[Federal Register Volume 76, Number 185 (Friday, September 23, 2011)]
[Notices]
[Pages 59180-59182]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-24437]


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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 extensions and revisions of OMB-approved 
information collections, and an information collection in use without 
an OMB number.
    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, email, 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, 
E-mail address: [email protected].
    I. 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 
November 22, 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 email address.
    1. Incoming and Outgoing Intergovernmental Personnel Act Assignment 
Agreement--5 CFR 334--0960-NEW. The Intergovernmental Personnel Act 
(IPA) mobility program provides for the temporary assignment of 
civilian personnel between the Federal Government and state and local 
governments, colleges and universities, Indian tribal governments, 
federally funded research and development centers, and other eligible 
organizations. The Office of Personnel Management (OPM) created a 
generic form, the OF-69, for agencies to use as a template when 
collecting information for the IPA assignment. The OF-69 collects 
specific information about the agreement including the name, social 
security number, job title, salary, classification, and address of the 
employee enrolled in the program, as well as the type of assignment, 
reimbursement arrangement, and explanation as to how the assignment 
will benefit both SSA and the non-federal organization involved in the 
exchange.
    OPM directs agencies to use their own forms for recording these 
agreements. Therefore, SSA modified the OF-69 to meet our needs, 
creating the SSA-187 for incoming employees, and the SSA-188 for 
outgoing employees. Respondents are the individuals we describe above 
who participate in the IPA exchange with SSA.
    Type of Request: Existing collection in use without an OMB number.

[[Page 59181]]



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                                                                               Average burden    Estimated total
             Respondent type                  Number of       Frequency of      per response      annual burden
                                             respondents        response          (minutes)          (hours)
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Non-federal employee, SSA-187...........                10                 1                30                 5
Non-federal employer signers, both SSA-                 20                 1                 5                 2
 187 & SSA-188..........................
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    Totals..............................                30  ................  ................                 7
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    2. Coverage of Employees of State and Local Governments--20 CFR 
404, Subpart M--0960-0425. The Code of Federal Regulations at 20 CFR 
part 404, Subpart M, prescribes the rules for states submitting reports 
of deposits and recordkeeping to SSA. States (and interstate 
instrumentalities) are required to provide wage and deposit 
contribution information for pre-1987 periods. Not all the states have 
completely satisfied their pending wage report and contribution 
liability with SSA for pre-1987 tax years. These regulations are needed 
until all pending items with all states are closed out, and to provide 
for collection of this information in the future, if necessary. The 
respondents are state and local governments or interstate 
instrumentalities.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                               Average burden    Estimated total
           Regulation  section                Number of       Frequency of      per response      annual burden
                                             respondents        response           (hours)           (hours)
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404. 1204 (a) & (b).....................                52                 1               0.5                26
404.1215................................                52                 1                 1                52
404. 1216 (a) & (b).....................                52                 1                 1                52
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    Total...............................               156  ................  ................               130
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    3. Medical Report on Adult with Allegation of Human 
Immunodeficiency Virus Infection; Medical Report on Child with 
Allegation of Human Immunodeficiency Virus Infection--20 CFR 416.993-
416.994--0960-0500. SSA or state agencies (Disability Determination 
Services) use Forms SSA-4814-F5 and SSA-4815-F6 to collect information 
necessary to determine if an individual with the human immunodeficiency 
virus infection, who is applying for Supplemental Security Income 
(SSI), meets the requirements for presumptive disability payments. The 
respondents are the medical sources of the applicants for SSI 
disability payments.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                                 Estimated total
                  Form                        Number of       Frequency of      Response time     annual burden
                                             respondents        response          (minutes)          (hours)
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SSA-4814-F5.............................            46,200                 1                10             7,700
SSA-4815-F6.............................            12,900                 1                10             2,150
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    Totals..............................            59,100  ................  ................             9,850
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    4. Public Information Campaign--0960-0544. Periodically, SSA sends 
various public information materials, including public service 
announcements, news releases, and educational tapes, to public 
broadcasting systems so they can inform the public about the various 
programs and activities SSA conducts. SSA frequently sends follow-up 
business reply cards for these public information materials to obtain 
suggestions for improving them. The respondents are broadcast 
television sources.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 1,000.
    Frequency of Response: 2.
    Average Burden per Response: 1 minute.
    Estimated Total Annual Burden: 33 hours.
    5. Redetermination of Eligibility for Help with Medicare 
Prescription Drug Plan Costs--0960-0723. As per the requirements of the 
Medicare Modernization Act of 2003 (Pub. L. 108-173), SSA conducts low-
income subsidy eligibility redeterminations for Medicare beneficiaries 
who currently receive the Medicare Part D subsidy and who meet certain 
criteria. Respondents complete Form SSA-1026-REDE under the following 
circumstances: (1) When individuals became entitled to the Medicare 
Part D subsidy during the past 12 months; (2) if they were eligible for 
the Part D subsidy for more than 12 months; or (3) if they reported a 
change in income, resources, or household size. Part D beneficiaries 
complete the SSA-1026-SCE when they need to report a potentially 
subsidy-changing event, including the following: (1) Marriage, (2) 
spousal separation, (3) divorce, (4) annulment of a marriage, (5) 
spousal death, or (6) moving back in with one's spouse following a 
separation. The respondents are current recipients of the Medicare Part 
D low-income subsidy who will undergo an eligibility redetermination 
for one of the reasons mentioned above.
    Type of Request: Extension of an OMB-approved information 
collection.

[[Page 59182]]



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                                                                               Average burden    Estimated total
                  Form                        Number of       Frequency of      per response      annual burden
                                             respondents        response          (minutes)          (hours)
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SSA-1026-OCR-MS-SCE.....................            11,400                 1                18             3,420
SSA-1026-OCR-SM-REDE....................           225,000                 1                18            67,500
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    Total...............................           236,400  ................  ................            70,920
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    II. SSA submitted the information collection below to OMB for 
clearance. Your comments regarding the information collection 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 October 24, 2011. Individuals can obtain copies of 
the OMB clearance package by calling the SSA Reports Clearance Officer 
at 410-965-8783 or by writing to the above e-mail address.
    Statement of Claimant or Other Person--Medical Resident FICA Refund 
Claims--20 CFR 404.702 and 416.570--0960-0786. The Internal Revenue 
Service (IRS) is contacting medical residents (and their employers) who 
filed Federal Insurance Contributions Act (FICA) refund claims from 
1993 through 2005. Those medical residents who claimed their 
residencies were actually training, not employment, should not have 
been subject to FICA tax. The IRS made a decision to honor these claims 
and issue a full refund of FICA tax, plus statutory interest, to those 
who wish to participate in the refund resolution. SSA will remove wages 
from the participating residents' earnings records for the period of 
the refund requests, which will cause the residents' recorded earnings 
to decrease. This not only affects earnings for future retirement 
benefits, but also could adversely affect those residents (or their 
beneficiaries) who are currently receiving Social Security benefits.
    To ensure they understand the potential impact on their benefits, 
SSA will call those residents who will be adversely affected and 
explain the effect on their Social Security benefits if they accept the 
IRS FICA refund. If SSA cannot reach the resident by phone, we will 
send a contact letter and the SSA-795-OP2 to the resident to complete 
and return to SSA to document the decision. Once we have the 
information, we will forward the signed forms to the IRS for the 
residents who no longer want the FICA refund.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 496.
    Frequency of Response: 1.
    Average Burden per Response: 4 minutes.
    Estimated Total Annual Burden: 33 hours.

    Dated: September 20, 2011.
Faye Lipsky,
Reports Clearance Officer, Center for Reports Clearance, Social 
Security Administration.
[FR Doc. 2011-24437 Filed 9-22-11; 8:45 am]
BILLING CODE 4191-02-P