[Federal Register Volume 77, Number 9 (Friday, January 13, 2012)]
[Notices]
[Pages 2114-2118]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-580]
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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, information collections in use without an OMB number, and
a new information collection.
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: (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
March 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. Request for Documents or Information--20 CFR 404.703--0960-NEW.
SSA asks individuals applying for Social Security benefits for
additional information when the information they provided is incomplete
or insufficient for us to determine their eligibility for benefits. SSA
uses Form SSA-2118-U2, Request for Documents or Information, to request
the additional documents or information we need to process individuals'
claims for benefits. Respondents are claimants for title II Social
Security Old Age, Survivors, and Disability Insurance (OASDI) benefits.
Type of Request: Existing collection in use without an OMB number.
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Average burden Estimated
Collection instrument Number of Frequency of per response total annual
respondents response (minutes) burden (hours)
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SSA-2118-U2..................................... 7,500 1 5 625
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2. Notice to Show Cause for Failure to Appear--20 CFR 404.938,
416.1438, 404.957(a)(ii)--0960-NEW. In situations where claimants who
requested a hearing before an administrative law judge (ALJ) fail to
appear at their scheduled hearings, the ALJ may reschedule the hearing
if the claimants establish good cause for missing the hearings. The
claimants can provide a reason for not appearing at their scheduled
hearings using Form HA-L90. If the ALJ determines the claimants
established good cause for failure to appear at the hearings, the ALJ
will schedule a supplemental hearing; if not, the ALJ makes a claims
eligibility determination based on the claimants' evidence of record.
Respondents are claimants seeking to show cause for failure to appear
at a scheduled hearing before an ALJ.
Type of Request: Existing collection in use without an OMB number.
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Average burden Estimated total
Collection instrument Number of Frequency of per response annual burden
respondents response (minutes) (hours)
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HA-L90 PDF/Paper............................ 7,000 1 10 1,167
Electronic Records Express.................. 28,000 1 10 4,667
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Total................................... 35,000 ............... ............... 5,834
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3. Permanent Residence in the United States Under Color of Law
(PRUCOL)--20 CFR 416.1615 and 416.1618--0960-0451. As discussed in 20
CFR 416.1415 and 416.1618 of the Code of Federal Regulations, PRUCOL
aliens must present evidence of their alien status when they apply for
Supplemental Security Income (SSI) payments, and periodically
thereafter as part of the eligibility re-determination process for SSI.
SSA verifies the validity of the PRUCOL evidence for grandfathered
nonqualified aliens with the Department of Homeland Security (DHS). SSA
determines whether the individual is PRUCOL based on the DHS response.
Without this information, SSA is unable to determine whether the
individual is eligible for SSI payments. Respondents are qualified and
unqualified aliens who apply for SSI payments under PRUCOL.
Type of Request: Extension of an OMB-approved information
collection.
[[Page 2115]]
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Average burden Estimated total
Collection instrument Number of Frequency of per response annual burden
respondents response (minutes) (hours)
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Personal or Telephone Interview............. 1,300 1 5 108
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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 13, 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. Homeless with Schizophrenia Presumptive Disability Pilot
Demonstration--45 CFR 46.101(b)(5)--0960--NEW. The Federal Strategic
Plan to Prevent and End Homelessness 2010 calls on Federal agencies to
work in partnership with State and local governments and with the
private sector to end homelessness. A specific objective of the
Strategic Plan is to increase economic security by improving access to
mainstream programs and services.
In response to and in support of the President's efforts to end
homelessness, SSA has developed the Homeless with Schizophrenia
Presumptive Disability Pilot Demonstration, which tests both
administrative improvements to the SSI application process and
interventions that provide financial stability to individuals who are
homeless. The pilot will test strategies that would remove the barriers
homeless adult applicants with schizophrenia or schizoaffective
disorder experience when completing the SSI application process.
SSA uses two key forms to conduct the demonstration: The Research
Subject Information and Consent Form and the Schizophrenia Presumptive
Disability Recommendation Form. The consent form provides assurances
from the participants that they understand the demonstration project
and voluntarily are consenting to participate in it. The Presumptive
Disability Recommendation Form, filled out by a medical authority,
provides information on how the applicant meets the disability criteria
necessary to qualify for SSI benefits. SSA uses the information in
making a presumptive disability determination. Respondents are
homeless, adult SSI applicants with schizophrenia or schizoaffective
disorder.
Type of Request: Request for a new information collection.
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Average burden Estimated
Collection instrument Number of Frequency of Number of per response total annual
respondents response responses (minutes) burden (hours)
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Consent Form.................... 200 1 (200) 120 400
PD Recommendation Form.......... 16 13 (208) 10 35
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Totals...................... 216 .............. (408) .............. 435
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2. Partnership Questionnaire--20 CFR 404.1080-1082--0960-0025. SSA
considers partnership income in determining entitlement to Social
Security benefits. SSA uses information from the SSA-7104 to determine
several aspects of eligibility for benefits, including the accuracy of
reported partnership earnings, the veracity of a retirement, and lag
earnings. The respondents are applicants for, and recipients of, title
II Social Security OASDI benefits.
Type of Request: Revision of an OMB-approved information
collection.
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Estimated
Average burden total
Collection instrument Number of Frequency of (Number of per response annual
respondents response responses) (minutes) burden
(hours)
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SSA-7104........................... 12,350 1 30 6,175
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3. 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.{time} 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 an alien 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.
Note: This is a correction notice. SSA published the incorrect
burden information for this collection at 76 FR 65315, on 10/20/11.
We are correcting this error here.
Type of Request: Revision of an OMB-approved information
collection.
[[Page 2116]]
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Estimated
Number of Frequency of Average burden total annual
Collection instrument responses response per response burden
(minutes) (hours)
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SSA-21 (non-residents).......................... 36,874 1 5 3,073
SSA-21 (U.S. citizens and residents)............ 1,941 1 15 485
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Totals...................................... 38,815 .............. .............. 3,558
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4. Statement of Funds You Provided to Another and Statement of
Funds You Received--20 CFR 404.1520(b), 404.1571-.1576, 404.1584-.1593
and 416.971-.976--0960-0059. SSA uses the SSA-821-BK to collect
recipient employment information to determine whether recipients worked
after becoming disabled and, if so, whether the work is substantial
gainful activity (SGA). SSA's field offices use Form SSA-821-BK to
obtain work information during the initial claims process, the
continuing disability review process, and for SSI claims involving work
issues. SSA's processing centers and the Office of Disability and
International Operations use the form to document post-adjudicative
work issues with recipients. SSA reviews and evaluates the data to
determine if the applicant or recipient meets the disability
requirements of the law. The respondents are applicants and recipients
of Title II Social Security and SSI disability payments.
Note: This is a correction notice: SSA published the incorrect
burden information for this collection at 76 FR 68805, on 11/07/11.
We provide the correct burden data below.
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)
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SSA-821-BK.................................. 300,000 1 30 150,000
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5. Application for a Social Security Number Card, and the Social
Security Number Application Process (SSNAP)--20 CFR 422.103-422.110--
0960-0066. SSA collects information on the SS-5 (used in the United
States) and SS-5-FS (used outside the United States) to issue original
or replacement Social Security cards. SSA also enters the application
data into the Social Security Number Application Process (SSNAP) when
applicants request a new or replacement card via telephone or in
person.
In addition, hospitals collect the same information on SSA's behalf
for newborn children through the Enumeration-at-Birth process. In this
process, parents of newborns provide hospital birth registration clerks
with information required to register these newborns. Hospitals send
this information to State Bureaus of Vital Statistics (BVS), and they
send the information to SSA's National Computer Center. SSA then
uploads the data to the SSA mainframe along with all other enumeration
data, and we assign the newborn a Social Security Number (SSN) and
issue a Social Security card.
The respondents for this collection are applicants for original and
replacement Social Security cards who use any of the modalities
described above.
Type of Request: Revision of an OMB-approved information
collection.
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Estimated
Number of Frequency of Average burden total annual
Application scenario respondents response per response burden
(minutes) (hours)
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Respondents who do not have to provide parents' 10,500,000 1 8.5 1,487,500
SSNs..........................................
Respondents whom we ask to provide parents' 400,000 1 9 60,000
SSNs (when applying for original SSN cards for
children under age 18)........................
Applicants age 12 or older who need to answer 1,100,000 1 9.5 174,167
additional questions so SSA can determine
whether we previously assigned an SSN.........
Applicants asking for a replacement SSN card 600 1 60 600
beyond the new allowable limits (i.e., who
must provide additional documentation to
accompany the application)....................
Authorization to SSA to obtain personal 500 1 15 125
information cover letter......................
Authorization to SSA to obtain personal 500 1 15 125
information follow-up cover letter............
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Totals..................................... 12,001,600 .............. ............... 1,722,517
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Cost Burden: The state BVSs incur costs of approximately $9.5
million for transmitting data to SSA's mainframe. However, SSA
reimburses the states for these costs.
6. Application for Search of Census Records for Proof of Age--20
CFR 404.716-0960-0097. When preferred evidence of age is not available
or the available evidence is not convincing, SSA may ask the U.S.
Department of Commerce, Bureau of the Census, to search its records to
establish a claimant's date of birth. SSA collects information from
claimants using Form SSA-1535-U3 to provide the Census Bureau with
sufficient identification information to allow an accurate search of
census records. Additionally, the Census Bureau uses a completed,
signed SSA-1535-U3 to bill SSA for the search. The respondents are
applicants for Social Security benefits who need to
[[Page 2117]]
establish their date of birth as a factor of entitlement.
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)
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SSA-1535-U3................................. 18,030 1 12 3,606
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7. 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 SSI disability
benefits, meets the requirements for presumptive disability payments.
The respondents are the medical sources of the applicants for SSI
disability payments.
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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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8. Modified Benefit Formula Questionnaire--Foreign Pension--0960-
0561. SSA uses Form SSA-308 to determine exactly how much (if any) of a
foreign pension SSA may use to reduce the amount of title II Social
Security retirement or disability benefits under the modified benefit
formula. The respondents are applicants for title II Social Security
retirement or disability benefits who have foreign pensions.
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-308..................................... 13,452 1 10 2,242
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9. Medicare Subsidy Quality Review Forms--20 CFR 418(b)(5)-0960-
0707. The Medicare Modernization Act of 2003 mandated the creation of
the Medicare Part D prescription drug coverage program and provides
certain subsidies for eligible Medicare beneficiaries to help pay for
the cost of prescription drugs. As part of its stewardship duties of
the Medicare Part D subsidy program, SSA must conduct periodic quality
review checks of the information Medicare beneficiaries report on their
subsidy applications (Form SSA-1020). SSA uses the Medicare Quality
Review program to conduct these checks. The respondents are applicants
for the Medicare Part D subsidy whom SSA chose to undergo a quality
review.
Type of Request: Revision of an OMB-approved information
collection.
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Average Estimated
Number of Frequency of burden per total annual
Collection instrument respondents response response burden
(minutes (hours)
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SSA-9301 (Medicare Subsidy Quality Review Case 3,500 1 30 1,750
Analysis Questionnaire)........................
SSA-9302 (Notice of Quality Review 3,500 1 15 875
Acknowledgement Form for those with Phones)....
SSA-9303 (Notice of Quality Review 350 1 15 88
Acknowledgement Form for those without Phones).
SSA-9304 (Checklist of Required Information; .............. .............. .............. ..............
burden accounted for with Forms SSA-9302, SSA-
9303, SSA-9311, SSA-9314)......................
SSA-9308 (Request for Information).............. 7,000 1 15 1,750
SSA-9310 (Request for Documents)................ 3,500 1 5 292
SSA-9311 (Notice of Appointment--Denial-Reviewer 450 1 15 113
Will Call).....................................
SSA-9312 (Notice of Appointment--Denial- Please 50 1 15 13
Call Reviewer).................................
SSA-9313 (Notice of Quality Review 2,500 1 15 625
Acknowledgement Form for those with Phones)....
SSA-9314 (Notice of Quality Review 500 1 15 125
Acknowledgement Form for those without Phones).
[[Page 2118]]
SSA-8510 (Authorization to the Social Security 3,500 1 5 292
Administration to Obtain Personal Information).
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Totals...................................... 24,850 .............. .............. 5,923
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10. Application to Collect a Fee for Payee Service--20 CFR
416.640.640(a), 416.1103(f)--0960-0719. Sections 205(j)(4)(A) and (B)
and 1631(a)(2) of the Social Security Act (Act) allow SSA to authorize
certain organizational representative payees to collect a fee for
providing payee services. Before an organization may collect this fee,
they complete and submit Form SSA-445. SSA uses the information to
determine whether to authorize or deny permission to collect fees for
payee services. The respondents are private sector businesses or State
and local government offices applying to become fee-for-service
organizational representative payees.
Type of Request: Revision of an OMB-approved information
collection.
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Estimated
Number of Frequency of Average burden total annual
Collection instrument responses response per response burden
(minutes) (hours)
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Private sector business......................... 90 1 10 15
State/local government offices.................. 10 1 10 2
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Totals...................................... 100 .............. .............. 17
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Dated: January 10, 2012.
Faye Lipsky,
Reports Clearance Officer, Office of Regulations and Reports Clearance,
Social Security Administration.
[FR Doc. 2012-580 Filed 1-12-12; 8:45 am]
BILLING CODE 4191-02-P