the SSA Reports Clearance Officer to the 
addresses or 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,1332 Annex Building,6401 Security Blvd.,Baltimore, MD 
21235,Fax: 410-965-6400,E-mail address: [email protected].

    I. The information collection below is pending at SSA. SSA will 
submit it to OMB within 60 days from the date of this notice. 
Therefore, your comments would be most helpful if you submit them to 
SSA within 60 days from the date of this publication. Individuals can 
obtain copies of the collection instrument by calling the SSA Reports 
Clearance Officer at 410-965-3758 or by writing to the email address 
listed above.
    1. Application for Search of Census Records for Proof of Age--20 
CFR 404.716-0960--0097. SSA uses the information collected by the SSA-
1535-U3 to provide the Census Bureau with sufficient identification 
information for an accurate search of census records for proof of age 
of an individual applying for Social Security benefits. When preferred 
evidence of age is not available and the available evidence is not 
convincing, SSA may request the U.S. Department of Commerce, Bureau of 
the Census, to search its records in order to establish a claimant's 
date of birth. The Census Bureau uses the information from a completed, 
signed SSA-1535-U3 to bill SSA for the search. The respondents are 
applicants for Social Security benefits who need to establish their 
date of birth as a factor of entitlement.

[[Page 7507]]

    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 18,030.
    Frequency of Response: 1.
    Average Burden Per Response: 12 minutes.
    Estimated Annual Burden: 3,606 hours.
    2. Youth Transition Process Demonstration Evaluation Data 
Collection--0960-0687.

Background

    The purpose of the Youth Transition Demonstration (YTD) project is 
to help young people with disabilities make the transition from school 
to work. While participating in the project, youth can continue to work 
and/or continue their education because SSA waives certain disability 
program rules and offers services to youth who are receiving disability 
benefits or have a high probability of receiving them. We are currently 
implementing YTD projects in eight sites across the country. The 
evaluation will produce empirical evidence on the effects of the 
waivers and project services including educational attainment, 
employment, earnings, and receipt of benefits by youth with 
disabilities, but also on the Social Security Trust Fund and federal 
income tax revenues. This project is authorized by Sections 1110 and 
234 of the Social Security Act.

Project Description

    Given the importance of estimating YTD effects as accurately as 
possible, we will evaluate the project using rigorous analytic methods 
based on randomly assigning youth to a treatment or control group. We 
will conduct several data collections. These include (1) baseline 
interviews with youth and their parents or guardians prior to random 
assignment; (2) follow-up interviews at 12 and 36 months after random 
assignment; (3) interviews and/or roundtable discussions with local 
program administrators, program supervisors, and service delivery 
staff; and (4) focus groups of youths, their parents, and service 
providers. The respondents are youths with disabilities enrolled in the 
project; their parents or guardians; program staff; and service 
providers.
    Type of Request: Revision of an existing OMB Clearance.

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                         Average burden
              Data collection year                            Collection                 Number of      Responses per     per response    Total response
                                                                                        respondents       respondent        (hours)      burden  (hours)
--------------------------------------------------------------------------------------------------------------------------------------------------------
2009............................................  Baseline..........................            1,895                1            0.55             1,042
                                                  Informed Consent..................            1,895                1            0.083              157
                                                  12 Month Follow-up................            1,518                1            0.83             1,260
                                                  In-depth Interviews...............              120                1            0.42                50
                                                  Focus Group.......................              150                1            1.5                225
                                                  Program Staff/Service Provider....               80                1            1                   80
                                                  36 Month Follow-up................              364                1            0.83               302
                                                 -------------------------------------------------------------------------------------------------------
    Total 2009..................................  ..................................  ...............  ...............  ...............            3,116
--------------------------------------------------------------------------------------------------------------------------------------------------------

    3. 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 pre-disability earnings. SSA uses Form SSA-546 to collect 
the data necessary to determine if 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: Revision 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.
    4. 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 on an SSI beneficiary's allegations that 
he or she borrowed funds informally from non-commercial lender, e.g. a 
relative or friend. The borrower/beneficiary and the lender of the 
funds complete these statements. Forms SSA-2854 and SSA-2855 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. Form SSA-2855 
(Statement of Funds You Received) requests information from the SSI 
applicant/recipient by personal interview. Form SSA-2854 (Statement of 
Funds You Provided to Another) requests information by mail from the 
other party to the transaction. The respondents are SSI recipients who 
informally borrow money and those persons who lend the funds.
    Type of Request: Revision 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.
    5. The Mental Health Treatment Study (MHTS)--0960-0726.

Background

    Because of advances in medical treatment, assistive devices, 
changes in the way we view those with disabilities, and legislation 
designed to assure access to employment, SSA is taking on an 
increasingly active role in assisting Social Security disability 
beneficiaries who want to return to work. As a result, SSA developed 
the MHTS under Section 234 of the Social Security Act (42 U.S.C. 434), 
which gives the Commissioner of Social Security the authority to carry 
out experiments and demonstration projects designed to determine the 
relative advantages and disadvantages of interventions that facilitate 
a beneficiary's return to work. Part of the agency's role involves 
finding ways to promote work and increase independence among disability 
beneficiaries.
    SSA received additional support for this study in February 2001, 
through President Bush's New Freedom Initiative--a comprehensive 
program whose primary goal is to promote the full participation of 
individuals with disabilities in all areas of society. The aim of the 
Initiative is to help Americans with disabilities by increasing their 
access to effective technologies, expanding educational opportunities, 
increasing the ability of Americans with disabilities to integrate into 
the workforce, and promoting increased access into daily community 
life. This initiative provided SSA with

[[Page 7508]]

the support that will enable beneficiaries to maximize their self-
sufficiency and potentially enter or reenter the workforce.

MHTS Collection

    The MHTS implemented a randomized trial study designed to evaluate 
the effect of the intervention on employment and functional outcomes 
for SSDI beneficiaries with a primary mental impairment of 
schizophrenia or affective disorder. SSA is currently implementing the 
MHTS in 22 demonstration sites across the United States, with one site 
having two locations. The study participants are SSDI beneficiaries 
with varying clinical and demographic characteristics, employment 
histories, and, sometimes, additional medical impairments. The study 
design has two arms: treatment (special services), and control (regular 
services) groups. SSA randomly assigned study participants to the 
treatment or control group. Each treatment or control recipient will 
participate for a total of 24 months following enrollment. The 
treatment intervention activities include the following: diagnostic 
psychiatric assessment, comprehensive medical assessment, systematic 
medication management, supporting employment, individualized clinical 
treatment, supplemental health insurance, coordination and payment of 
recipients' claims, as well as quality assurance mechanisms and 
adherence to treatment guidelines, with subsequent training to improve 
deficiencies as identified.
    The comprehensive assessment of the MHTS outcomes will identify 
which, if any, of the interventions resulted in successful employment 
and functioning outcomes, and identify the characteristics of the 
interventions that contributed to the success. This information enables 
SSA to develop better ways to improve services to current and future 
recipients. SSA also uses this information to guide any potential 
changes to program rules to allow for better coordination among other 
federal and state programs.
    Type of Request: Extension of an OMB-approved information 
collection.

                                            Screener Estimated Burden
----------------------------------------------------------------------------------------------------------------
                                                                                 Burden per
              Questionnaire                 Frequency of        Number of         responses       Total burden
                                              response         respondents        (minutes)           hours
----------------------------------------------------------------------------------------------------------------
Screener Survey.........................                1             2,265                 4               151
----------------------------------------------------------------------------------------------------------------


                                      Estimated Burden for Treatment Group
----------------------------------------------------------------------------------------------------------------
                                                                                   Hours per
                Questionnaire                   Frequency of   Total number of      response       Total burden
                                                  response      respondents\1\     (minutes)          hours
----------------------------------------------------------------------------------------------------------------
Baseline....................................                1            1,121               47              878
Quarterly...................................                7            1,121               18            2,354
Follow-up...................................                1            1,121               30              561
                                             -------------------------------------------------------------------
    Total...................................  ...............  ...............  ...............            3,793
----------------------------------------------------------------------------------------------------------------
\1\ The number of respondents may reduce over time due to study withdrawals.


                                       Estimated Burden for Control Group
----------------------------------------------------------------------------------------------------------------
                                                                                   Hours per
                Questionnaire                   Frequency of   Total number of      response       Total burden
                                                  response       respondents       (minutes)          hours
----------------------------------------------------------------------------------------------------------------
Baseline....................................                1            1,117       47 minutes              875
Quarterly...................................                7            1,117        7 minutes              912
Follow-up...................................                1            1,117       30 minutes              559
                                             -------------------------------------------------------------------
    Total...................................  ...............  ...............  ...............            2,346
----------------------------------------------------------------------------------------------------------------


                                 Total Estimated Burden for All Study Activities
----------------------------------------------------------------------------------------------------------------
                                                                 Frequency of   Total number of    Total burden
                        Questionnaire                              response       respondents         hours
----------------------------------------------------------------------------------------------------------------
Screener Survey..............................................                1            2,265              151
Treatment Group..............................................                9            1,121            3,792
Control Group................................................                9            1,117            2,345
                                                              --------------------------------------------------
    Total....................................................  ...............            4,503            6,288
----------------------------------------------------------------------------------------------------------------

    6. Application for SSA Employee Testimony--20 CFR 403.100-155--
0960-0619. SSA regulations at 20 CFR 403.100-155 establish policies and 
procedures whereby an individual, organization, or governmental entity 
may request official agency information, records, or testimony of an 
agency employee in a legal proceeding where the agency is not a party. 
The request, which must be in writing to the Commissioner, must fully 
set out the nature and relevance of the sought testimony. Respondents 
are individuals

[[Page 7509]]

or entities who request testimony from SSA employees in a legal 
proceeding.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 100.
    Frequency of Response: 1.
    Average Burden Per Response: 60 minutes.
    Estimated Annual Burden: 100 hours.
    7. Self-Employment/Corporate Officer Questionnaire--20 CFR 
404.435(e), 404.446--0960-0487. SSA uses Form SSA-4184 to develop 
earnings and corroborate the claimant's allegations of retirement when 
the claimant is self-employed or a corporate officer. SSA uses the 
information to determine an individual's Old Age, Survivors, and 
Disability Insurance (OASDI) benefit amount. The respondents are self-
employed individuals or corporate officers who apply for OASDI 
benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 50,000.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 16,667 hours.
    8. Claimant's Medication--20 CFR 404.1512, 416.912--0960-0289. In 
cases where a claimant is requesting a hearing after denial of his or 
her claim for Social Security benefits, SSA uses Form HA-4632 to 
request information from the claimant regarding the medications they 
are using. This information helps the Administrative Law Judge (ALJ) 
hearing the case to inquire fully into the medical treatment the 
claimant is receiving and the effect of medications on the claimant's 
medical impairments and functional capacity. Respondents are applicants 
for OASDI benefits and/or Supplemental Security Income (SSI) payments.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 200,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 50,000 hours.
    9. Request for Withdrawal of Application--20 CFR 404.640--0960-
0015. Individuals complete Form SSA-521 to request withdrawal of an 
application for benefits. Individuals who wish to withdraw their 
applications for benefits complete this form. SSA uses the information 
from Form SSA-521 to process the request for withdrawal. The 
respondents are applicants for OASDI benefits.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 100,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 8,333 hours.
    10. Authorization for the Social Security Administration to Obtain 
Account Records from a Financial Institution and Request for Records 
(Medicare Low-Income Subsidy)--0960-0729. 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 applicants' accounts. Financial 
institutions will also use the form 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: Extension of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden     Estimated
                                                 Number of       Frequency of     per response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
Medicare Part D Subsidy Applicants..........            5,000                1                1               84
Financial Institutions......................            5,000                1                5              333
                                             -------------------------------------------------------------------
    Totals..................................           10,000  ...............  ...............              417
----------------------------------------------------------------------------------------------------------------

    11. Request to Pay Civil Monetary Penalty by Installment 
Agreement--20 CFR 498--0960-NEW. SSA uses Form SSA-640 to obtain the 
information necessary to determine a repayment rate for individuals who 
have a civil monetary penalty imposed on them for various fraudulent 
conduct related to SSA-administered programs. SSA needs this financial 
information to ensure the repayment rate is in the best interest of 
both the individual and the agency. The respondents are recipients of 
Social Security benefits and non-entitled individuals who must pay a 
civil monetary penalty.
    Type of Request: New information collection.
    Number of Respondents: 400.
    Frequency of Response: 1.
    Average Burden Per Response: 120 minutes.
    Estimated Annual Burden: 800 hours.
    II. SSA has submitted the information collections listed below 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 410-965-3758, 
or by writing to the above listed address.
    1. Report of New Information in Disability Cases--20 CFR 404.1588--
0960-0071. SSA uses the information it collects on Form SSA-612 to 
ensure federal Old Age, Survivors, and Disability Insurance (OASDI) 
payments are correct. It is essential beneficiaries notify SSA of any 
information that may affect their continuing entitlement to disability 
benefits. To facilitate and encourage timely reporting of such events, 
SSA furnishes beneficiaries a Form SSA-612. The beneficiary completes 
and returns the form to SSA when there is a change in his/her 
circumstances. When a beneficiary reports a change, SSA investigates 
any reported work activity or improvement in the beneficiary's 
condition, updates its records, and makes necessary payment changes. 
The respondents are recipients of federal OASDI benefits.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 27,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 2,250 hours.

    Note: This is a correction notice: SSA inadvertently published 
the incorrect burden information for this collection on December 02, 
2008. We are correcting this error here. Previously, SSA published 
this collection as an extension; however, as we are revising the 
Privacy Act Statement, this is now a revision.

    2. Statement of Marital Relationship (By one of the parties)--20 
CFR 404.726--0960-0038. Where no formal marriage documentation exists, 
SSA

[[Page 7510]]

uses the information it collects on Form SSA-754-F4 to determine 
whether an individual applying for spousal benefits meets the criteria 
of common-law marriage under state law. The respondents are applicants 
for spouse's Social Security benefits or SSI payments. Note: SSA listed 
this information collection as an extension of an OMB-approved 
information collection in the 60-Day Federal Register Notice published 
on October 27, 2008; it is a revision of an OMB-approved information 
collection.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 30,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 15,000 hours.
    3. Application for Parent's Insurance Benefits--20 CFR 404.370-
404.374, 20 CFR 404.601-404.603--0960-0012. SSA uses Form SSA-7 to 
collect information used to entitle an individual to his or her 
parent's OASDI benefits. The respondents are claimants who wish to 
apply to receive their parent's OASDI benefits.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 315.
    Frequency of Response: 1
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 79 hours.
    4. Request for Waiver of Overpayment Recovery or Change in 
Repayment Notice--20 CFR 404.502-404.513, 404.515 and 20 CFR 416.550--
416.570, 416.572--0960-0037. An individual may request waiver of 
recovery of an overpayment or a different repayment rate of OASDI 
benefits and SSI payments. To make this request, the overpaid 
individual uses the SSA-632-BK. The individual explains why he/she is 
without fault in causing the overpayment and provides financial 
information, so SSA can determine whether recovery would cause 
financial hardship. If the individual agrees to repay the overpayment, 
he/she can use the SSA-632-BK to request a monthly rate or to request a 
different rate of recovery. In those cases, the individual must provide 
financial information to SSA for a determination of how much the 
overpaid person can afford to repay each month. Respondents are 
overpaid beneficiaries or claimants who are requesting a waiver of 
recovery of the overpayment, or a lesser rate of withholding.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                       Number of       Frequency of       Average burden per       Total annual
          Type of request             respondents        response              response               burden
----------------------------------------------------------------------------------------------------------------
Waiver of Overpayment (Completes            400,000                1  2 hours..................          800,000
 Whole Form).
Change in Repayment (Completes              100,000                1  45 minutes...............           75,000
 Partial Form).
Internet Instructions.............          500,000                1  5 minutes................           41,667
                                   -----------------------------------------------------------------------------
    Totals........................        1,000,000  ...............  .........................          916,667
----------------------------------------------------------------------------------------------------------------

    5. You Can Make Your Payment by Credit Card--0960-0462. SSA uses 
the information on Forms SSA-4588 and SSA-4589 to update an 
individual's Social Security record to reflect payments made on their 
overpayment and to effect payment through the appropriate credit card 
company. SSA is modifying the Form SSA-4588 to include a recurring 
credit card payment option to allow individuals to authorize automatic 
monthly payments. SSA sends out the SSA-4588 with initial overpayment 
notices informing individuals SSA has detected an overpayment. 
Individuals may choose to make a one-time payment or recurring monthly 
payments by completing and submitting the SSA-4588.
    SSA uses the Form SSA--4589 only when individuals choose to call 
the program service centers to make payments in lieu of completing the 
Form SSA-4588. An SSA debtor contact representative completes Form SSA-
4589 when a debtor calls to make a payment by telephone. The debtor 
contact representative also uses the information from Form SSA-4589 to 
make recurring monthly payments via telephone call with the debtor. 
Respondents are OASDI beneficiaries and SSI recipients who have 
outstanding overpayments.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden
               Form                     Number of       Frequency of     per response     Total burden
                                                respondents        response        (minutes)          hours
----------------------------------------------------------------------------------------------------------------
SSA-4588....................................            3,500                1               10              583
SSA-4589....................................           36,500                1                5            3,042
                                             -------------------------------------------------------------------
    Totals..................................           40,000  ...............  ...............            3,625
----------------------------------------------------------------------------------------------------------------

    6. Medical Source Statement of Ability To Do Work Related 
Activities (Physical and Mental)--20 CFR 404.1512-404.1514, 404.912-
404.914, 404.1517, 416.917, 404.1519-404.1520, 416.919-416.920, 
404.946, 416.946, 404-1546--0960-0662. SSA uses the Forms HA-1151 and 
HA-1152 to collect data SSA needs to determine the residual functional 
capacity (RFC) of individuals who are appealing denied claims for 
benefits based on disability. SSA uses the RFC when the agency cannot 
make a determination on a claim for benefits based on current work 
activity or on medical facts alone. The respondents are medical sources 
paid by SSA to provide reports either based on existing medical 
evidence or on consultative examinations conducted for the purposes of 
the report. Note: SSA listed this as an extension of an OMB-approved 
information collection in the 60-Day Federal Register Notice published 
on October 27, 2008; it is a revision of an OMB-approved collection.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 10,000.
    Frequency of Response: 20.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 50,000 hours.
    7. Statement of Funds You Provided to Another and Statement of 
Funds You

[[Page 7511]]

Received--20 CFR 404.1520(b), 404.1571-.1576, 404.1584-.1593 and 
416.971-.976 --0960-0059. SSA's field offices use Form SSA-821-BK to 
obtain work information from recipients during the continuing 
disability review process, and whenever a work issue arises in SSI 
claims. SSA's processing centers and Office of Disability and 
International Operations use the form to obtain post-adjudicative work 
issues from recipients' by mail. The primary purpose of this form is to 
collect recipient employment information in order to determine whether 
or not recipients have worked in employment after becoming disabled 
and, if so, whether the work is substantial gainful activity. SSA will 
review and evaluate the data to determine if the recipient continues to 
meet the disability requirements of the law. The respondents are Social 
Security disability applicants, beneficiaries, and SSI applicants. 
Note: SSA listed this information collection as an extension of an OMB-
approved information collection in the 60-Day Federal Register Notice 
published on December 11, 2008; it is a revision of an OMB-approved 
information collection.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 300,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 50,000 hours.
    8. Application for Supplemental Security Income --20 CFR 416.305-
416.335, Subpart C--0960-0444. Form SSA-8001-BK collects information 
SSA uses to determine an applicant's eligibility for SSI, and the 
amount of SSI payments. SSA employees secure this information during 
interviews conducted with members of the public who wish to file for 
SSI payments. SSA uses this form for two purposes: (1) To establish a 
disability claim, but defer the complete development of non-medical 
issues until SSA approves the disability, or (2) to formally deny SSI 
payments for non-medical reasons when information provided by the 
applicant results in ineligibility. The respondents are applicants for 
SSI payments.

    Note: SSA listed this information collection as an extension of 
an OMB-approved information collection in the 60-Day Federal 
Register Notice published on December 11, 2008; it is a revision of 
an OMB-approved information collection.

    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                   Number of
                          Form type                               Number of        minutes to      Burden hours
                                                                 respondents     complete form
----------------------------------------------------------------------------------------------------------------
MSSIC........................................................          711,135               15          177,784
MSSIC/Signature Proxy........................................          237,045               14           55,311
Paper........................................................           19,351               18            5,805
                                                              --------------------------------------------------
    Totals...................................................          967,531  ...............          238,900
----------------------------------------------------------------------------------------------------------------

    9. Medicaid Use Report--20 CFR 416.268--0960-0267. SSA uses the 
information required by this regulation to determine if an individual 
is entitled to special SSI payments and, consequently, to Medicaid 
benefits. The respondents are SSI recipients for whom SSA has stopped 
payments 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.
    10. Claimant's Recent Medical Treatment-- 20 CFR 404.1512 and 
416.912--0960-0292. Each claimant who requests a hearing before an ALJ 
has a right to such a hearing once the Disability Determination Service 
(DDS), at the reconsideration level, has denied the claim. For the 
hearing, SSA requests the claimant complete and return the HA-4631 if 
the claimant's file does not reflect a current, complete medical 
history as the claimant proceeds through the appeals process. ALJs must 
obtain the information to update and complete the record and to verify 
the accuracy of the information. It is by this process ALJs can 
ascertain whether the claimant's situation has changed. The ALJ and 
hearing office staff use the response to make arrangements for 
consultative examination(s) and the attendance of an expert witness(es) 
at the hearing, if appropriate. During the hearing, the ALJ offers any 
completed questionnaires as exhibits and may use them to refresh the 
claimant's memory, and to inquire into the matters at issue. The 
respondents are claimants requesting hearings on entitlement to OASDI 
benefits or SSI payments.
    Type of Request: Extension of an OMB-Approved Information 
Collection
    Number of Respondents: 350,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 58,333 hours.

    Dated: February 9, 2009.
John Biles,
Reports Clearance Officer, Center for Reports Clearance, Social 
Security Administration.
[FR Doc. E9-3171 Filed 2-13-09; 8:45 am]
BILLING CODE 4191-02-P