[Federal Register Volume 77, Number 20 (Tuesday, January 31, 2012)]
[Notices]
[Pages 4854-4857]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-1947]


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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 extensions of OMB-approved information 
collections, 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 
April 2, 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. Electronic Health Records Partnering Program Evaluation Form--24 
CFR 495.300-495.370--0960-New. The Health Information Technology for 
Economic and Clinical Health (HITECH) Act promotes the adoption and 
meaningful use of health information technology (IT), particularly in 
the context of working with government agencies. Similarly, Section 
3004 of the Public Health Service Act requires health care providers or 
health insurance issuers with government contracts to implement, 
acquire, or upgrade their health IT systems and

[[Page 4855]]

products to meet adopted standards and implementation specifications. 
To support expansion of SSA's health IT initiative as defined under 
HITECH, SSA developed Form SSA-680, the Partnering Program Evaluation 
Form. The SSA-680 allows healthcare providers to provide the 
information SSA needs to determine their ability to exchange health 
information with us electronically. We intend to evaluate potential 
partners (i.e., healthcare providers and organizations) on (1) the 
accessibility of the health information they possess and (2) the 
content value of their electronic health records' systems for our 
disability adjudication processes. SSA reviews the completeness of 
organizations' SSA-680 responses as one part of our careful analysis of 
their readiness to enter into a health IT partnership with us. The 
respondents are healthcare providers and organizations exchanging 
information with the agency.
    Type of Request: This is a new information collection request.

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                                                                                 Average burden  Estimated total
            Collection instrument                Number of       Frequency of    per  response    annual burden
                                                 responses         response         (hours)          (hours)
----------------------------------------------------------------------------------------------------------------
SSA-680.....................................              30                1                5              150
----------------------------------------------------------------------------------------------------------------

    2. Third Party Liability Information Statement--42 CFR 433.136-
433.139--0960-0323. To reduce Medicaid costs, Medicaid state agencies 
must identify third party insurers liable for medical care or services 
for Medicaid beneficiaries. Regulations at 42 CFR 433.136-433.139 
require Medicaid state agencies to obtain this information on Medicaid 
applications and redeterminations as a condition of Medicaid 
eligibility. States may enter into agreements with the Commissioner of 
Social Security to make Medicaid eligibility determinations for aged, 
blind, and disabled beneficiaries in those states. Applications for and 
redeterminations of Supplemental Security Income (SSI) eligibility in 
jurisdictions with such agreements are applications and 
redeterminations of Medicaid eligibility. Under these agreements, SSA 
obtains third party liability information using Form SSA-8019, and 
provides that information to the Medicaid state agencies. The Medicaid 
state agencies use the information to bill third parties liable for 
medical care, support, or services for a beneficiary to guarantee that 
Medicaid remains the payer of last resort. The respondents are SSI 
claimants and recipients.
    Type of Request: Extension 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)
----------------------------------------------------------------------------------------------------------------
SSA-8012 Paper form.............................             130               1               5              11
SSA Intranet Modernized SSI Claims System                 66,904               1               5           5,575
 (MSSICS).......................................
                                                 ---------------------------------------------------------------
    Totals......................................          67,034  ..............  ..............           5,586
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    3. Prohibition of Payment of SSI Benefits to Fugitive Felons and 
Parole/Probation Violators--20 CFR 416.708(o)--0960-0617. Section 
1611(e)(4) of the Social Security Act (Act) precludes eligibility for 
SSI payments for certain fugitives and probation/parole violators. 
Regulations at 20 CFR 416.708(o) require individuals applying for or 
receiving SSI benefits to report to SSA that (1) they are fleeing to 
avoid prosecution for a crime; (2) they are fleeing to avoid custody or 
confinement after conviction of a crime; or (3) they are violating a 
condition of probation or parole. SSA will use the information we 
receive to deny eligibility, or suspend recipients SSI payments. The 
respondents are SSI applicants and recipients, or representative payees 
of SSI applicants and recipients, who are reporting their status as a 
fugitive felon or probation/parole violator.
    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
                                                 responses         response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
MSSICS......................................           1,000                1                1               17
----------------------------------------------------------------------------------------------------------------

    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 March 1, 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. Statement of Marital Relationship (By one of the parties)--20 
CFR 404.726--0960-0038. SSA must obtain a signed statement from a 
spousal applicant if the applicant claims a common-law marriage to the 
insured in a state in which such marriages are recognized, and no 
formal marriage documentation exists. SSA uses information we collect 
on Form SSA-754-F4 to determine if an individual applying for spousal 
benefits meets the criteria of common-law marriage under state law. The 
respondents are applicants for spouse's Social Security benefits or SSI 
payments.

[[Page 4856]]

    This is a correction notice. SSA published this information 
collection as an extension on November 16, 2011 at 76 FR 71105. Since 
we are revising the Privacy Act Statement, this is actually a revision 
of an OMB-approved information collection.
    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-754-F4..................................          30,000                1               30           15,000
----------------------------------------------------------------------------------------------------------------

    2. Medicaid Use Report--20 CFR 416.268--0960-0267. Section 20 CFR 
416.268 of the Code of Federal Regulations requires SSA to determine 
eligibility for (1) special SSI cash payments and (2) special SSI 
eligibility status for a person who works despite a disabling 
condition. It also explains how, in order to qualify for special SSI 
eligibility status, an individual must establish that termination of 
eligibility for benefits under title XIX of the Act would seriously 
inhibit the ability to continue employment. SSA uses the information 
required by this regulation to determine if an individual is entitled 
to special title XVI SSI payments and, consequently, to Medicaid. The 
respondents are SSI recipients for whom SSA has stopped payments based 
on earnings.
    Type of Request: Extension of an OMB-approved information 
collection.

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                                                                                 Average burden  Estimated total
             Regulation section                  Number of       Frequency of    per  response    annual burden
                                                 responses         response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
20 CFR 416.268..............................          60,000                1                3            3,000
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    3. Supplemental Security Income (SSI) Claim Information Notice--20 
CFR 416.210--0960-0324. Section 1611(e)(2) of the Act requires 
individuals to file for and obtain all payments (annuities, pensions, 
disability benefits, veteran's compensation, etc.) for which they are 
eligible before qualifying for SSI payments. Individuals do not qualify 
for SSI if they do not first apply for all other benefits. SSA uses the 
information on Form SSA-L8050-U3 to verify and establish a claimant's 
or recipient's eligibility under the SSI program. Respondents are SSI 
applicants or recipients who may be eligible for other payments from 
public or private programs.
    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-L-8050-U3...............................           7,500                1               10            1,250
----------------------------------------------------------------------------------------------------------------

    4. Filing Claims Under the Federal Tort Claims Act--20 CFR 429.101-
429.110--0960-0667. The Federal Tort Claims Act is the legal mechanism 
for compensating persons injured by negligent or wrongful acts that 
occur during the performance of official duties by Federal employees. 
In accordance with the law, SSA accepts monetary claims filed under the 
Federal Tort Claims Act for damages against the United States, loss of 
property, personal injury, or death resulting from an SSA employee's 
wrongful act or omission. The regulation sections this information 
collection comprises require claimants to provide information SSA can 
use to investigate and determine whether to make an award, compromise, 
or settlement under the Federal Tort Claims Act. The respondents are 
individuals or entities making a claim under the Federal Tort Claims 
Act.
    Type of Request: Extension of an OMB-approved information 
collection.

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                                                                                                     Estimated
                                                     Number of     Frequency of   Average burden   total annual
               Regulation section                    responses       response      per  response      burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
20 CFR 429.102; 20 CFR 492.103 \1\..............              --              --              --               1
20 CFR 429.104(a)...............................              31               1               5               3
20 CFR 429.104(b)...............................              25               1               5               2
20 CFR 429.104(c)...............................               2               1               5             .17
20 CFR 429.106(b)...............................              10               1              10               2
                                                 ---------------------------------------------------------------
    Totals......................................              68  ..............  ..............               8
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\1\ The 1 hour represents a placeholder burden. We are not reporting a burden for this collection because
  respondents complete OMB-approved Form SF-95 (OMB Control 1105-0008).



[[Page 4857]]

    Dated: January 25, 2012.
Faye Lipsky,
Reports Clearance Officer, Office of Regulations and Reports Clearance, 
Social Security Administration.
[FR Doc. 2012-1947 Filed 1-30-12; 8:45 am]
BILLING CODE 4191-02-P