[Federal Register Volume 77, Number 185 (Monday, September 24, 2012)]
[Notices]
[Pages 58903-58906]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-23441]


=======================================================================
-----------------------------------------------------------------------

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 to 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,

[[Page 58904]]

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 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 
November 23, 2012. Individuals can obtain copies of the collection 
instruments by writing to the above email address.
    1. Reporting Changes that Affect Your Social Security Payment--20 
CFR 404.301-305, 404.310-311, 404.330-.333, 404.335-.341, 404.350-.352, 
and 404.468--0960-0073. When Social Security benefits recipients 
experience a change that could affect their payments, they must report 
these changes to SSA. Title II beneficiaries in this category use form 
SSA-1425 to report the relevant information to SSA; the agency then 
determines if the respondents continue to be entitled to benefits, and 
if so, the proper amount of these benefits. The respondents are Social 
Security beneficiaries receiving Title II SSA retirement, disability, 
or survivor's auxiliary benefits who need to report an event that could 
affect their payments.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden  Estimated total
           Modality of completion                Number of       Frequency of    per  response    annual burden
                                                 responses         response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1425....................................          70,000                1                5            5,833
----------------------------------------------------------------------------------------------------------------

    2. Privacy and Disclosure of Official Records and Information; 
Availability of Information and Records to the Public--20 CFR 
401.40(b)&(c), 401.55(b), 401.100(a), 402.130, 402.185--0960-0566. SSA 
has established methods for the public to: (1) Access their SSA 
records; (2) allow SSA to disclose records; (3) correct or amend their 
SSA records; (4) consent to release of their records; (5) request 
records under the Freedom of Information Act (FOIA); and (6) request 
SSA waive or reduce fees normally charges for release of FOIA. SSA 
often collects the necessary information for these requests through a 
written letter, with the exception of the consent for release of 
records, for which there is the Form SSA-3288. The respondents are 
individuals requesting access to, correction of, or disclosure of SSA 
records.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden  Estimated total
           Modality of completion                Number of       Frequency of    per  response    annual burden
                                                 responses         response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
Access to Records...........................          10,000                1               11            1,833
Designating a Representative for Disclosure            3,000                1              120            6,000
 of Records.................................
Amendment of Records........................             100                1               10               17
Consent of Release of Records...............       3,000,000                1                3          150,000
FOIA Requests for Records...................          15,000                1                5            1,250
Waiver/Reduction of Fees....................             400                1                5               33
                                             -------------------------------------------------------------------
    Totals..................................       3,028,500   ...............  ...............         159,133
----------------------------------------------------------------------------------------------------------------

    3. Claimant Statement about Loan of Food or Shelter; Statement 
about Food or Shelter Provided to Another--20 CFR 416.1130-416.1148--
0960-0529. SSA uses Forms SSA-5062 and SSA-L5063 in the administration 
of the Supplemental Security Income (SSI) program. SSA bases an SSI 
claimant or recipient's eligibility on need. We measure need by the 
amount of income an individual receives. Income includes other persons 
providing in-kind support and maintenance in the form of food and 
shelter to SSI applicants or recipients. SSA uses Forms SSA-5062 and 
SSA-L5063 to obtain statements about food or shelter provided to SSI 
claimants or recipients. SSA uses this information to determine whether 
food or shelters are bona fide loans or income for SSI purposes. This 
determination may affect a claimant or recipient's eligibility for SSI 
and the amount of SSI payments. The respondents are claimants and 
recipients for SSI payments, and individuals who provide loans of food 
or shelter to them.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden  Estimated total
           Modality of completion                Number of       Frequency of     of  response    annual burden
                                                 responses         response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-5062 Paper form.........................          34,900                1               10            5,817
SSA-L5063 Paper form........................          34,900                1               10            5,817
SSA-5062 Modernized SSI Claims System                 34,900                1               10            5,817
 (MSSICS)...................................
SSA-L5063 MSSICS............................          34,900                1               10            5,817
                                             -------------------------------------------------------------------

[[Page 58905]]

 
    Total...................................         139,600   ...............  ...............          23,268
----------------------------------------------------------------------------------------------------------------

    4. Site Review Questionnaire for Volume and Fee-for-Service Payees 
and Beneficiary Interview Form--20 CFR 404.2035, 404.2065, 416.665, 
416.701, and 416.708--0960-0633. SSA asks organizational representative 
payees to complete Form SSA-637, the Site Review Questionnaire for 
Volume and Fee-for-Service Payees, to provide information on how they 
carry out their responsibilities, including how they manage beneficiary 
funds. SSA then obtains information from the beneficiaries these 
organizations represent via Form SSA-639, Beneficiary Interview Form, 
to corroborate the payees' statements. Due to the sensitivity of the 
information, SSA employees always complete the forms based on the 
answers respondents give during the interview. The respondents are 
individuals, State and local governments, non-profit and for-profit 
organizations serving as representative payees, and the beneficiaries 
they serve.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden  Estimated total
           Modality of completion                Number of       Frequency of     per response    annual burden
                                                 responses         response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-637.....................................           1,999                1              120            3,998
SSA-639.....................................           8,293                1               10            1,382
                                             -------------------------------------------------------------------
    Totals..................................          10,292   ...............  ...............           5,380
----------------------------------------------------------------------------------------------------------------

    5. Certification of Prisoner Identity Information--20 CFR 422.107--
0960-0688. Inmates of Federal, State, or local prisons may need a 
Social Security card as verification of their Social Security number 
for school or work programs, or as proof of employment eligibility upon 
release from incarceration. Before SSA can issue a replacement Social 
Security card, applicants must show SSA proof of their identity. People 
who are in prison for an extended period typically do not have current 
identity documents. Therefore, under formal written agreement with the 
correctional institution, SSA allows prison officials to verify the 
identity of certain incarcerated U.S. citizens who need replacement 
Social Security cards. Information prison officials provide comes from 
the official prison files, sent on correctional facility letterhead. 
SSA uses this information to establish the applicant's identity in the 
replacement Social Security card process. The respondents are prison 
officials who certify the identity of prisoners applying for 
replacement Social Security cards.
    Type of Request: Extension of an OMB-approved Information 
Collection.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden  Estimated total
           Modality of completion                Number of       Frequency of    per  response    annual burden
                                                 responses         Response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
Certification of Prisoner Identity..........           1,100              200                3           11,000
----------------------------------------------------------------------------------------------------------------

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 30 days from the date of this 
publication. To be sure we consider your comments, we must receive them 
no later than October 24, 2012. Individuals can obtain copies of the 
OMB clearance packages by writing to [email protected].
    1. Statement of Care and Responsibility for Beneficiary--20 CFR 
404.2020, 404.2025, 408.620, 408.625, 416.620, 416.625--0960-0109. SSA 
uses the information from Form SSA-788 to verify payee applicants' 
statements of concern and to identify other potential payees. SSA is 
concerned with selecting the most qualified representative payee who 
will use Social Security benefits in the beneficiary's best interest. 
SSA considers factors such as the payee applicant's capacity to perform 
payee duties, awareness of the beneficiary's situation and needs, 
demonstration of past and current concern for the beneficiary's well-
being, etc. If the payee applicant does not have custody of the 
beneficiary, SSA will obtain information from the custodian for 
evaluation against information provided by the applicant. Respondents 
are individuals who have custody of the beneficiary in cases where 
someone else has filed to be the beneficiary's representative payee.
    This is a correction notice: SSA published the incorrect burden 
information for this collection at 77 FR 47688, on 08/09/12. We are 
correcting this error here.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 58906]]



----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden  Estimated total
           Modality of completion                Number of       Frequency of    per  response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-788.....................................         130,000                1               10           21,667
----------------------------------------------------------------------------------------------------------------

    2. Function Report Adult--Third Party--20 CFR 404.1512 & 416.912--
0960-0635. Individuals receiving or applying for Social Security 
Disability Insurance (SSDI) or SSI provide SSA with medical evidence 
and other proof SSA requires to prove their disability. SSA, and 
Disability Determination Services (DDS) on our behalf, collect this 
information using Form SSA-3380-BK. We use the information to document 
how claimant's disabilities affect their ability to function, and to 
determine eligibility for SSI and SSDI claims. The respondents are 
third parties familiar with the functional limitations (or lack 
thereof) of claimants who apply for SSI and SSDI benefits.

    Note:  This is a correction notice: SSA published the incorrect 
burden information for this collection at 77 FR 40401, on 7/09/12. 
We are correcting this error here.

    Type of Request: Revision of an OMB approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden  Estimated total
           Modality of completion                Number of       Frequency of    per  response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-338-BK (Individuals)....................         527,000                1               61          535,783
SSA-338-BK (Private Sector).................         527,000                1               61          535,783
                                             -------------------------------------------------------------------
    Totals..................................       1,054,000   ...............  ...............       1,071,566
----------------------------------------------------------------------------------------------------------------

    3. Function Report Adult--20 CFR 404.1512 & 416.912--0960-0681. 
Individuals receiving or applying for SSDI or SSI must provide medical 
evidence and other proof SSA requires to prove their disability. SSA, 
and DDS on our behalf, collect the information using Form SSA-3373. We 
use the information to document how claimants' disabilities affect 
their ability to function, and to determine eligibility for SSI and 
SSDI claims. The respondents are title II and title XVI applicants (or 
current recipients undergoing redeterminations) for disability 
payments.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden  Estimated total
           Modality of completion                Number of       Frequency of    per  response    annual burden
                                                 responses         response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3373....................................       4,221,656                1               61        4,292,017
----------------------------------------------------------------------------------------------------------------


    Dated: September 19, 2012.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2012-23441 Filed 9-21-12; 8:45 am]
BILLING CODE 4191-02-P