[Federal Register Volume 79, Number 90 (Friday, May 9, 2014)]
[Notices]
[Pages 26798-26801]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-10662]


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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 July 
8, 2014. Individuals can obtain copies of the collection instruments by 
writing to the above email address.
    1. Statement Regarding Date of Birth and Citizenship--20CFR 
404.716--0960-0016. Section 205(a) of the Social Security Act (Act) 
gives the Commissioner of SSA the authority to make rules and 
regulations, and to establish procedures for collecting evidence from 
individuals applying for Social Security benefits. When individuals 
apply for Social Security benefits and cannot provide preferred methods 
of proving age or citizenship, SSA uses Form SSA-702 to establish these 
facts. Specifically, SSA uses the SSA-702 to establish age as a factor 
of entitlement to Social Security benefits, or U.S. citizenship as a 
payment factor. Respondents are individuals with knowledge about the 
date of birth or citizenship of applicants filing for one or more 
Social Security benefits who need to establish age or citizenship.
    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        (minutes)     burden  (hours)
----------------------------------------------------------------------------------------------------------------
SSA-7157....................................           1,200                1               10              200
----------------------------------------------------------------------------------------------------------------


[[Page 26799]]

    2. Disability Report-Appeal--20 CFR 404.1512, 416.912, 404.916(c), 
416.1416(c), 422.140, 404.1713, 416.1513, 404.1740(b)(4), 
416.1540(b)(4), and 405 Subpart C--0960-0144. SSA requires disability 
applicants who wish to appeal an unfavorable disability determination 
to complete Form SSA-3441-BK, the associated Electronic Disability 
Collect System (EDCS) interview, or the Internet application, i3441. 
This allows claimants to disclose any changes to their disability or 
resources that might influence SSA's unfavorable determination. We may 
use the information to: (1) Reconsider and review an initial disability 
determination; (2) review a continuing disability; and (3) evaluate a 
request for a hearing. This information assists the State Disability 
Determination Services (DDS) and administrative law judges (ALJ) in 
preparing for the appeals and hearings, and in issuing a determination 
or decision on an individual's entitlement (initial or continuing) to 
disability benefits. In addition, the information we collect on the 
SSA-3441-BK facilitates SSA's collection of medical information to 
support the applicant's request for reconsideration; request for 
benefits cessation appeal; and request for a hearing before an ALJ. 
Respondents are individuals who appeal denial, reduction, or cessation 
of Social Security disability income and Supplemental Security Income 
(SSI) payments; who wish to request a hearing before an ALJ; or their 
representatives.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency  of    burden per     total annual
             Modality of completion                 respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3441-BK.....................................           2,396               1              45           1,797
Electronic Disability Collect System (EDCS).....         476,771               1              45         357,578
i3441 (Internet)................................       1,046,938               1              28         488,571
                                                 ---------------------------------------------------------------
    Totals......................................       1,526,105  ..............  ..............         847,946
----------------------------------------------------------------------------------------------------------------

    3. Request for Hearing by Administrative Law Judge--20 CFR 404.929, 
404.933, 416.1429, 404.1433, 418.1350, and 42 CFR 405.722--0960-0269. 
When SSA denies applicants' or beneficiaries' requests for new or 
continuing benefits, the Act entitles those applicants or beneficiaries 
to request a hearing to appeal the decision. To request a hearing, 
individuals complete Form HA-501, the associated Modernized Claims 
System (MCS) or Modernized Supplemental Security Income Claims System 
(MSSICS) interview, or the Internet application (i501). SSA uses the 
information to determine if the individual: (1) Filed the request 
within the prescribed time; (2) is the proper party; and (3) took the 
steps necessary to obtain the right to a hearing. SSA also uses the 
information to determine: (1) The individual's reason(s) for 
disagreeing with SSA's prior determinations in the case; (2) if the 
individual has additional evidence to submit; (3) if the individual 
wants an oral hearing or a decision on the record; and (4) whether the 
individual has (or wants to appoint) a representative. The respondents 
are Social Security benefit applicants and recipients who want to 
appeal SSA's denial of their request for new or continued benefits, and 
Medicare Part B recipients who must pay the Medicare Part B Income-
Related Monthly Adjustment Amount.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency  of    burden per     total annual
             Modality of completion                 respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
HA-501; Modernized Claims System (MCS);                   25,953               1              10           4,326
 Modernized Supplemental Security Income Claims
 System (MSSICS)................................
I501 (Internet iAppeals)........................         643,516               1               5          53,626
                                                 ---------------------------------------------------------------
    Totals......................................         669,469  ..............  ..............          57,952
----------------------------------------------------------------------------------------------------------------

    4. Application for Benefits under a U.S. International Social 
Security Agreement--20 CFR 404.1925--0960-0448. Section 233(a) of the 
Act authorizes the President of the United States to broker 
international Social Security agreements (Totalization Agreements) 
between the United States and foreign countries. SSA collects 
information using Form SSA-2490-BK to determine entitlement to Social 
Security benefits from the United States, or from a country that enters 
into a totalization agreement with the United States. The respondents 
are individuals applying for Old Age, Survivors, and Disability 
Insurance benefits from the United States or from a Totalization 
Agreement country.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency of     burden per     total annual
             Modality of completion                 respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-2490-BK (MCS)...............................          14,175               1              30           7,088
SSA-2490-BK (paper).............................           2,025               1              30           1,013
                                                 ---------------------------------------------------------------
    Totals......................................          16,200  ..............  ..............           8,101
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[[Page 26800]]

    5. Information Collections Conducted by State Disability 
Determination Services on Behalf of SSA--20 CFR, subpart P, 404.1503a, 
404.1512, 404.1513, 404.1514 404.1517, 404.1519; 20 CFR subpart Q, 
404.1613, 404.1614, 404.1624; 20 CFR subpart I, 416.903a, 416.912, 
416.913, 416.914, 416.917, 416.919 and 20 CFR subpart J, 416.1013, 
416.1024, 416.1014--0960-0555. State DDSs collect the information 
necessary to administer the Social Security Disability Insurance and 
SSI programs. They collect medical evidence from consultative 
examination (CE) sources, credential information from CE source 
applicants, and medical evidence of record (MER) from claimants' 
medical sources. The DDSs collect information from claimants regarding 
medical appointments and pain or other symptoms. The respondents are 
medical providers, other sources of MER, and disability claimants.
    Type of Request: Revision of an OMB-approved information 
collection.

CE Collections

    There are three CE information collections: (1) Medical evidence 
about claimants' medical condition(s) that DDS's use to make disability 
determinations when the claimant's own medical sources cannot or will 
not provide the required information, and proof of credentials from CE 
providers; (2) CE appointment letters; and (3) CE claimant reports sent 
to claimants' doctors.
(1) Medical Evidence and Credentials From CE Providers

----------------------------------------------------------------------------------------------------------------
                                                                                      Average          Total
                                                     Number of     Frequency  of    burden per       estimated
             Modality of completion                 respondents      response        response      annual burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
CE Paper Submissions............................       1,400,000               1              30         700,000
CE Electronic Submissions.......................         300,000               1              15          75,000
                                                 ---------------------------------------------------------------
    Totals......................................       1,700,000  ..............  ..............         775,000
----------------------------------------------------------------------------------------------------------------

(2) CE Appointment Letters and (3) CE Claimants' Report to Medical 
Providers

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Frequency  of    burden per       Estimated
             Modality of completion                 respondents      response        response      annual burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
(b) CE Appointment Letters......................         880,000               1               5          73,333
(c) CE Claimants' Report to Medical Providers...         450,000               1               5          37,500
                                                 ---------------------------------------------------------------
    Totals......................................       1,330,000  ..............  ..............         110,833
----------------------------------------------------------------------------------------------------------------

MER Collections

    The DDS's collect MER information from the claimant's medical 
sources to determine a claimant's physical or mental status prior to 
making a disability determination.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average          Total
                                                     Number of     Frequency of     burden per       estimated
             Modality of completion                 respondents      response        response      annual burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
Paper Submissions...............................       3,150,000               1              20       1,050,000
Electronic Submissions..........................       9,450,000               1              12       1,890,000
                                                 ---------------------------------------------------------------
    Totals......................................      12,600,000  ..............  ..............       2,940,000
----------------------------------------------------------------------------------------------------------------

Pain or Other Symptoms--Impairment Information From Claimants

    The DDSs use information about pain or symptoms to determine how 
pain or symptoms affect the claimant's ability to do work-related 
activities prior to making a disability determination.

----------------------------------------------------------------------------------------------------------------
                                                                                                      Total
                                                 Number of       Frequency of   Average  burden     estimated
           Modality of completion               respondents        response      per  response    annual burden
                                                                                   (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
Pain or Other Symptoms......................       2,100,000                1               20          700,000
----------------------------------------------------------------------------------------------------------------

    The total estimated annual burden for all of the categories 
described in this information collection is 4,525,833 hours.
    6. Request for Reconsideration--20 CFR 404.907-404.921, 416.1407-

[[Page 26801]]

416.1421, 408.1009, and 418.1325--0960-0622. Individuals use Form SSA-
561-U2, the associated MCS interview, or the Internet application 
(i561) to initiate a request for reconsideration of a denied claim. SSA 
uses the information to document the request and to determine an 
individual's eligibility or entitlement to Social Security benefits 
(Title II), SSI payments (Title XVI), Special Veterans Benefits (Title 
VIII), Medicare (Title XVIII), and for initial determinations regarding 
Medicare Part B income-related premium subsidy reductions. The 
respondents are individuals filing for reconsideration of a denied 
claim.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency of     burden per     total  annual
             Modality of completion                 respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-561 and MCS.................................         550,370               1               8          73,383
I561 (Internet iAppeals)........................         911,330               1               5          75,944
                                                 ---------------------------------------------------------------
    Totals......................................       1,461,700  ..............  ..............         149,327
----------------------------------------------------------------------------------------------------------------

    7. Teacher Questionnaire and Request for Administrative 
Information--20 CFR 416.1103(f)--0960-0646. When determining the 
effects of a child's impairment for children applying for Title II 
childhood disability benefits, SSA obtains information about the 
child's functioning from teachers, parents, and others who observe the 
child on a daily basis. SSA obtains results of formal testing, teacher 
reports, therapy progress notes, individualized education programs, and 
other records of a child's educational aptitude and achievement using 
Forms SSA-5665-BK and SSA-5666. The respondents are parents, teachers, 
and other education personnel.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency of     burden per     total annual
             Modality of completion                 respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-5665-BK (electronic)........................         368,098               1              40         245,399
SSA-5665 (paper form)...........................           2,562               1              40           1,708
SSA-5666 (electronic)...........................         137,590               1              30          68,795
SSA-5666 (paper form)...........................           1,843               1              30             922
                                                 ---------------------------------------------------------------
    Totals......................................         510,093  ..............  ..............         316,824
----------------------------------------------------------------------------------------------------------------

    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 30 days from the date of this 
publication. To be sure we consider your comments, we must receive them 
no later than June 9, 2014. Individuals can obtain copies of the OMB 
clearance package by writing to [email protected].
    Request for Social Security Earnings Information--20CFR 404.810 & 
401.100--0960-0525. The Act permits wage earners, or their authorized 
representative, to request Social Security earnings information from 
SSA using Form SSA-7050-F4. SSA uses the information to verify the 
requestor's right to access to the information and to produce the 
earnings statement. The respondents are wage earners and their 
authorized representatives.
    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        (minutes)     burden  (hours)
----------------------------------------------------------------------------------------------------------------
SSA-7050-F4.................................          66,800                1               11           12,247
----------------------------------------------------------------------------------------------------------------


    Dated: May 6, 2014.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2014-10662 Filed 5-8-14; 8:45 am]
BILLING CODE 4191-02-P