[Federal Register Volume 79, Number 46 (Monday, March 10, 2014)]
[Notices]
[Pages 13368-13369]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-05054]


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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 
9, 2014. Individuals can obtain copies of the collection instruments by 
writing to the above email address.
    1. Statement Regarding Marriage--20 CFR 404.726--0960-0017. 
According to section 216(h)(1)(A) of the Social Security Act (Act), SSA 
must apply state law when determining an individual's marital status. 
Some state laws recognize marriages without a ceremony (i.e., common-
law marriages). In such cases, SSA provides the same spouse or 
widow(er) benefits to common-law spouses as it does to ceremonially 
married spouses. To determine if someone is a common-law spouse, SSA 
must elicit information from blood relatives or other persons who are 
knowledgeable about the alleged common-law relationship. SSA uses Form 
SSA-753, Statement Regarding Marriage, to collect information from 
third parties to verify the applicant's statements about intent, 
cohabitation, and holding out to the public as married, which are the 
basic tenets of a common-law marriage. SSA uses the information to 
determine if a valid marital relationship exists, and if the common-law 
spouse is entitled to Social Security spouse or widow(er) benefits. The 
respondents are third parties who can confirm or deny an alleged 
common-law marriage.
    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-753.....................................          40,000                1                9            6,000
----------------------------------------------------------------------------------------------------------------

    2. Request for Review of Hearing Decision/Order--20 CFR 404.967--
404.981, 416.1467-416.1481--0960-0277. Claimants have a statutory right 
under the Act and current regulations to request review of an 
administrative law judge's (ALJ) hearing decision or dismissal of a 
hearing request on Title II and Title XVI claims. Claimants may request 
Appeals Council review by filing a written request using Form HA-520. 
SSA uses the information to establish the claimant filed the request 
for review within the prescribed time and to ensure the claimant 
completed the requisite steps permitting the Appeals Council review. 
The Appeals Council uses the information to: (1) Document the 
claimant's reason(s) for disagreeing with the ALJ's decision or 
dismissal; (2) determine whether the claimant has additional evidence 
to submit; and (3) determine whether the claimant has a representative 
or wants to appoint one. The respondents are claimants requesting 
review of an ALJ's decision or dismissal of hearing.
    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)
----------------------------------------------------------------------------------------------------------------
HA-520......................................         171,000                1               10           28,500
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[[Page 13369]]

    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 9, 2014. Individuals can obtain copies of the OMB 
clearance packages by writing to [email protected].
    1. State Mental Institution Policy Review Booklet--20 CFR 404.2035, 
404.2065, 416.635, & 416.665--0960-0110. SSA uses Form SSA-9584-BK: (1) 
To determine if the policies and practices of a state mental 
institution acting as a representative payee for SSA beneficiaries 
conform to SSA's regulations in the use of benefits; (2) to confirm 
institutions are performing other duties and responsibilities required 
of representative payees; and (3) as the basis for conducting onsite 
reviews of the institutions and preparing subsequent reports of 
findings. The respondents are state mental institutions serving as 
representative payees for Social Security beneficiaries and 
Supplemental Security Income (SSI) recipients.
    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-9584-BK.................................              78                1               60               78
----------------------------------------------------------------------------------------------------------------

    2. Modified Benefit Formula Questionnaire-Employer--20 CFR 401 & 
402--0960-0477. Sections 215(a)(7) and 215(d)(3) of the Act require SSA 
to use the Windfall Elimination Provision (WEP), a modified benefit 
formula, to compute Social Security retirement or disability benefits 
for persons first eligible (after 1985) for both a Social Security 
benefit and a pension or annuity, based on employment not covered by 
Social Security. SSA determines if the WEP is applicable and when to 
apply it to a person's benefit. SSA uses Form SSA-58 to verify the 
claimant's allegations on Form SSA-150 (OMB No. 0960-0395, Modified 
Benefits Formula Questionnaire). SSA sends the SSA-58 to an employer 
for pension-related information, if the claimant is unable to provide 
it. The respondents are employers of people who are eligible after 1985 
for both Social Security benefits and a pension based on work not 
covered by SSA.
    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-58......................................          30,000                1               20           10,000
----------------------------------------------------------------------------------------------------------------

    3. Employee Work Activity Questionnaire--20 CFR 404.1574, 
404.1592--0960-0483. Social Security disability beneficiaries and SSI 
recipients qualify for payments when a verified physical or mental 
impairment prevents them from working. If disability claimants attempt 
to return to work after receiving payments, but are unable to continue 
working, they submit the SSA-3033, Employee Work Activity 
Questionnaire, so SSA can evaluate their work attempt. SSA also uses 
this form to evaluate unsuccessful subsidy work and determine 
applicants' continuing eligibility for disability payments. The 
respondents are employers of Social Security disability beneficiaries 
and SSI recipients who unsuccessfully attempted to return to work.
    This is a correction notice: SSA published the incorrect burden 
information for this collection at 78 FR 76378, on 12/17/13. 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-3033....................................          15,000                1               15            3,750
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    Date: March 5, 2014.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2014-05054 Filed 3-7-14; 8:45 am]
BILLING CODE 4191-02-P