[Federal Register Volume 74, Number 205 (Monday, October 26, 2009)]
[Notices]
[Pages 55080-55083]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-25663]


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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 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.
    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, e-mail, or 
fax your comments and recommendations on the information collection(s) 
to the OMB Desk Officer and the SSA Director for Reports Clearance to 
the addresses or fax numbers shown 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: Director, Center 
for Reports Clearance, 1333 Annex Building, 6401 Security Blvd., 
Baltimore, MD 21235, Fax: 410-965-0454, 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. To be 
sure we consider your comments, we must receive them no later than 
December 28, 2009. Individuals can obtain copies of the collection 
instrument by calling the SSA Director for Reports Clearance at 410-
965-0454 or by writing to the above e-mail address.
    1. Certificate of Support--20 CFR 404.370, 404.750, 404.408a--0960-
0001. A parent of a deceased, fully insured worker may be entitled to 
Title II benefits on the earnings record of the deceased worker under 
certain conditions. One of the conditions is the parent must have 
received at least one-half support from the deceased worker. The one-
half support requirement also applies to a spouse applicant in 
determining whether Title II benefits are subject to Government Pension 
Offset (GPO). SSA uses the information from form SSA-760-F4 to 
determine whether the parent of a deceased worker or a

[[Page 55081]]

spouse applicant meets the one-half support requirement. Respondents 
are parents of deceased workers or spouses who may be exempt from GPO.
    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.
    Estimated Annual Burden: 4,500 hours.
    2. Physician's/Medical Officer's Statement of Patient's Capability 
to Manage Benefits--20 CFR 404.2015 and 416.615--0960-0024. SSA 
collects information on form SSA-787 to determine an individual's 
capability to handle his or her own benefits. This information assists 
SSA in determining the need for a representative payee. The respondents 
are the beneficiary's physicians or medical officers of the institution 
where the beneficiary resides.
    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. Reporting Changes that Affect Your Social Security Payment--20 
CFR 404.301-305, .310-311, .330-.333, .335-.341, .350-.352, .370-.371, 
.401-.402, .408(a), .421-.425, .428-.430, .434-.437, .439-.441, 
.446-.447, .450-.455, .468--0960-0073. SSA collects the information on 
the SSA-1425 to determine continuing entitlement to Title II Social 
Security benefits and to determine the proper benefit amount. The 
respondents are Social Security beneficiaries receiving SSA retirement, 
disability, or survivor's auxiliary benefits who need to report an 
event that could affect payments.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 70,000.
    Frequency of Response: 1.
    Average Burden per Response: 5 minutes.
    Estimated Annual Burden: 5,833 hours.
    4. Child Relationship Statement--20 CFR 404.355 & 404.731--0960-
0116. SSA collects information on the SSA-2519 to help determine a 
child's entitlement to Social Security benefits under section 216(h)(3) 
of the Social Security Act (deemed child provision). An insured 
individual's child may be deemed his or her child if: (1) The insured 
individual is shown by evidence satisfactory to SSA to be the child's 
parent and was living with or contributing to the child's support at 
certain specified times; or (2) the insured individual acknowledged the 
child in writing or the court decreed the individual to be the child's 
parent or ordered the individual to support the child. Respondents are 
persons with knowledge of the relationship between an individual 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. Pre-1957 Military Service--Federal Benefit Questionnaire--20 CFR 
404.1301-404.1371--0960-0120. Sections 217(a) through (e) of the Social 
Security Act provide for crediting military service before 1957 to the 
wage earner's record. Form SSA-2512 collects specific information about 
other Federal, military, or civilian benefits the wage earner may 
receive when the applicant indicates both pre-1957 military service and 
the receipt of a Federal benefit. SSA uses the data in the claims 
adjudication process to grant gratuitous military wage credits when 
applicable, and to solicit sufficient information to make a 
determination of eligibility. Respondents are applicants for Social 
Security benefits on a record where the wage earner has pre-1957 
military service.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 5,000.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 833 hours.
    6. Application for Circuit Court Law--20 CFR 404.985 & 416.1458--
0960-0581. SSA collects certain information in readjudication requests 
it receives from persons claiming the application of an acquiescence 
ruling (AR) would change a prior determination or decision. SSA uses 
this information to determine whether persons are entitled to 
readjudication of their claims in accordance with Social Security 
regulations. SSA reviews the information in the requests to determine 
whether the issue(s) stated in the AR pertains to the claimant's case. 
If readjudication is appropriate, SSA considers only those issue(s) the 
AR covers. Any new determination or decision is subject to 
administrative or judicial review as specified in regulations. 
Respondents are claimants for Social Security benefits and Supplemental 
Security Income (SSI) payments who request readjudication.
    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.
    II. SSA has submitted the information collections listed below to 
OMB for clearance. Your comments on the information collections would 
be most useful if OMB and SSA receive them within 30 days from the date 
of this publication. To be sure we consider your comments, we must 
receive them no later than November 25, 2009. You can obtain a copy of 
the OMB clearance packages by calling the SSA Director for Reports 
Clearance at 410-965-0454 or by writing to the above e-mail address.
    1. State Supplementation Provisions: Agreement; Payments--20 CFR 
416.2095-416.2098, 416.2099--0960-0240. Section 1618 of the Social 
Security Act contains pass-along provisions of the Social Security 
amendments. These provisions require states that supplement the Federal 
SSI payments to pass along Federal cost-of-living increases to 
individuals who are eligible for state supplemental payments. If a 
state fails to keep payments at the required level, it becomes 
ineligible for Medicaid reimbursement under Title XIX of the Social 
Security Act. SSA uses the information to determine a state's 
eligibility for Medicaid reimbursement. Respondents are state agencies 
administering supplemental programs.

    Note:  This is a correction notice. We are revising this notice 
to include the chart below that was not in the 60-day Federal 
Register Notice published on August 19, 2009, at 74 FR 41959.

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

[[Page 55082]]



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                                                                                      Average
                                                     Number of     Frequency of     burden per       Estimated
                Reporting method                    respondents      response        response      annual burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
Total Expenditures..............................               7               4              60              28
Maintenance of Payment Levels...................              23               1              60              23
                                                 ---------------------------------------------------------------
    Total.......................................              30  ..............  ..............              51
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    2. Vocational Rehabilitation Provider Claim--20 CFR 404.2108(b), 
404.2117(c)(1)&(2), 404.2101(b)&(c), 404.2121(a), 416.2208(b), 
416.2217(c)(1)&(2), 416.2201(b)&(c), 416.2221(a)--0960-0310. SSA refers 
certain disability beneficiaries to State Vocational Rehabilitation 
(VR) agencies. The State VR agencies use the SSA-199 to make claims for 
reimbursement of the costs they incur when providing VR services for 
beneficiaries. SSA uses the information on the SSA-199 to determine 
whether or not, and how much, to pay the State VR agencies under SSA's 
VR program. Respondents are State VR agencies who offer vocational and 
employment services to Social Security and SSI recipients.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                      Average
  Form or regulation section      Number of       Frequency of         Total        burden per       Estimated
         No. (20 CFR)            respondents        response         responses       response      annual burden
                                                                                     (minutes)        (hours)
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a. SSA-199 (404.2108 &                     80  160 each/year              12,800              23           4,907
 416.2208).
b. (404.2117 & 416.2217).....              80  1 per year                     80              60              80
c. (404.2121 & 416.2221).....              80  2-3 per year                  200             100             333
                              ----------------------------------------------------------------------------------
    Total....................            * 80  .................          13,080  ..............           5,320
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* Same respondents used for each section.

    3. Internet Request for Replacement of Forms SSA-1099/SSA-1042S--20 
CFR 401.45--0960-0583. Recipients use the SSA-1099 and SSA-1042S to 
determine if Social Security benefits are taxable and the amount they 
need to report to the Internal Revenue Service. An individual may use 
SSA's Internet request form to obtain a replacement SSA-1099 and SSA-
1042S. SSA uses the information from the Internet request form to 
verify the identity of the requestor and to provide replacement copies 
of the forms. The Internet option eliminates the need for phone calls 
to the national 800 number or visits to a local field office. The 
respondents are Title II recipients who wish to request a replacement 
SSA-1099 or SSA-1042S via the Internet.

    Note:  This is a correction notice. SSA published this 
information collection as an extension on July 10, 2009, at 74 FR 
33313. Since we are revising the Privacy Act Statement, this is now 
a revision of an OMB-approved information collection.

    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 136,455.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 22,743 hours.
    4. Uniform Administrative Requirements for Grants and Agreements 
with Institutions of Higher Learning, Hospitals and Other Non-Profit 
Organizations--20 CFR 435--0960-0616. The information contained in 20 
CFR 435 of the Code of Federal Regulations provides SSA's standards for 
administering grants and agreements it awards to institutions of higher 
learning, hospitals, and other non-profit and/or commercial 
organizations. The regulations discuss administrative guidelines and 
reporting, recordkeeping, and disclosure requirements for recipients of 
grants and agreements. SSA uses the information to monitor the progress 
and successful completion of funded projects. Respondents are 
recipients of grants and agreements with SSA.
    Type of Request: Extension of an OMB-approved information 
collection.

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                                                                                      Average
                                           Number of                                burden per       Estimated
         Section No.  (20 CFR)             responses      Frequency of response      response      annual burden
                                                                                      (hours)         (hours)
----------------------------------------------------------------------------------------------------------------
435.23 Rec-kp.........................             107  Monthly (12)............               1           1,284
435.25 Rpt............................             127  Biannually (2)..........               4           1,016
435.51 Rpt............................             127  Quarterly (4)...........              12           6,096
435.53 Rec-kp.........................             127  Annually (1)............               8           1,016
                                       -------------------------------------------------------------------------
    Total.............................  ..............  ........................  ..............           9,412
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    5. Certificate of Incapacity--5 CFR 890.302(d)--0960-0739. Rules 
governing the Federal Employee Health Benefits (FEHB) plan require that 
the physician verify disability of Federal employees' children ages 22 
and over to retain health benefits under the employees' plans. The 
physician must verify the adult child has a disability that meets the 
following criteria: (1) Pre-dates the child's 22nd birthday; (2) is 
very serious; and (3) is expected to last at least one year. Physicians 
use Form SSA-604, the Certificate of Incapacity, to document and 
certify the disability of

[[Page 55083]]

children ages 22 and over whose parents are SSA employees. SSA uses the 
information to determine adult children's (age 22 and above) 
eligibility for coverage under a parent's FEHB plan. The respondents 
are physicians of SSA employees' children ages 22 or over who are 
seeking to retain health benefits under their parents' FEHB coverage.

    Note:  This is a correction notice. SSA published this 
information collection as a new information collection on August 19, 
2009, at 74 FR 41959. Since we are revising the Privacy Act 
Statement, this is now a revision of an OMB-approved information 
collection.

    Type of Request: Revision of an OMB approved information 
collection.
    Number of Respondents: 50.
    Frequency of Response: 1.
    Average Burden per Response: 45 minutes.
    Estimated Annual Burden: 38 hours.
    6. Representative Payment Policies and Administrative Procedures 
for Imposing Penalties for False or Misleading Statements or 
Withholding of Information--0960-0740. This information collection 
request (ICR) comprises several regulation sections that provide 
additional safeguards for Social Security beneficiaries whose 
representative payees receive their payments. The respondents are 
representative payees who receive and use benefits on behalf of Social 
Security beneficiaries.
    Type of Collection: Extension of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                     Number of      Completion
                   Regulation section (20 CFR)                      respondents    time (hours)   Burden (hours)
----------------------------------------------------------------------------------------------------------------
404.2035(d).....................................................         550,000            .083          45,650
404.2035(f).....................................................           5,500            .083             457
416.635(d)......................................................         300,000            .083          24,900
416.635(f)......................................................           3,000            .083             249
                                                                 -----------------------------------------------
    Total.......................................................         858,500  ..............          71,256
----------------------------------------------------------------------------------------------------------------

    7. Ticket to Work Program Evaluation Survey (National Beneficiary 
Survey)--0960-0666. The 1999 Ticket to Work and Work Incentives 
Improvement Act, Public Law 106-170, established the Ticket to Work 
program (TTW) to create additional access to services for SSA 
beneficiaries through a new system of public and private Employment 
Network (EN) providers. Along with establishing the TTW program, the 
legislation mandated an evaluation of the program.
    In February 2003, SSA began a multi-phase evaluation of this 
program. Although we had originally planned to complete the final data 
collection wave by 2009, significant changes we made to the TTW program 
in 2008 (such as changes to the way State VR agencies can provide 
services) compelled us to extend the final evaluation to 2010.
    In this ICR, we are seeking clearance for Round 4 of the National 
Beneficiary Survey and two associated experiments (all three activities 
will use the same data). The respondents are Social Security 
beneficiaries and TTW enrollees. As with the previous three phases of 
this project, a contractor will conduct this study for SSA.
    Type of Collection: Revision of an OMB-approved information 
collection.

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                                        Annual  number                                Average        Estimated
              Instrument                      of         Number of responses per   burden hours    annual burden
                                          respondents          respondent          per response        hours
----------------------------------------------------------------------------------------------------------------
National Beneficiary Sample...........           2,400  1.......................            .750           1,800
Ticket Participant Sample.............           3,000  1.......................            .917           2,751
                                       -------------------------------------------------------------------------
Grand Total--Burden for NBS:
    Grand Total for All...............           5,400  ........................  ..............           4,551
----------------------------------------------------------------------------------------------------------------

    8. Continuation of SSI Benefits for the Temporarily 
Institutionalized--Certification of Period and Need to Maintain Home--
20 CFR 416.212(b)(1)--0960-0516. When SSI recipients (1) enter a public 
institution or (2) enter a private medical treatment facility with 
Medicaid paying more than 50 percent of expenses, their SSI payments 
are reduced to a nominal sum. However, if this institutionalization is 
temporary (defined as a maximum of 3 months), SSA may waive the 
reduction of benefits.
    Before SSA can waive the benefits reduction, the agency must obtain 
the following documentation: (1) A physician's certification the 
beneficiary will be institutionalized for a maximum of 3 months; and 
(2) certification from the beneficiary, beneficiary's family, or 
beneficiary's friend confirming the need for SSI payments to maintain 
the living arrangements to which the beneficiary will return post-
institutionalization. The respondents are doctors of SSI recipients and 
the recipients or their family/friends.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 60,000.
    Frequency of Response: 1.
    Average Burden per Response: 5 minutes.
    Estimated Annual Burden: 5,000 hours.

    Dated: October 20, 2009.
Elizabeth A. Davidson,
Director, Center for Reports Clearance, Social Security Administration.
[FR Doc. E9-25663 Filed 10-23-09; 8:45 am]
BILLING CODE 4191-02-P