[Federal Register Volume 79, Number 41 (Monday, March 3, 2014)]
[Notices]
[Pages 11852-11854]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-04577]


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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, OLCA, Attn: Reports Clearance 
Director, 3100 West High Rise, 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 
2, 2014. Individuals can obtain copies of the collection instruments by 
writing to the above email address.
    1. Disability Update Report--20 CFR 404.1589-404.1595 and 416.988-
416.996--0960-0511. As part of our statutory requirements, SSA 
periodically uses Form SSA-455, the Disability Update Report, to 
evaluate current Title II disability beneficiaries' and Title XVI 
disability payment recipients' continued eligibility for

[[Page 11853]]

Social Security disability payments. Specifically, SSA uses the form to 
determine if: (1) There is enough evidence to warrant referring the 
respondent for a full medical Continuing Disability Review (CDR); (2) 
the respondent's impairment(s) is still present and is indicative of no 
medical improvement, precluding the need for a CDR; or (3) there are 
unresolved work-related issues for the respondent. SSA mails Form SSA-
455 to specific disability recipients, whom we select as possibly 
qualifying for the continuing disability review process. SSA pre-fills 
the form with data specific to the disability recipient, except for the 
sections we ask the beneficiary to complete. When SSA receives the 
completed form, we scan it into SSA's system. This allows us to gather 
the information electronically to enable SSA to process the returned 
forms through automated decision logic to decide the proper course of 
action to take. The respondents are recipients of Title II and Title 
XVI Social Security disability payments.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                Average  burden  Estimated total
           Modality of completion                Number of       Frequency of    per  response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-455.....................................       1,500,000                1               15          375,000
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    2. Request for Evidence from Doctor and Request for Evidence from 
Hospital--20 CFR 404 Subpart P and 20 CFR 416 Subpart I--0960-0722. 
Sections 223(d)(5) and 1614(a)(3)(H)(i) of the Social Security Act 
require claimants to furnish medical evidence of their disability when 
filing a disability claim. SSA uses Forms HA-66 and HA-67 to obtain 
evidence from medical sources identified by the claimants as having 
information relative to their impairments or ability to do work-related 
activities. In addition to accepting manual paper responses, SSA sends 
a barcode with the HA-66 and HA-67, allowing respondents to fax the 
information directly into the electronic claims folder rather than 
submitting it manually. SSA uses the information to determine 
eligibility for benefits. The respondents are medical sources, doctors, 
and hospitals that evaluate the claimants.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                      Average        Estimated
                                     Number of     Frequency of      Number of      burden per     total annual
     Modality of completion         respondents      response        responses       response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
HA-66--Paper....................           3,060              22          67,320              15          16,830
HA-66--Electronic...............           8,940              22         196,680              15          49,170
HA-67--Paper....................           3,060              22          67,320              15          16,830
HA-67--Electronic...............           8,940              22         196,680              15          49,170
                                 -------------------------------------------------------------------------------
  Totals........................          24,000  ..............         528,000  ..............         132,000
----------------------------------------------------------------------------------------------------------------

    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 2, 2014. Individuals can obtain copies of the OMB 
clearance packages by writing to [email protected].
    1. Advanced Notice of Termination of Child's Benefits & Student's 
Statement Regarding School Attendance--20 CFR 404.350-404.352, 404.367-
404.368--0960-0105. SSA collects information on Forms SSA-1372-BK and 
SSA-1372-BK-FC to determine whether children of an insured worker meet 
the eligibility requirements for student benefits. The data we collect 
allows SSA to determine entitlement to initial and continuing student 
benefits. The respondents are student claimants for Social Security 
benefits, their respective schools and, in some cases, their 
representative payees.
    Type of Request: Revision of an OMB-approved information 
collection.
    SSA-1372-BK:

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                                                                                      Average        Estimated
                                                     Number of     Frequency of     burden per     total annual
               Type of respondent                   respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
Individuals/Households..........................          99,850               1               8          13,313
State/Local/Tribal Government...................          99,850               1               3           4,993
                                                 ---------------------------------------------------------------
    Totals......................................         199,700  ..............  ..............          18,306
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    SSA-1372-BK-FC:

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                                                                                      Average        Estimated
                                                     Number of     Frequency of     burden per     total annual
               Type of respondent                   respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
Individuals/Households..........................             150               1               8              20

[[Page 11854]]

 
State/Local/Tribal Government...................             150               1               3               8
                                                 ---------------------------------------------------------------
    Totals......................................             300  ..............  ..............              28
                                                 ---------------------------------------------------------------
        Grand Total.............................         200,000  ..............  ..............          18,334
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    2. Work History Report--20 CFR 404.1515, 404.1560, 404.1565, 
416.960 and 416.3965--0960-0578. Under certain circumstances, SSA asks 
individuals applying for disability about work they have performed in 
the past. Applicants use Form SSA-3369, Work History Report, to provide 
detailed information about jobs held prior to becoming unable to work. 
State Disability Determination Services evaluate the information, 
together with medical evidence, to determine eligibility for disability 
payments. Respondents are disability applicants and third parties 
assisting applicants.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency of     burden per     total annual
             Modality of collection                 respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3369 (Paper form)...........................       1,553,900               1              60       1,553,900
Electronic Disability Collect System 3369.......          38,049               1              60          38,049
                                                 ---------------------------------------------------------------
    Totals......................................       1,591,949  ..............  ..............       1,591,949
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    Dated: February 28, 2014.
Naomi Sipple,
Management Analyst, Reports Clearance, Social Security Administration.
[FR Doc. 2014-04577 Filed 2-28-14; 8:45 am]
BILLING CODE 4191-02-P