[Federal Register Volume 78, Number 54 (Wednesday, March 20, 2013)]
[Notices]
[Pages 17276-17281]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-06350]


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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 and extensions 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 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 May 
20, 2013. Individuals can obtain copies of the collection instruments 
by writing to the above email address.
    1. Request for Earnings and Benefit Estimate Statement--20 CFR 
404.810--0960-0466. Section 205(c)(2)(A) of the Social Security Act 
(Act) requires the Commissioner of SSA to establish and maintain 
records of wages paid to, and amounts of self-employment income derived 
by, each individual as well as the periods in which such wages were 
paid and such income derived. An individual may complete and mail Form 
SSA-7004 to SSA to obtain a Statement of Earnings or Quarters of 
Coverage. SSA uses the information Form SSA-7004 collects to identify 
respondents' Social Security earnings records, extract posted earnings 
information, calculate potential benefit estimates, produce the 
resulting Social Security statements, and mail them to the requesters. 
The respondents are Social Security number holders requesting 
information about their Social Security earnings records and estimates 
of their potential benefits.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 17277]]



----------------------------------------------------------------------------------------------------------------
                                                                                                     Estimated
                                                     Number of     Frequency of   Average burden   total annual
             Modality of collection                 respondents      response      per  response      burden
                                                                                       (min)          (hours)
----------------------------------------------------------------------------------------------------------------
SSA-7004 (paper)................................          17,219               1               5           1,435
SSA-7004 (Internet).............................       3,198,361               1               5         266,530
                                                 ---------------------------------------------------------------
    Totals......................................       3,215,580  ..............  ..............         267,965
----------------------------------------------------------------------------------------------------------------

    2. Agency/Employer Government Pension Offset Questionnaire--20 CFR 
404.408(a)--0960-0470. When an individual is concurrently receiving 
Social Security spousal or surviving spousal benefits and a government 
pension, the individual may have the amount of Social Security benefits 
reduced by the government pension amount. This is the Government 
Pension Offset (GPO). SSA uses Form SSA-L4163 to collect accurate 
pension information from the Federal or State government agency paying 
the pension for purposes of applying the pension offset provision. The 
form is used only when (1) the claimant does not have the information; 
and (2) the pension-paying agency has not cooperated with the claimant. 
Respondents are State government agencies that have information SSA 
needs to determine if the GPO applies and the amount of offset.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                                     Estimated
                                                     Number of     Frequency of   Average burden   total annual
             Modality of collection                 respondents      response      per  response      burden
                                                                                       (min)          (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L4163.......................................           1,000               1               3              50
----------------------------------------------------------------------------------------------------------------

    3. Employer Verification of Earnings After Death--20 CFR 404.821 
and 404.822--0960-0472. When SSA records show a wage earner is deceased 
and we receive wage reports from an employer for the wage earner for a 
year subsequent to the year of death, SSA mails the employer Form SSA-
L4112 (Employer Verification of Earnings After Death). SSA uses the 
information Form SSA-L4112 provides to verify wage information 
previously received from the employer is correct for the employee and 
the year in question. The respondents are employers who report wages 
for employees who have died.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                                     Estimated
                                                     Number of     Frequency of   Average burden   total annual
             Modality of collection                 respondents      response      per  response      burden
                                                                                       (min)          (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L4112.......................................          50,000               1              10           8,333
----------------------------------------------------------------------------------------------------------------

    4. Function Report--Child: Birth to 1st Birthday (SSA-3375), Age 1 
to 3rd Birthday (SSA-3376), Age 3 to 6th Birthday (SSA-3377), Age 6 to 
12th Birthday, (SSA-3378), and Age 12 to 18th Birthday (SSA-3379)--20 
CFR 416.912--0960-0542. SSA uses Forms SSA-3375-BK through SSA-3379-BK 
in the disability determination process to request information from a 
child's parent or guardian for children applying for Supplemental 
Security Income (SSI). The five different versions of the form contain 
questions about the child's day-to-day functioning appropriate to a 
particular age group; thus, respondents use only one version of the 
form for each child.
    The adjudicative team (disability examiners and medical/
psychological consultants) of State disability determination services 
offices collect the information on the appropriate version of this form 
(in conjunction with medical and other evidence) to form a complete 
picture of the children's ability to function and their impairment-
related limitations. The adjudicative team uses the completed profile 
to determine whether each child's impairment(s) results in marked and 
severe functional limitations and whether each child is disabled. The 
respondents are parents and guardians of child applicants for SSI.
    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          (min)           (hours)
----------------------------------------------------------------------------------------------------------------
Function Report--Child: (SSA-3375-BK through         660,000                1               20          220,000
 SSA-3379-BK)...............................
----------------------------------------------------------------------------------------------------------------

    5. Registration for Appointed Representative Services and Direct 
Payment--0960-0732. SSA uses Form SSA-1699 to register appointed 
representatives of claimants before SSA who:
     Want to register for direct payment of fees;
     Registered for direct payment of fees prior to 10/31/09, 
but need to update their information;

[[Page 17278]]

     Registered as appointed representatives on or after 10/31/
09, but need to update their information; or
     Received a notice from SSA instructing them to complete 
this form.

By registering these individuals, SSA: (1) Authenticates and authorizes 
them to do business with us; (2) allows them to access our records for 
the claimants they represent; (3) facilitates direct payment of 
authorized fees to appointed representatives; and, (4) collects the 
information we need to meet Internal Revenue Service (IRS) requirements 
to issue specific IRS forms if we pay an appointed representative in 
excess of a specific amount ($600). The respondents are appointed 
representatives who want to use Form SSA-1699 for any of the purposes 
cited in this Notice.
    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          (min)           (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1699....................................          52,800                1               20           17,600
----------------------------------------------------------------------------------------------------------------

    6. Technical Updates to Applicability of the Supplemental Security 
Income (SSI) Reduced Benefit Rate for Individuals Residing in Medical 
Treatment Facilities--20 CFR 416.708(k)--0960-0758. Section 
1611(e)(1)(A) of the Act states that residents of public institutions 
are ineligible for SSI. However, Sections 1611(e)(1)(B) and (G) list 
certain exceptions to this provision making it necessary for SSA to 
collect information from SSI recipients who enter or leave a medical 
treatment facility or other public or private institution. SSA's 
regulation 20 CFR 416.708(k) establishes the reporting guidelines that 
implement this legislative requirement. SSA collects the information to 
determine eligibility for SSI and the payment amount. The respondents 
are SSI recipients who enter or leave an institution.
    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
                                                respondents        response          (min)           (hours)
----------------------------------------------------------------------------------------------------------------
Technical Updates Statement.................          34,200                1                7            3,990
----------------------------------------------------------------------------------------------------------------

    7. Statement for Certificate of Election for Reduced Widow(er)'s 
and Surviving Divorced Spouse's Benefits--20 CFR 404.335--0960-0759. 
Section 202(q) of the Act provides SSA the authority to reduce benefits 
under certain conditions when elected by a title II beneficiary. 
However, reduced benefits are not payable to an already entitled spouse 
(or divorced spouse) who:
     Is at least age 62 and under full retirement age in the 
month of the number holder's death; and
     Is receiving both reduced spouse's (or divorced spouse's) 
benefits and either retirement or disability benefits in the month 
before the month of the number holder's death.

To elect reduced widow(er) benefits, a recipient completes Form SSA-
4111. SSA uses the information Form SSA-4111 collects to pay a 
qualified dually entitled widow(er) (or surviving divorced spouse) who 
elects to receive a reduced widow(er) benefit. The respondents are 
qualified dually entitled widow(er)s (or surviving divorced spouse) who 
    elect to receive a reduced widow(er) benefit.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          (min)           (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4111....................................          30,000                1                2            1,000
----------------------------------------------------------------------------------------------------------------

    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 April 19, 2013. Individuals can obtain copies of the OMB 
clearance packages by writing to [email protected].
    1. Statement for Determining Continuing Eligibility, Supplemental 
Security Income Payment(s)--416.204--0960-0416. SSA conducts disability 
redeterminations to determine if SSI recipients (1) met and continue to 
meet all statutory and regulatory requirements for SSI eligibility and 
(2) are receiving the correct SSI payment amount. SSA makes these 
redeterminations through periodic use of Form SSA-8203-BK. SSA conducts 
this legally mandated information collection in field offices via 
personal contact (face-to-face or telephone interview) using the 
automated Modernized SSI Claim System (MSSICS). The respondents are SSI 
recipients or their representative payees.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 17279]]



----------------------------------------------------------------------------------------------------------------
                                                                                                     Estimated
                                                     Number of     Frequency of   Average burden   total annual
             Modality of collection                 respondents      response      per  response      burden
                                                                                       (min)          (hours)
----------------------------------------------------------------------------------------------------------------
MSSICS..........................................         810,824               1              20         270,275
MSSICS/Signature Proxy..........................         777,085               1              19         246,077
Paper...........................................          27,824               1              20           9,275
                                                 ---------------------------------------------------------------
    Totals......................................       1,615,733  ..............  ..............         525,627
----------------------------------------------------------------------------------------------------------------

    2. Application for Benefits Under the Italy-U.S. International 
Social Security Agreement--20 CFR 404.1925--0960-0445. As per the 
November 1, 1978 agreement between the United States and Italian Social 
Security agencies, residents of Italy filing an application for U.S. 
Social Security benefits directly with one of the Italian Social 
Security agencies must complete Form SSA-2528. SSA uses Form SSA-2528 
to establish age, relationship, citizenship, marriage, death, military 
service, or to evaluate a family bible or other family record when 
determining eligibility for benefits. The Italian Social Security 
agencies assist applicants in completing Form SSA-2528 and then forward 
the application to SSA for processing. The respondents are individuals 
living in Italy who wish to file for U.S. Social Security benefits.
    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          (min)           (hours)
----------------------------------------------------------------------------------------------------------------
SSA-2528....................................             300                1               20              100
----------------------------------------------------------------------------------------------------------------

    3. Information About Joint Checking/Savings Accounts--20 CFR 
416.120, 416.1208--0960-0461. SSA considers a person's resources when 
evaluating eligibility for SSI. Generally, we consider funds in 
checking and savings accounts as resources owned by the individuals 
whose names appear on the account. However, individuals applying for 
SSI may rebut this assumption of ownership in a joint account by 
submitting certain evidence to establish the funds do not belong to 
them. SSA uses Form SSA-2574 to collect information from SSI applicants 
and recipients who object to the assumption that they own all or part 
of the funds in a joint checking or savings account bearing their 
names. SSA collects information about the account from both the SSI 
applicant/recipient and the other account holder(s). After receiving 
the completed form, SSA determines if we should consider the account to 
be a resource for the SSI applicant/recipient. The respondents are 
applicants and recipients of SSI, and individuals who list themselves 
as joint owners of financial accounts with SSI applicants/recipients.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                                     Estimated
                                                     Number of     Frequency of   Average burden   total annual
             Modality of completion                 respondents      response      per  response      burden
                                                                                       (min)          (hours)
----------------------------------------------------------------------------------------------------------------
SSA-2574 Paper Form.............................          50,000               1               7           5,833
Modernized SSI Claims System....................         150,000               1               7          17,500
                                                 ---------------------------------------------------------------
    Totals......................................         200,000  ..............  ..............          23,333
----------------------------------------------------------------------------------------------------------------

    4. Real Property Current Market Value Estimate--0960-0471. SSA 
considers an individual's resources when evaluating eligibility for SSI 
payments. The value of an individual's resources, including non-home 
real property, is one of the eligibility requirements for SSI payments. 
SSA obtains current market value estimates of the claimant's real 
property through Form SSA-L2794. We allow respondents to use readily 
available records to complete the form, or we can accept their best 
estimates. We use this form as part of initial applications and in 
post-entitlement situations. The respondents are small business 
operators in real estate, State and local government employees tasked 
with assessing real property values, and other individuals 
knowledgeable about local real estate values.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden     Estimated
           Modality of completion                Number of       Frequency of    per  response     total annual
                                                respondents        response          (min)       burden  (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L2794...................................           5,438                1               20            1,813
----------------------------------------------------------------------------------------------------------------

    5. Certification of Contents of Document(s) or Record(s)--20 CFR 
404.715--0960-0689. SSA established procedures for individuals to 
provide the evidence necessary to establish rights to Social Security 
benefits.

[[Page 17280]]

Examples of such evidence categories include age, relationship, 
citizenship, marriage, death, and military service. Form SSA-704 allows 
SSA employees, State record custodians, and other custodians of 
evidentiary documents to certify and record information from original 
documents and records under their custodial ownership to establish 
these types of evidence. SSA uses Form SSA-704 in situations where 
individuals cannot produce the original evidentiary documentation 
required to establish benefits eligibility. The respondents are State 
record custodians and other custodians of evidentiary documents.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden     Estimated
           Modality of completion                Number of       Frequency of    per  response     total annual
                                                respondents        response          (min)       burden  (hours)
----------------------------------------------------------------------------------------------------------------
SSA-704.....................................           4,800                1               10              800
----------------------------------------------------------------------------------------------------------------

    6. Supplemental Security Income Wage Reporting (Telephone and 
Mobile)--20 CFR 416.701-732--0960-0715. SSA requires SSI recipients to 
report changes which could affect their eligibility for, and the amount 
of, their SSI payments, such as changes in income, resources, and 
living arrangements. SSA's SSI Telephone Wage Reporting (SSITWR) and 
SSI Mobile Wage Reporting (SSIMWR) enable SSI recipients to meet these 
requirements via an automated mechanism to report their monthly wages 
by telephone and mobile application, instead of contacting their local 
field offices. The SSITWR allows callers to report their wages by 
speaking their responses through voice recognition technology, or by 
keying in responses using a telephone key pad. The SSIMWR allows 
recipients to report their wages through the mobile wage reporting 
application on their smartphone. SSITWR and SSIMWR systems collect the 
same information and send it to SSA over secure channels. To ensure the 
security of the information provided, SSITWR and SSIMWR ask respondents 
to provide information SSA can compare against our records for 
authentication purposes. Once the system authenticates the identity of 
the respondents, they can report their wage data. The respondents are 
SSI recipients, deemors, or their representative payees.
    Type of Request: Extension of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                                     Estimated
                                                     Number of     Frequency of   Average burden   total annual
             Modality of completion                 respondents      response      per  response      burden
                                                                                       (min)          (hours)
----------------------------------------------------------------------------------------------------------------
Training/Instruction*...........................          85,000               1              35          49,583
SSITWR..........................................          80,000              12               5          80,000
SSIMWR..........................................           5,000              12               3           3,000
                                                 ---------------------------------------------------------------
    Total.......................................          85,000  ..............  ..............         132,583
----------------------------------------------------------------------------------------------------------------
*Note: The same 85,000 respondents are completing training and a modality of collection, therefore the actual
  total number of respondents is still 85,000.

    7. Certificate of Incapacity--5 CFR 890.302(d)--0960-0739. Rules 
governing the Federal Employee Health Benefits (FEHB) plan require a 
physician to verify the disability of Federal employees' children ages 
26 and over for such children to retain health benefits under their 
employed parents' plans. The physician must verify that the adult 
child's disability (1) Pre-dates the child's 26th birthday; (2) is very 
serious; and (3) will continue for at least one year. Physicians use 
Form SSA-604, the Certificate of Incapacity, to document this 
information. The respondents are physicians of SSA employees' children 
ages 26 or over who are seeking to retain health benefits under their 
parent's FEHB coverage.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden     Estimated
           Modality of completion                Number of       Frequency of    per  response     total annual
                                                respondents        response          (min)       burden  (hours)
----------------------------------------------------------------------------------------------------------------
SSA-604.....................................              50                1               45               38
----------------------------------------------------------------------------------------------------------------

    8. Centenarian Project Development Worksheets: Face-to-Face 
Interview and Telephone Interview--20 CFR 416.204(b) and 422.135--0960-
0780. SSA conducts interviews with centenary title II beneficiaries and 
title XVI recipients age 100 and older to: (1) Assess if the 
beneficiaries are still living; (2) prevent fraud, through either 
identity misrepresentation or representative payee misuse of funds; and 
(3) evaluate the well-being of the beneficiaries. SSA field office 
personnel obtain the information through one-time interviews with the 
centenarians. If the centenarians have representatives or caregivers, 
SSA personnel invite them to the interviews. During the interview, SSA 
employees make overall observations of the centenarian and their 
representative payee (if applicable). The interviewer uses the 
appropriate Centenarian Development Worksheet as a guide for the 
interview, in addition to documenting findings during the interview. 
Non-completion of the Worksheets, or refusal of the interview, does not 
result in the suspension of the centenarian's payments. SSA conducts 
the interview either over the telephone or through a face-to-face 
discussion with the centenarian. This is a national project

[[Page 17281]]

for our title II beneficiaries and title XVI recipients. Respondents 
are SSI recipients or Social Security beneficiaries 100 years old or 
older, their representative payees, or their caregivers.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden     Estimated
           Modality of completion                Number of       Frequency of    per  response     total annual
                                                respondents        response          (min)       burden  (hours)
----------------------------------------------------------------------------------------------------------------
Centenarian Worksheets: Face-to-Face                  22,000                1               15            5,500
 Interview; Telephone Interview.............
----------------------------------------------------------------------------------------------------------------


    Dated: March 15, 2013.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2013-06350 Filed 3-19-13; 8:45 am]
BILLING CODE 4191-02-P