[Federal Register Volume 79, Number 128 (Thursday, July 3, 2014)]
[Notices]
[Pages 38107-38110]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-15621]


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SOCIAL SECURITY ADMINISTRATION


Agency Information Collection Activities: Proposed 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 (PRA) 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].
    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 
September 2, 2014. Individuals can obtain copies of the collection 
instruments by writing to the above email address.
    1. Medical Report on Adult with Allegation of Human 
Immunodeficiency Virus Infection; Medical Report on Child with 
Allegation of Human Immunodeficiency Virus Infection--20 CFR 416.933-20 
CFR 416.934 --0960-0500. Section 1631(e)(i) of the Social Security Act 
(Act) authorizes the Commissioner of SSA to gather information 
necessary to make an immediate determination about an applicant's claim 
for Supplemental Security Income (SSI) payments; this procedure is the 
Presumptive Disability (PD). SSA uses Forms SSA-4814-F5 and SSA-4815-F6 
to collect information necessary to determine if an individual with 
human immunodeficiency virus infection, who is applying for SSI 
disability payments, meets the requirements for PD. The respondents are 
the medical sources of the applicants for SSI disability payments.
    Type of Request: Revision of an OMB-approved information 
collection.

 
----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Frequency of     burden per       Estimated
             Modality of completion                  responses       response        response      total annual
                                                                                     (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4814-F5.....................................          46,200               1              10           7,700
SSA-4815-F6.....................................          12,900               1              10           2,150
                                                 ---------------------------------------------------------------
    Totals......................................          59,100  ..............  ..............           9,850
----------------------------------------------------------------------------------------------------------------


[[Page 38108]]

    2. SSI Notice of Interim Assistance Reimbursement (IAR)--0960-0546. 
Section 1631(g) of the Act authorizes SSA to reimburse an IAR agency 
from an individual's retroactive SSI payment for assistance the IAR 
agency gave the individual for meeting basic needs while an SSI claim 
was pending or when SSI payments were suspended or terminated. The 
State or local agency needs an IAR agreement with SSA to participate in 
the IAR program. The individual receiving the IAR payment signs an 
authorization form with an IAR agency to allow SSA to repay the IAR 
agency for funds paid in advance prior to SSA's determination on the 
individual's claim. The authorization represents the individual's 
intent to file for SSI, if they did not file an application prior to 
SSA receiving the authorization. Agencies who wish to enter into an IAR 
agreement with SSA need to meet the following requirements:
    (a) Reporting Requirements--Each IAR agency agrees to:
    (1) Notify SSA of receipt of an authorization for initial claims or 
cases they are appealing, and submit a copy of that authorization 
either through a manual or electronic process;
    (2) inform SSA of the amount of reimbursement;
    (3) submit a written request for dispute resolution on a 
determination;
    (4) notify SSA of interim assistance paid (using the SSA-8125 or 
the SSA-L8125-F6);
    (5) inform SSA of any deceased claimants who participate in the IAR 
program; and,
    (6) review and sign an agreement with SSA.
    (b) Recordkeeping Requirements--The IAR agencies agree to retain 
all notices, agreements, authorizations, and accounting forms for the 
period defined in the IAR agreement for the purposes of SSA verifying 
transactions covered under the agreement.
    (c) Third Party Disclosure Requirements--Each participating IAR 
agency agrees to send written notices from the IAR agency to the 
recipient regarding payment amounts and appeal rights.
    (d) Periodic Review of Agency Accounting Process--The IAR agency 
makes the IAR accounting records of paid cases available for SSA review 
and verification. SSA conducts reviews either onsite or through the 
mail of the authorization forms, notices to the claimant, and 
accounting forms. Upon completion of the review, SSA provides a written 
report of findings to the IAR agency director. The respondents are 
State IAR officers.
    Type of Request: Revision of an OMB-approved information 
collection.

                                             Reporting Requirements
----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                  Number of       Frequency of      Number of       burden per       Estimated
    Modality of completion       respondents        response        responses        response      total annual
                                                                                     (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
a) State notification of       11 States......  Once per SSI     97,330.........               1           1,622
 receipt of authorization                        claimant.
 (Electronic Process).
b) State submission of copy    27 States......  Once per SSI     68,405.........               3           3,420
 of authorization (Manual                        claimant.
 Process).
c) State submission of amount  38 States......  Once per SSI     101,352........               8          13,514
 of IA paid to recipients                        claimant.
 (using eIAR).
d) State request for           Average is       As needed......  2..............              30               1
 determination--dispute         about 2 states
 resolution.                    per year.
e) State computation of        38 States......  Once per SSI     1,524..........              30             762
 reimbursement due form SSA                      claimant.
 using paper form
 SSA[dash]L8125-F6.
f) State notification to SSA   20 States......  As needed when   40.............              15              10
 of deceased claimant.                           SSI claimant
                                                 dies while
                                                 claim is
                                                 pending.
g) State reviewing/signing of  38 States......  Once during      38.............        12 hours             456
 IAR agreement.                                  life of the
                                                 IAR agreement.
h) Maintenance of              38 States......  One form per     165,735                       3           8,287
 authorization forms.                            SSI claimant.    (includes both
                                                                  denied and
                                                                  approved SSI
                                                                  claims).
i) Maintenance of accounting   38 States......  One set per SSI  101,352........               3           5,068
 forms and notices.                              claimant.
----------------------------------------------------------------------------------------------------------------


                                                           Third Party Disclosure Requirements
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                        Average  burden  Estimated total
          Modality of completion               Number of respondents         Frequency of response        Number of      per  response    annual burden
                                                                                                          responses        (minutes)         (hours)
--------------------------------------------------------------------------------------------------------------------------------------------------------
j) Written notice from State to recipient  38 States...................  Once per SSI claimant.......         101,352                7           11,824
 regarding amount of payment.
--------------------------------------------------------------------------------------------------------------------------------------------------------


[[Page 38109]]


                                  Periodic Review of Agency Accounting Process
----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                   Number of       Frequency of      Number of      burden per       Estimated
    Modality of completion        respondents        response        responses       response      total annual
                                                                                     (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
k) Retrieve and consolidate    12 States.......  One set of                   12               3              36
 authorization and accounting                     forms per SSI
 forms.                                           claimant for
                                                  review by SSA
                                                  once every 2
                                                  to 3 years.
l) Participate in periodic     12 States.......  For review by                12              16             192
 review.                                          SSA once every
                                                  2 to 3 years.
m) Correct administrative and  6 States........  To correct                    6               4              24
 accounting discrepancies.                        errors
                                                  discovered by
                                                  SSA in
                                                  periodic
                                                  review.
----------------------------------------------------------------------------------------------------------------


                                                               Total Administrative Burden
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                        Average  burden  Estimated total
                                                         Number of respondents         Frequency  of      Number of      per  response    annual burden
                                                                                          response        responses        (minutes)         (hours)
--------------------------------------------------------------------------------------------------------------------------------------------------------
    Total.......................................  38 States.........................          varies          639,161           varies           45,217
--------------------------------------------------------------------------------------------------------------------------------------------------------

    3. Medical Source Statement of Ability To Do Work Related 
Activities (Physical and Mental)--20 CFR 404.1512-404.1514, 404.912-
404.914, 404.1517, 416.917, 404.1519-404.1520, 416.919-416.920, 
404.946, 416.946, 404-1546-0960-0662. In some instances when a claimant 
appeals a denied disability claim, SSA may ask the claimant to have a 
consultative examination, at the agency's expense, if the claimant's 
medical sources cannot or will not give the agency sufficient evidence 
to determine whether the claimant is disabled. The medical providers 
who perform these consultative examinations provide a statement about 
the claimant's state of disability. Specifically, these medical source 
statements determine the work-related capabilities of these claimants. 
SSA collects the medical data on the HA-1151 and HA-1152 to assess the 
work-related physical and mental capabilities of claimants who appeal 
SSA's previous determination on their issue of disability. The 
respondents are medical sources who provide reports based either on 
existing medical evidence or on consultative examinations.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average          Total
                                                     Number of     Frequency  of    burden per       estimated
             Modality of completion                 respondents      response        response     annual  burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
HA-1151.........................................           5,000              30              15          37,500
HA-1152.........................................           5,000              30              15          37,500
                                                 ---------------------------------------------------------------
    Totals:.....................................          10,000  ..............  ..............          75,000
----------------------------------------------------------------------------------------------------------------

    4. Application for Access to SSA Systems--20 CFR 401.45-0960-0791. 
SSA uses Form SSA-120, Application for Access to SSA Systems, to allow 
limited access to SSA's information resources for SSA employees and 
non-Federal employees (contractors). SSA requires supervisory approval, 
and local or component Security Officer review prior to granting this 
access. The respondents are SSA employees and non-Federal Employees 
(contractors) who require access to SSA systems to perform their jobs.
    Note: Because SSA employees are Federal workers exempt from the 
requirements of the PRA, the burden below is only for SSA contractors.
    Type of Request: Revision of an OMB-approved information 
collection.

 
----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency  of     burden of     total  annual
             Modality of collection                 respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-120 (paper version).........................           2,148               1               2              73
SSA-120 (Internet version)......................           1,105               1               3              37
                                                 ---------------------------------------------------------------
    Totals......................................           3,289  ..............  ..............             110
----------------------------------------------------------------------------------------------------------------



[[Page 38110]]

    Dated: June 30, 2014.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2014-15621 Filed 7-2-14; 8:45 am]
BILLING CODE 4191-02-P