[Federal Register Volume 77, Number 27 (Thursday, February 9, 2012)]
[Notices]
[Pages 6853-6855]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-2962]


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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 of 1995, effective October 1, 1995. This notice 
includes revisions 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,

[[Page 6854]]

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 9, 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 Withdrawal of Application--20 CFR 404.640--0960-
0015. Form SSA-521 documents the information SSA needs to process the 
withdrawal of an application for benefits. A paper SSA-521 is the 
preferred instrument for executing a withdrawal request; however, any 
written request for withdrawal signed by the claimant or a proper 
applicant on the claimant's behalf will suffice. Individuals who wish 
to withdraw their applications for benefits complete Form SSA-521, or 
sign the completed form for each request to withdraw. SSA uses the 
information from the SSA-521 to process the request for withdrawal. The 
respondents are applicants for Retirement, Survivors, Disability, and 
Health Insurance benefits.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                  Average burden     Estimated
              Collection instrument                  Number of     Frequency of    per response    total annual
                                                    respondents      response        (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-521.........................................          39,000               1               5           3,250
----------------------------------------------------------------------------------------------------------------

    2. Request for Reconsideration--Disability Cessation--20 CFR 
404.909, 416.1409--0960-0349. SSA uses Form SSA-789-U4 to arrange for a 
hearing or to prepare a decision based on the evidence of record. 
Specifically, claimants or their representatives use Form SSA-789-U4 to 
(1) ask SSA to reconsider a determination; (2) indicate if they wish to 
appear at a disability hearing; (3) submit any additional information 
or evidence for use in the reconsidered determination; and (4) indicate 
if they will need an interpreter for the hearing. The respondents are 
applicants or claimants for Social Security benefits or Supplemental 
Security Income payments.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                  Average burden     Estimated
              Collection instrument                  Number of     Frequency of    per response    total annual
                                                    respondents      response        (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-789-U4......................................          30,000               1              13           6,500
----------------------------------------------------------------------------------------------------------------

    II. SSA submitted the information collections 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 March 12, 2012. 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 email address.
    Workers' Compensation/Public Disability Questionnaire--20 CFR 
404.408--0960-0247. Section 224 of the Social Security Act provides for 
the reduction of disability insurance benefits (DIB) when the 
combination of DIB and any workers' compensation (WC) or certain 
Federal, State or local public disability benefits (PDB) exceeds 80 
percent of the worker's pre-disability earnings. SSA uses Form SSA-546 
to collect the data necessary to determine if the worker's receipt of 
WC or PDB payments should cause a reduction of DIB. The respondents are 
applicants for title II DIB.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                  Average burden     Estimated
              Collection instrument                  Number of     Frequency of    per response    total annual
                                                     responses       response        (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-546 (Paper form)............................           2,000               1              15             500
MCS.............................................         248,000               1              15          62,000
                                                 ---------------------------------------------------------------
    Totals......................................         250,000  ..............  ..............          62,500
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[[Page 6855]]

    Dated: February 6, 2012.
Faye Lipsky,
Reports Clearance Officer, Office of Regulations and Reports Clearance, 
Social Security Administration.
[FR Doc. 2012-2962 Filed 2-8-12; 8:45 am]
BILLING CODE 4191-02-P