[Federal Register Volume 76, Number 241 (Thursday, December 15, 2011)]
[Notices]
[Pages 78068-78072]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-32145]


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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 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, 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, Email address: [email protected].
(SSA), Social Security Administration, DCRDP, Attn: Reports Clearance 
Officer, 107 Altmeyer Building, 6401 Security Blvd., Baltimore, MD 
21235, Fax No.: (410) 966-2830, Email 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 
February 13, 2012. 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. Application for Mother's or Father's Insurance Benefits--20 CFR 
404.339-404.342, 20 CFR 404.601-404.603--0960-0003. Section 202(g) of 
the Social Security Act (Act) provides for the payment of monthly 
benefits to the widow or widower of an insured individual if the 
surviving spouse is caring for the deceased worker's child (who is 
entitled to Social Security benefits). SSA uses the information on Form 
SSA-5-F6 to determine an individual's eligibility for mother's or 
father's insurance benefits. The respondents are individuals caring for 
a child of the deceased worker who is applying for mother's or father's 
insurance benefits under the Old Age, Survivors, and Disability 
Insurance (OASDI) program.
    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
                                             respondents        response          (minutes)          (hours)
----------------------------------------------------------------------------------------------------------------
SSA-5-F6 (paper)........................             1,611                 1                15               403
MCS.....................................            26,045                 1                15             6,511
MCS/Signature Proxy.....................            26,044                 1                15             6,511
                                         -----------------------------------------------------------------------
    Total...............................            53,700  ................  ................            13,425
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    2. Letter to Employer Requesting Information About Wages Earned by 
Beneficiary--20 CFR 416.703 & 404.801--0960-0034. SSA uses information 
from Form SSA-L725 to verify a beneficiary's wages when SSA has 
incomplete or questionable wage data. SSA uses the information to 
calculate the correct amount of benefits payable, and to maintain an 
accurate record of earnings for the beneficiary. Respondents are 
employers who provide information SSA needs to establish specific 
monthly earnings.
    Type of Request: Extension of an OMB-approved information 
collection.

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                                                                              Average burden    Estimated total
        Collection instrument             Number of         Frequency of       per response      annual burden
                                         respondents          response          (minutes)           (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L725............................           150,000                  1                 40            100,000
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[[Page 78069]]

    3. Student Reporting Form--20 CFR 404.367 & 20 CFR 404.368--0960-
0088. Sections 20 CFR 404.367 and 20 CFR 404.368 mandate that a student 
beneficiary be in full-time attendance at an educational institution to 
qualify for student Social Security benefits. SSA requires 
beneficiaries to report events that may cause a reduction, termination, 
or suspension of their benefits. Using the information from Form SSA-
1383, SSA determines if the change or event reported affects continuing 
entitlement to SSA benefits. In addition, SSA uses the information to 
determine the correct benefit amounts for student beneficiaries. The 
respondents are Social Security student beneficiaries.
    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
                                             respondents        response          (minutes)          (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1383................................            74,887                 1                 6             7,489
SSA-1383-FC.............................               113                 1                 6                11
                                         -----------------------------------------------------------------------
    Total...............................            75,000  ................  ................             7,500
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    4. Letter to Employer Requesting Wage Information--20 CFR 404.726--
0960-0138. SSA must establish and verify wage information for 
Supplemental Security Income (SSI) applicants and recipients when 
determining SSI eligibility and payment amounts. SSA uses Form SSA-
L4201 to collect this information. SSA uses the information to 
determine eligibility and proper payment amounts for SSI applicants and 
recipients. The respondents are employers of SSI applicants and 
recipients.
    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
                                         respondents          response          (minutes)           (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L4201...........................           133,000                  1                 30             66,500
----------------------------------------------------------------------------------------------------------------

    5. Claimant's Recent Medical Treatment--20 CFR 404.1512 and 
416.912--0960-0292. When Disability Determination Services deny a claim 
at the reconsideration level, the claimant has a right to request a 
hearing before an administrative law judge (ALJ). For the hearing, SSA 
asks the claimant to 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. Through this process, ALJs can ascertain 
whether the claimant's situation has changed. The ALJs and hearing 
office staff use the response to make arrangements for consultative 
examination(s) and the attendance of an expert witness(es), if 
appropriate. During the hearing, the ALJs offer any completed 
questionnaires as exhibits and may use them to refresh the claimant's 
memory and to shape their questions. The respondents are claimants 
requesting hearings on entitlement to Old Age, Survivors, and 
Disability Insurance (OASDI) benefits or SSI payments.
    Type of Request: Extension of an OMB-approved information 
collection.

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                                                                              Average burden    Estimated total
        Collection instrument             Number of         Frequency of       per response      annual burden
                                         respondents          response          (minutes)           (hours)
----------------------------------------------------------------------------------------------------------------
HA-4631.............................           200,000                  1                 10             33,333
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    6. You Can Make Your Payment by Credit Card--0960-0462. Using 
information from Form SSA-4588 and its electronic application, form 
SSA-4589, SSA updates individuals' Social Security records to reflect 
payments made on their overpayments. In addition, SSA uses this 
information to process payments through the appropriate credit card 
company. SSA provides the SSA-4588 when we inform an individual that we 
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 SSA-4589 electronic intranet application only when 
individuals choose to telephone the Program Service Centers to make a 
one-time payment in lieu of completing Form SSA-4588. An SSA debtor 
contact representative completes the SSA-4589 electronic intranet 
application. Respondents are OASDI beneficiaries and SSI recipients who 
owe outstanding overpayments to SSA.
    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
                                             respondents        response          (minutes)          (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4588 Paper Form.....................            13,200                 1                10             2,200
SSA-4589 Electronic Intranet Application           171,320                 1                 5            14,277
                                         -----------------------------------------------------------------------
    Total...............................           184,520  ................  ................            16,477
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[[Page 78070]]

    7. Request for Internet Services--Password Authentication--20 CFR 
401.45--0960-0632. SSA uses a password infrastructure and process to 
verify the identity of individuals who choose to use the Internet to 
conduct personal business with SSA electronically. To obtain a password 
from SSA's Individual Password Services, we ask an individual for 
certain information prescribed by SSA. SSA uses the information to 
authenticate individuals prior to issuing a temporary password. Once 
SSA authenticates individuals, and these individuals create a permanent 
password, they may use SSA's password protected services, e.g., account 
status, change of address, direct deposit elections, or changes. The 
respondents are individuals electing to do personal business with SSA 
electronically.
    Type of Request: Extension of an OMB-approved information 
collection.

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                                                                               Average burden    Estimated total
          Collection instrument               Number of       Frequency of      per response      annual burden
                                             respondents        response          (minutes)          (hours)
----------------------------------------------------------------------------------------------------------------
Internet Requestors.....................         3,092,069                 1                10           515,345
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    II. SSA submitted the information collections below to OMB for 
clearance. Your comments regarding 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 January 17, 2012. Individuals can obtain copies of 
the OMB clearance packages by calling the SSA Reports Clearance Officer 
at (410) 965-8783 or by writing to the above email address.
    1. Coverage of Employees of State and Local Governments--20 CFR 
404, Subpart M--0960-0425. Regulation section 20 CFR 404, Subpart M, 
prescribes the rules for states submitting reports of deposits and 
recordkeeping to SSA. SSA requires states (and interstate 
instrumentalities) to provide wage and deposit contribution information 
for pre-1987 periods. Not all states have completely satisfied their 
pending wage report and contribution liability with SSA for pre-1987 
tax years. SSA needs these regulations 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          (minutes)          (hours)
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404.1204(a) & (b).......................                52                 1                30                26
404.1215................................                52                 1                60                52
404.1216(a) & (b).......................                52                 1                60                52
                                         -----------------------------------------------------------------------
    Total...............................               156  ................  ................               130
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    2. SSI Notice of Interim Assistance Reimbursement (IAR)--0960-0546. 
Section 1631(g) of the Act authorizes SSA to reimburse an IAR agency 
from an individual's retroactive SSI payment for assistance the IAR 
agency gave the individual for meeting basic needs while an SSI claim 
was pending or SSI payments were suspended or terminated. The State or 
local agency needs an IAR agreement with SSA to participate in the IAR 
program. The individual receiving the IAR payment signs an 
authorization form with an IAR agency to allow SSA to repay the IAR 
agency for funds paid in advance prior to SSA's determination on the 
individual's claim. The authorization represents the individual's 
intent to file for SSI, if they did not file an application prior to 
SSA receiving the authorization. Agencies who wish to enter into an IAR 
agreement with SSA need to meet the following requirements:
    (a) Reporting Requirements--Each IAR agency agrees to:
    (1) Notify SSA of receipt of an authorization for initial claims or 
cases they are appealing, and submit a copy of that authorization 
either through a manual or electronic process;
    (2) Inform SSA of the amount of reimbursement;
    (3) Submit a written request for dispute resolution on a 
determination;
    (4) Notify SSA of interim assistance paid (using the SSA-8125 or 
the
    SSA-L8125-F6);
    (5) Inform SSA of any deceased claimants who participated in the 
IAR program and;
    (6) Review and sign an agreement with SSA.
    (b) Recordkeeping Requirements--The IAR agencies agree to retain 
all notices, agreement, authorizations, and accounting forms for the 
period defined in the IAR agreement for the purposes of SSA verifying 
transactions covered under the agreement.
    (c) Third Party Disclosure Requirements--Each participating IAR 
agency agrees to send written notices from the IAR agency to the 
recipient regarding payment amounts and appeal rights.
    (d) Periodic Review of Agency Accounting Process--The IAR agency 
makes the IAR accounting records of paid cases available for SSA review 
and verification. SSA conducts reviews either onsite or through the 
mail of the authorization forms, notices to the claimant, and 
accounting forms. Upon completion of the review, SSA provides a written 
report of findings to the IAR agency director.
    The respondents are State IAR officers.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 78071]]



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                                                                                      Average        Estimated
                                  Number of       Frequency of      Number of       burden per     total annual
       Type of request           respondents        response        responses        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
                                             Reporting Requirements
----------------------------------------------------------------------------------------------------------------
(a) State notification of      11.............  Once per SSI     97,330.........               1           1,622
 receipt of authorization                        Claimant.
 (electronic process).
(b) State submission of copy   27.............  Once per SSI     68,405.........               3           3,420
 of authorization (manual                        Claimant.
 process).
(c) State submission of        38.............  Once per SSI     101,352........               8          13,514
 amount of IA paid to                            Claimant.
 recipients (using eIAR).
(d) State request for          Average is       As needed......  2..............              30               1
 determination--dispute         about 2 States
 resolution.                    per year.
(e) State computation of       38.............  Once per SSI     1,524..........              30             762
 reimbursement due form SSA                      Claimant.
 using paper Form
 SSA[dash]L8125-F6.
(f) State notification to SSA  20.............  As needed when   40.............              15              10
 of deceased claimant.                           SSI claimant
                                                 dies while
                                                 claim is
                                                 pending.
(g) State reviewing/signing    38.............  Once during      38.............              12             456
 of IAR Agreement.                               life of the
                                                 IAR agreement.
----------------------------------------------------------------------------------------------------------------
                                           Recordkeeping Requirements
----------------------------------------------------------------------------------------------------------------
(h) Maintenance of             38.............  One form per     165,735                       3           8,287
 authorization forms.                            SSI claimant.    (includes both
                                                                  denied and
                                                                  approved SSI
                                                                  claims).
(i) Maintenance of accounting  38.............  One set per SSI  101,352........               3           5,068
 forms and notices.                              claimant.
----------------------------------------------------------------------------------------------------------------
                                       Third Party Disclosure Requirements
----------------------------------------------------------------------------------------------------------------
(j) Written notice from State  38.............  Once per SSI     101,352........               7          11,824
 to recipient regarding                          claimant.
 amount of payment.
----------------------------------------------------------------------------------------------------------------
                                  Periodic Review of Agency Accounting Process
----------------------------------------------------------------------------------------------------------------
(k) Retrieve and consolidate   12.............  One set of       12.............         3 hours              36
 authorization and accounting                    forms per SSI
 forms.                                          claimant for
                                                 review by SSA
                                                 once every 2
                                                 to 3 years.
(l) Participate in periodic    12.............  For review by    12.............        16 hours             192
 review.                                         SSA once every
                                                 2 to 3 years.
(m) Correct administrative     6..............  To correct       6..............         4 hours              24
 and accounting discrepancies.                   errors
                                                 discovered by
                                                 SSA in
                                                 periodic
                                                 review.
----------------------------------------------------------------------------------------------------------------
                                           Total Administrative Burden
----------------------------------------------------------------------------------------------------------------
    Total....................  38.............  varies.........  637,160........          varies          45,216
----------------------------------------------------------------------------------------------------------------

    3. 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.

    Note:  This is a correction notice. SSA published this 
information collection as an extension on September 23, 2011 at 76 
FR 59180. 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.


[[Page 78072]]



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                                                                                      Average        Estimated
                                                     Number of     Frequency of     burden per     total annual
              Collection instrument                 respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1026-OCR-MS-SCE.............................          11,400               1              18           3,420
SSA-1026-OCR-SM-REDE............................         225,000               1              18          67,500
                                                 ---------------------------------------------------------------
    Total.......................................         236,400  ..............  ..............          70,920
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    Dated: December 12, 2011.
Faye Lipsky,
Reports Clearance Officer, Center for Reports Clearance, Social 
Security Administration.
[FR Doc. 2011-32145 Filed 12-14-11; 8:45 am]
BILLING CODE 4191-02-P