[Federal Register Volume 79, Number 141 (Wednesday, July 23, 2014)]
[Notices]
[Pages 42863-42867]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-17275]


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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 extensions and 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 
September 22, 2014. Individuals can obtain copies of the collection 
instruments by writing to the above email address.
    1. Application for Search of Census Records for Proof of Age--20 
CFR 404.716--0960-0097. When preferred evidence of age is not 
available, or the available evidence is not convincing, SSA may ask the 
U.S. Department of Commerce, Bureau of the Census, to search its 
records to establish a claimant's date of birth. SSA collects 
information from claimants using Form SSA-1535-U3 to provide the Census 
Bureau with sufficient identification information to allow an accurate 
search of census records. Additionally, the Census Bureau uses a 
completed, signed SSA-1535-U3 to bill SSA for the search. The 
respondents are applicants for Social Security benefits who need to 
establish their date of birth as a factor of entitlement.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                       Number of       Frequency    burden per   Estimated total
              Modality of completion                  respondents     of response    response     annual burden
                                                                                     (minutes)       (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1535-U3.......................................          18,030             1            12            3,606
----------------------------------------------------------------------------------------------------------------

    2. Public Information Campaign--0960-0544. Periodically, SSA sends 
various public information materials, including public service 
announcements, news releases, and educational tapes, to public 
broadcasting systems so they can inform the public about various 
programs and activities SSA conducts. SSA frequently sends follow-up 
business reply cards for these public information materials to obtain 
suggestions for improving them. The respondents are broadcast 
television sources.
    Type of Request: Extension of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                       Number of     Frequency of   burden per   Estimated total
              Modality of completion                  respondents      response      response    burden  (hours)
                                                                                     (minutes)
----------------------------------------------------------------------------------------------------------------
Television........................................           1,000             2             1               33
----------------------------------------------------------------------------------------------------------------

    3. Medicare Subsidy Quality Review Forms--20 CFR 418(b)(5)--0960-
0707. The Medicare Modernization Act (MMA) of 2003 mandated the 
creation of the Medicare Part D prescription drug coverage program and 
provides certain subsidies for eligible Medicare beneficiaries to help 
pay for the cost of prescription drugs. As part of its stewardship 
duties of the Medicare Part D subsidy program, SSA must conduct 
periodic quality review checks of the information Medicare 
beneficiaries report on their subsidy applications (Form SSA-1020). SSA 
uses the Medicare Quality Review program to conduct these checks. The 
respondents are applicants for the Medicare Part D subsidy whom SSA 
chose to undergo a quality review.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 42864]]



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                                                                                       Average       Estimated
                                                           Number of     Frequency    burden per   total annual
                Modality of completion                    respondents   of response    response       burden
                                                                                       (minutes       (hours)
----------------------------------------------------------------------------------------------------------------
SSA-9301 (Medicare Subsidy Quality Review Case                   3,500            1           30           1,750
 Analysis Questionnaire)..............................
SSA-9302 (Notice of Quality Review Acknowledgement               3,500            1           15             875
 Form for those with Phones)..........................
SSA-9303 (Notice of Quality Review Acknowledgement                 350            1           15              88
 Form for those without Phones).......................
SSA-9308 (Request for Information)....................           7,000            1           15           1,750
SSA-9310 (Request for Documents)......................           3,500            1            5             292
SSA-9311 (Notice of Appointment--Denial--Reviewer Will             450            1           15             113
 Call)................................................
SSA-9312 (Notice of Appointment--Denial--Please Call                50            1           15              13
 Reviewer)............................................
SSA-9313 (Notice of Quality Review Acknowledgement               2,500            1           15             625
 Form for those with Phones)..........................
SSA-9314 (Notice of Quality Review Acknowledgement                 500            1           15             125
 Form for those without Phones).......................
SSA-8510 (Authorization to the Social Security                   3,500            1            5             292
 Administration to Obtain Personal Information).......
                                                       ---------------------------------------------------------
    Totals............................................          24,850            -            -           5,923
----------------------------------------------------------------------------------------------------------------

    4. Application to Collect a Fee for Payee Service--20 CFR 
416.640.640(a), 416.1103(f)--0960-0719. Sections 205(j)(4)(A) and (B) 
and 1631(a)(2) of the Social Security Act (Act) allow SSA to authorize 
certain organizational representative payees to collect a fee for 
providing payee services. Before organizations may collect this fee, 
they complete and submit Form SSA-445. SSA uses the information to 
determine whether to authorize or deny permission to collect fees for 
payee services. The respondents are private sector businesses or State 
and local government offices applying to become fee-for-service 
organizational representative payees.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                       Average       Estimated
                                                           Number of     Frequency    burden per   total annual
                Modality of completion                     responses    of response    response       burden
                                                                                      (minutes)       (hours)
----------------------------------------------------------------------------------------------------------------
Private sector business...............................              90            1           10              15
State/local government offices........................              10            1           10               2
                                                       ---------------------------------------------------------
    Totals............................................             100  ...........  ...........              17
----------------------------------------------------------------------------------------------------------------

    5. Redetermination of Eligibility for Help with Medicare 
Prescription Drug Plan Costs--0960-0723. As per the requirements of the 
MMA of 2003, SSA conducts low-income subsidy eligibility 
redeterminations for Medicare beneficiaries who currently receive the 
Medicare Part D subsidy and who meet certain criteria. Respondents 
complete Form SSA-1026-REDE under the following circumstances: (1) When 
individuals became entitled to the Medicare Part D subsidy during the 
past 12 months; (2) if they were eligible for the Part D subsidy for 
more than 12 months; or (3) if they reported a change in income, 
resources, or household size. Part D beneficiaries complete the SSA-
1026-SCE when they need to report a potentially subsidy-changing event, 
including the following: (1) Marriage, (2) spousal separation, (3) 
divorce, (4) annulment of a marriage, (5) spousal death, or (6) moving 
back in with one's spouse following a separation. The respondents are 
current recipients of the Medicare Part D low-income subsidy who will 
undergo an eligibility redetermination for one of the reasons mentioned 
above.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                       Average       Estimated
                                                           Number of     Frequency    burden per   total annual
                Modality of completion                    respondents   of response    response       burden
                                                                                      (minutes)       (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1026-OCR-MS-SCE...................................           9,176            1           18           2,753
SSA-1026-OCR-SM-REDE..................................         161,766            1           18          48,530
                                                       ---------------------------------------------------------
    Total.............................................         170,942  ...........  ...........          51,283
----------------------------------------------------------------------------------------------------------------

    6. Electronic Records Express (Third Parties)--20 CFR 404.1700-
404.1715--0960-0767. Electronic Records Express (ERE) is an online 
system which enables medical providers and various third party 
representatives to download and submit disability claimant information 
electronically to SSA as part of the disability application process. To 
ensure only authorized people access ERE, SSA requires third parties to 
complete a unique registration process if they wish to use this system. 
This information collection request (ICR) includes the third-party 
registration process; the burden for submitting evidence to SSA is part 
of other, various ICRs. The respondents are third party

[[Page 42865]]

representatives of disability applicants or recipients who want to use 
ERE to electronically access clients' disability files online and 
submit information to SSA.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden  Estimated total
      Modality of completion          Number of     Frequency of    Number of    per  response    annual burden
                                     respondents      response      responses      (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
ERE..............................          12,000           281   (3,372,000)                1           56,200
----------------------------------------------------------------------------------------------------------------

    7. Screen Pop--20 CFR 401.45--0960-0790. Section 205(a) of the Act 
requires SSA to verify the identity of individuals who request a record 
or information pertaining to themselves, and to establish procedures 
for disclosing personal information. SSA established Screen Pop, an 
automated telephone process, to increase speed of verification for such 
individuals. Accessing Screen Pop, callers enter their Social Security 
number (SSN) using their telephone keypad or speech technology prior to 
speaking with a National 800 Number Network (N8NN) agent. The automated 
Screen Pop application collects the SSN and routes it to the ``Start 
New Call'' Customer Help and Information (CHIP) screen. Functionality 
for the Screen Pop application ends once the SSN connects to the CHIP 
screen and the SSN routes to the agent's screen. When the call connects 
to the N8NN agent, the agent can use the SSN to access the caller's 
record as needed. The respondents for this collection are individuals 
who contact SSA's N8NN to speak with an agent.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                       Number of     Frequency of   burden per   Estimated total
              Modality of completion                   responses       response      response     annual burden
                                                                                     (minutes)       (hours)
----------------------------------------------------------------------------------------------------------------
Screen Pop........................................      55,600,000             1             1          926,667
----------------------------------------------------------------------------------------------------------------

    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 August 22, 2014. Individuals can obtain copies of the OMB 
clearance packages by writing to [email protected].
    1. Statement Regarding Date of Birth and Citizenship--20 CFR 
404.716--0960-0016. Section 205(a) of the 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
                                                       Number of     Frequency of   burden per   Estimated total
              Modality of completion                  respondents      response      response     annual burden
                                                                                     (minutes)       (hours)
----------------------------------------------------------------------------------------------------------------
SSA-7157..........................................           1,200             1            10              200
----------------------------------------------------------------------------------------------------------------

    2. 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    burden per   total annual
                Modality of completion                    respondents   of response    response       burden
                                                                                      (minutes)       (hours)
----------------------------------------------------------------------------------------------------------------
SSA-2490-BK (Modernized Claims System)................          14,175            1           30           7,088
SSA-2490-BK (paper)...................................           2,025            1           30           1,013
                                                       ---------------------------------------------------------
    Totals............................................          16,200  ...........  ...........           8,101
----------------------------------------------------------------------------------------------------------------


[[Page 42866]]

    3. 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    burden per   total annual
                Modality of completion                    respondents   of 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
----------------------------------------------------------------------------------------------------------------

    4. Medicare Part D Subsidies Regulations--20 CFR 418.3625, 
418.3645, 418.3665(a), and 418.3670--0960-0702. The MMA of 2003 
established the Medicare Part D program for voluntary prescription drug 
coverage of premium, deductible, and co-payment costs for certain low-
income individuals. The MMA also mandated the provision of subsidies 
for those individuals who qualify for the program and who meet 
eligibility criteria for help with premium, deductible, or co-payment 
costs. This law requires SSA to make eligibility determinations and to 
provide a process for appealing SSA's determinations. Regulation 
sections 418.3625(c), 418.3645, 418.3665(a), and 418.3670 contain 
public reporting requirements pertaining to administrative review 
hearings. Respondents are applicants for the Medicare Part D subsidies 
who request an administrative review hearing.
    Type of Request: Extension of an existing OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                       Average       Estimated
                                                           Number of     Frequency    burden per   total annual
                Modality of completion                    respondents   of response    response       burden
                                                                                      (minutes)       (hours)
----------------------------------------------------------------------------------------------------------------
418.3625(c)...........................................             150            1            5              13
418.3645..............................................              10            1           20               3
418.3665(a)...........................................             300            1            5              25
418.3670..............................................               0            1           10               0
                                                       ---------------------------------------------------------
    Total.............................................             460  ...........  ...........              41
----------------------------------------------------------------------------------------------------------------

    5. Help America Vote Act--0960-0706. House Rule 3295, the Help 
America Vote Act of 2002, mandates that States verify the identities of 
newly registered voters. When newly registered voters do not have 
driver's licenses or State-issued ID cards, they must supply the last 
four digits of their Social Security number to their local State 
election agencies for verification. The election agencies forward this 
information to their State Motor Vehicle Administration (MVA), who 
inputs the data into the American Association of MVAs, a central 
consolidation system that routes the voter data to SSA's Help America 
Vote Verification (HAVV) system. Once SSA's HAVV system has confirmed 
the identity of the voter, the information will return along the same 
route in reverse until it reaches the State election agency. The 
official respondents for this collection are the State MVAs.
    Note: This is a correction notice: SSA published the incorrect 
burden information for this collection at 79 FR 37828 on 07/02/14. We 
are correcting this error here.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                       Number of     Frequency of   burden per   Estimated total
              Modality of completion                  respondents      response      response     annual burden
                                                                                     (minutes)       (hours)
----------------------------------------------------------------------------------------------------------------
HAVV..............................................       4,878,239             1             2          162,608
----------------------------------------------------------------------------------------------------------------


    Dated: July 18, 2014.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2014-17275 Filed 7-22-14; 8:45 am]
BILLING CODE 4191-02-P