[Federal Register Volume 76, Number 203 (Thursday, October 20, 2011)]
[Notices]
[Pages 65315-65317]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-27222]


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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 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, 107 Altmeyer Building, 6401 Security Blvd., Baltimore, MD 
21235. Fax No.: 410-966-2830. 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 
December 19, 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. Medical Report on Adult with Allegation of Human 
Immunodeficiency Virus Infection; Medical Report on Child with 
Allegation of Human Immunodeficiency Virus Infection--20 CFR 416.933-
20; CFR 416.934 --0960-0500. SSA uses Forms SSA-4814-F5 and SSA-4815-F6 
to collect information necessary to determine if an individual with 
human immunodeficiency virus infection, who is applying for 
Supplemental Security Income (SSI) disability benefits, 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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                                                                              Average burden    Estimated total
        Collection instrument             Number of         Frequency of       per response      annual burden
                                          responses           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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    2. Supplement to Claim of Person Outside the United States--20 CFR 
404.463, 20 CFR 422.505(b) and 20 CFR 407.27(c)--0960-0051. Claimants 
or beneficiaries (both United States (U.S.) citizens and aliens 
entitled to benefits) living outside the U.S. complete Form SSA-21 as a 
supplement to an application for benefits. SSA collects the information 
to determine eligibility for U.S. Social Security benefits for those 
months a beneficiary or claimant is outside the U.S., and to determine 
if tax withholding applies. In addition, SSA uses the information to 
terminate Supplemental Medical Insurance coverage for recipients who 
request it, because they are or will be out of the U.S. The respondents 
are individuals entitled to Social Security benefits who are, will be, 
or have been residing outside the U.S. for three months or longer.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                              Average burden    Estimated total
        Collection instrument             Number of         Frequency of       per response      annual burden
                                          responses           response          (minutes)           (hours)
----------------------------------------------------------------------------------------------------------------
SSA-21 (non-residents)..............             36,874                  1                  5              3,073

[[Page 65316]]

 
SSA-21 (U.S. citizens and residents)              1,941                  1                 15                485
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    Totals..........................             38,815  .................  .................              3,559
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    3. Credit Card Payment Form--0960-0648. SSA uses form SSA-1414 to 
process: (1) Credit card payments from former employees and vendors 
with outstanding debts to the agency; (2) advance payments for 
reimbursable agreements; and (3) credit card payments for all Freedom 
of Information Act (FOIA) requests requiring payment. The respondents 
are former employees and vendors who have outstanding debts to the 
agency, entities who have reimbursable agreements with SSA, and 
individuals who request information through FOIA.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                             Average  burden    Estimated total
        Collection instrument             Number of         Frequency of       per response      annual burden
                                          responses           response          (minutes)           (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1414............................              6,000                  1                  2                200
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    4. Benefit Offset National Demonstration--0960-0785. In an effort 
to produce strong evidence about the effectiveness of potential 
solutions that would improve the historically very low rate of return 
to work among SSDI beneficiaries, SSA is currently conducting the 
Benefit Offset National Demonstration (BOND) project. The demonstration 
project will evaluate the result of policy changes and services on the 
Social Security Disability Insurance (SSDI) program.
    Under current law, Social Security beneficiaries lose their SSDI 
benefit if they have earnings and/or work activity above the threshold 
of substantial gainful activity (SGA) after completing the trial work 
period and two-month grace period. The benefit-offset component of this 
demonstration reduces benefits by $1 for each $2 in earnings above the 
BOND threshold, resulting in a gradual reduction in benefits as 
earnings increase.
    BOND tests a benefit offset alone and in conjunction with enhanced 
work incentives counseling. The central research questions include:
     What is the effect of the benefit offset alone on 
employment and other outcomes?
     What is the effect of the benefit offset in combination 
with enhanced work incentives counseling on employment and other 
outcomes?
    The public survey data collections for BOND have four components--
an impact study, a cost-benefit analysis, a participation analysis, and 
a process study. The data collections are a primary source for data to 
measure the effects of a more generous benefit offset and the provision 
of enhanced work incentives counseling on SSDI beneficiaries' work 
efforts and earnings. Ultimately, these data will benefit researchers, 
policy analysts, policy makers, and the United States Congress in a 
wide range of program areas.
    The effects of BOND on the well-being of SSDI beneficiaries could 
manifest themselves in many dimensions and could be relevant to an 
array of other public programs. This project offers the opportunity to 
obtain reliable measures of these effects based upon a nationally 
representative sample. The long-term indirect benefits of this research 
are likely to be substantial. Respondents are SSDI beneficiaries and 
concurrent SSDI and SSI recipients who we randomly assign to the study 
(Stage 1), and SSDI beneficiaries who agree to participate in the study 
(Stage 2).
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                                                       Average burden    Estimated total
                            Survey                                  Number of       Frequency of        Number of       per response      annual burden
                                                                   respondents        response          responses         (minutes)          (hours)
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Participation Agreement.......................................            12,600                 1            12,600                20              4200
Baseline Survey...............................................            12,600                 1            12,600                41             8,610
Interim Survey................................................            10,080                 1            10,080                29             4,872
Stage 1 36-month Survey.......................................             8,000                 1             8,000                49             6,533
Stage 2 36-month Survey.......................................            10,080                 1            10,080                60            10,080
Enhanced Work Incentives Assessment...........................             3,000                 1             3,000                35             1,750
Key Informant Interviews......................................               100                 7               700                60               700
Stage 2 Participant Focus Groups..............................               600                 1               600                90               900
Stage 1 First Contact Letter Survey...........................               500                 1               500                 3                25
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    Totals....................................................            57,560  ................            58,160  ................            37,670
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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 November 21, 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.

[[Page 65317]]

    Claimant's Work Background--20 CFR 404.1565(b) and 20 CFR 
416.965(b)--0960-0300. Sections 205(a) and 1631(e) of the Social 
Security Act provide the Commissioner of Social Security with the 
authority to establish procedures for determining if a claimant is 
entitled to disability benefits. The administrative law judge (ALJ) may 
ask individuals to provide background information on Form HA-4633 about 
work they performed in the past 15 years. The ALJ uses the information 
to assess an individual's disability based on an updated summary of the 
individual's relevant work history. The HA-4633 becomes part of the 
documentary evidence of record. The respondents are claimants for 
disability benefits under title II or title XVI who requested a hearing 
before an ALJ.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                                Estimated total
      Collection instrument            Number of         Frequency of     Average burden per     annual burden
                                       responses           response       response (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
HA-4633.........................            200,000                   1                  15              50,000
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    Dated: October 17, 2011.
Faye Lipsky,
Reports Clearance Officer, Center for Reports Clearance, Social 
Security Administration.
[FR Doc. 2011-27222 Filed 10-19-11; 8:45 am]
BILLING CODE 4191-02-P