[Federal Register Volume 76, Number 4 (Thursday, January 6, 2011)]
[Notices]
[Pages 817-818]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-1]


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SOCIAL SECURITY ADMINISTRATION


Agency Information Collection Activities: Proposed 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 104-13, the 
Paperwork Reduction Act of 1995, effective October 1, 1995. This notice 
includes revisions to 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 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 SSA Reports Clearance Officer at the following 
addresses or fax numbers.
(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].

[[Page 818]]

    The information collections below are pending at SSA. SSA will 
submit them 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 
March 7, 2011. Individuals can obtain copies of the collection 
instruments by calling the SSA Reports Clearance Officer at 410-965-
8783 or by writing to the above e-mail address.
    1. Application for Survivors Benefits--20 CFR 404.611(a) and (c)--
0960-0062. Surviving family members of armed services personnel can 
file for Social Security and Veterans benefits at SSA or the Veterans 
Administration (VA). Applicants file for title II survivor benefits at 
the VA by completing Form SSA-24. The VA forwards Form SSA-24 to SSA 
for processing. SSA uses the information to determine eligibility for 
benefits. The respondents are survivors of deceased armed services 
personnel who are applying for benefits at the VA.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 3,200.
    Frequency of Response: 1.
    Average Burden per Response: 15 minutes.
    Estimated Annual Burden: 800 hours.
    2. Request for Medical Treatment in an SSA Employee Health 
Facility: Patient Self-Administered or Staff-Administered Care -- 0960-
0772 -- SSA's Employee Health Clinic (EHC) provides emergency care, 
treatment of on-the-job illnesses and injuries, and health care for 
employees with chronic medical conditions and allergies who require 
allergy antigens. SSA also permits employees to use the EHC for self-
administration of medical treatments for a chronic health condition. 
SSA collects information on Form SSA-5072 to approve or deny requests 
for medical treatment in an SSA EHC. The respondents are the private 
physicians of the SSA employees seeking medical treatment in an SSA 
EHC.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                      Average
                                     Number of     Frequency of    Total number     burden per       Estimated
    Medication dosage changes       respondents      response      of responses      response     annual  burden
                                                                                     (minutes)        (hours)
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Annually........................              25               1              25               5               2
Bi-Annually.....................              75               2             150               5              13
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    Totals......................             100  ..............             175  ..............              15
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    Dated: December 31, 2010.
Faye Lipsky,
Reports Clearance Officer, Center for Reports Clearance, Social 
Security Administration.
[FR Doc. 2011-1 Filed 1-5-11; 8:45 am]
BILLING CODE 4191-02-P