[Federal Register Volume 77, Number 131 (Monday, July 9, 2012)]
[Notices]
[Pages 40400-40401]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-16634]


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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, 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 
Director, 107 Altmeyer Building, 6401 Security Blvd., Baltimore, MD 
21235, Fax: 410-966-2830, Email address: [email protected].

    I. The information collection below is pending at SSA. SSA will 
submit it 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 
September 7, 2012. Individuals can obtain copies of the collection 
instrument by writing to the above email address.
    Statement of Employer--20 CFR 404.801-404.803--0960-0030. When 
workers report they were paid wages but cannot provide proof of those 
earnings, and the wages do not appear in SSA's records of earnings, SSA 
uses form SSA-7011-F4 to document the alleged wages. Specifically, the 
agency uses the form to resolve discrepancies in the individual's 
Social Security earnings record and to process claims for Social 
Security benefits. We only send Form SSA-7011-F4 to employers if we are 
unable to locate the earnings information in our own records. The 
respondents are employers who can verify wage allegations made by wage 
earners.
    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)
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SSA-7011-F4.................................         462,000                1               20          154,000
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    II. SSA submitted the information collection 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 August 8, 2012. Individuals can obtain copies of the 
OMB clearance package by writing to [email protected].
    Request for Workers' Compensation/Public Disability Benefit 
Information--20 CFR 404.408(e)--0960-0098. Claimants for Social 
Security disability payments who are also receiving Worker's 
Compensation/Public Disability Benefits (WC/PDB) must notify SSA about 
their WC/PDB, so the agency can reduce claimants' Social Security 
disability payments accordingly. If claimants provide necessary 
evidence, such as a copy of

[[Page 40401]]

their award notice, benefit check, etc., that is sufficient 
verification. In cases where claimants cannot provide such evidence, 
SSA uses Form SSA-1709. The entity paying the WC/PDB benefits, its 
agent, (such as an insurance carrier), or an administering public 
agency complete this form. The respondents are Federal, State, and 
local agencies, insurance carriers, and public or private self-insured 
companies administering WC/PDB benefits to disability claimants.
    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-1709....................................         120,000                1               15           30,000
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    Dated: July 3, 2012.
Faye Lipsky,
Reports Clearance Director, Office of Regulations and Reports 
Clearance, Social Security Administration.
[FR Doc. 2012-16634 Filed 7-6-12; 8:45 am]
BILLING CODE 4191-02-P