[Federal Register Volume 77, Number 1 (Tuesday, January 3, 2012)]
[Notices]
[Pages 147-150]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-33627]


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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 104-13, the 
Paperwork Reduction Act (PRA) of 1995, effective October 1, 1995. This 
notice includes revisions and one extension 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 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, 1333 Annex Building, 6401 Security Blvd., Baltimore, MD 21235, 
Fax: (410) 965-6400, 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 
March 5, 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 Parent's Insurance Benefits--20 CFR 404.370-
404.374, 20 CFR 404.601-404.603--0960-0012. Section 202(h) of the 
Social Security Act establishes the conditions of eligibility a 
claimant must meet to receive monthly benefits as a parent of a 
deceased worker. SSA uses information from form SSA-7-F6 to determine 
whether the claimant meets the eligibility and application criteria. 
The respondents are applicants for, and recipients of, Social Security 
Old Age, Survivors, and Disability Insurance benefits.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                  Average burden     Estimated
                Collection method                    Number of     Frequency of    per response    total annual
                                                    respondents      response        (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
Modernized Claims System (MCS)..................             153               1              15              38
MCS/Signature Proxy.............................             158               1              14              37
Paper SSA-7-F6..................................               4               1              15               1
                                                 ---------------------------------------------------------------
    Total.......................................             315  ..............  ..............              76
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    2. Statement of Living Arrangements, In-Kind Support and 
Maintenance--20 CFR 416.1130-416.1148--0960-0174. A recipient's need is 
the basis for determining Supplemental Security Income (SSI) payment 
amounts. Need is measured, in part, by the amount of income an 
individual receives. Income includes in-kind support and maintenance in 
the form of food and shelter provided by other persons. SSA uses 
information from form SSA-8006-F4 to determine if in-kind support and 
maintenance exists for SSI applicants and recipients. This information 
also assists SSA in determining the income value of in-kind support and 
maintenance SSI applicants and recipients receive. The respondents are 
individuals who apply for SSI, or who complete an SSI eligibility 
redetermination.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                 Average burden  Estimated total
              Collection method                  Number of       Frequency of     per response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-8006-F4.................................         173,380                1                7           20,228
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    3. Application for Supplemental Security Income--20 CFR 416.305-
416.335, Subpart C--0960-0444. SSA collects information on the SSA-
8001-BK to determine an applicant's eligibility for SSI and the SSI 
payment amounts. SSA employees also collect this information during 
interviews with members of the public who wish to file for SSI. SSA 
uses the information for two purposes: (1) To formally deny SSI for 
non-medical reasons when

[[Page 148]]

information the applicant provides results in ineligibility; or (2) to 
establish a disability claim, but defer the complete development of 
non-medical issues until SSA approves the disability. The respondents 
are applicants for SSI.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                  Average burden     Estimated
                Collection method                    Number of     Frequency of    per response    total annual
                                                    respondents      response        (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
Modernized SSI Claims System (MSSICS)...........       1,006,400               1              15         251,600
MSSICS/Signature Proxy..........................         326,400               1              14          76,160
Paper SSA-8001-BK...............................          27,200               1              18           8,160
                                                 ---------------------------------------------------------------
    Total.......................................       1,360,000  ..............  ..............         335,920
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    4. Statement of Funds You Provided to Another and Statement of 
Funds You Received--20 CFR 416.1103(f)--0960-0481. SSA uses forms SSA-
2854 and SSA-2855 to gather information to verify if a loan is bona 
fide for SSI recipients. The SSA-2854 asks the lender for details on 
the transaction, and form SSA-2855 asks the borrower the same basic 
questions independently. Agency personnel then compare the two 
statements, gather evidence if needed, and make a decision on the 
validity of the bona fide status of the loan.
    For SSI purposes, we consider a loan bona fide if it meets these 
requirements:
     Must be between a borrower and lender with the 
understanding that the borrower has an obligation to repay the money;
     Must be in effect at the time the cash goes to the 
borrower, that is, the agreement cannot come after the cash is paid; 
and
     Must be enforceable under State law, often there are 
additional requirements from the State.
    In addition to these elements: (1) There must be an understanding 
between borrower and lender that the borrower is obligated to repay the 
money; (2) the loan agreement must be in effect at the time the 
borrower receives the cash proceeds; and, (3) the transaction must be 
enforceable under State law. State requirements generally demand the 
presence of other conditions before the agreement is a bona fide loan.
    SSA collects this information at the time of initial application 
for SSI or at any point when an individual alleges being party to an 
informal loan while receiving SSI. SSA collects information on the 
informal loan through both interviews and mailed forms. The agency's 
field personnel conduct the interviews and mail the form(s) for 
completion, as needed. The respondents are SSI recipients and 
applicants, and individuals who lend money to them.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                  Average burden     Estimated
                Collection method                    Number of     Frequency of    per response    total annual
                                                    respondents      response        (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-2854........................................          20,000               1              10           3,333
SSA-2855........................................          20,000               1              10           3,333
                                                 ---------------------------------------------------------------
    Total.......................................          40,000  ..............  ..............           6,666
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    5. Certification of Low Birth Weight for SSI Eligibility--20 CFR 
416.931, 416.926a(m), and 416.924--0960-0720. Hospitals and claimants 
use form SSA-3380 to provide medical information to local field offices 
(FO) and State Disability Determination Services (DDSs) on behalf of 
infants with low birth weight. FOs use the form as a protective filing 
statement and the medical information to make presumptive disability 
findings, which allow expedited payment to eligible claimants. DDSs use 
the medical information to determine disability and continuing 
disability. The respondents are hospitals and claimants who have 
information identifying low birth weight babies and their medical 
conditions.
    Type of Request: Extension of an OMB-approved information 
collection.

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                                                                                 Average burden  Estimated total
              Collection method                  Number of       Frequency of     per response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3380....................................          24,000                1               15            6,000
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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 February 2, 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. 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

[[Page 149]]

(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 of 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.

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                                                                                  Average burden     Estimated
                 Respondent type                     Number of     Frequency of    per response    total annual
                                                    respondents      response        (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
Non-Federal employee............................              10               1              30               5
Non-Federal employer signers....................              20               1               5               2
                                                 ---------------------------------------------------------------
    Total.......................................              30  ..............  ..............               7
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    2. 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 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.

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                                                                                                                         Average burden  Estimated total
                         Collection method                              Number of       Frequency of      Number of      per  response    annual burden
                                                                       respondents        response        responses        (minutes)         (hours)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Reply Cards........................................................           1,000                2            2,000                1               33
--------------------------------------------------------------------------------------------------------------------------------------------------------

    3. Credit Card Payment Form--0960-0648. SSA uses the 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
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1414....................................           6,000                1                2              200
----------------------------------------------------------------------------------------------------------------

    4. Medical Source Statement of Ability To Do Work-Related 
Activities (Physical and Mental)--20 CFR 404.1512-404.1513, 404.912-
404.913, 404.1517, 416.917-0960 0662. In some instances, when a 
claimant appeals a denied disability claim and the claimant's medical 
sources cannot or will not give the agency sufficient evidence to 
determine whether the claimant is disabled, SSA may ask the claimant to 
have a consultative examination at the agency's expense. The medical 
providers who perform these consultative examinations provide a 
statement on forms HA-1151 and HA-1152 about the claimant's disability 
and ability to perform work-related activities. SSA uses the 
information to assess the work-related physical and mental capabilities 
of claimants who appeal SSA's previous determination on their issue of 
disability. The respondents are medical sources who provide reports 
based either on existing medical evidence or on consultative 
examinations.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                  Average burden     Estimated
        Collection method            Number of     Frequency of      Number of     per response    total annual
                                    respondents      response        responses       (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
HA-1151.........................           5,000              24         120,000              15          30,000
HA-1152.........................           5,000              24         120,000              15          30,000
----------------------------------------------------------------------------------------------------------------
    Total.......................          10,000  ..............         240,000  ..............          60,000
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[[Page 150]]

    Dated: December 28, 2011.
Naomi Sipple,
Management Analyst, Office of Regulations and Reports Clearance, Social 
Security Administration.
[FR Doc. 2011-33627 Filed 12-30-11; 8:45 am]
BILLING CODE 4191-02-P