[Federal Register Volume 79, Number 182 (Friday, September 19, 2014)]
[Notices]
[Pages 56428-56430]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-22341]


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SOCIAL SECURITY ADMINISTRATION


Agency Information Collection Activities: 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 (PRA), 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]

    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 October 20, 2014. Individuals can obtain copies of the 
OMB clearance packages by writing to [email protected].
    1. Marital Relationship Questionnaire--20 CFR 416.1826--0960-0460. 
SSA uses Form SSA-4178, Marital Relationship Questionnaire, to 
determine if unrelated individuals of the opposite sex who live 
together are misrepresenting themselves as husband and wife. SSA needs 
this information to determine whether we are making correct payments to 
couples and individuals applying for or currently receiving 
Supplemental Security Income (SSI) payments. The respondents are 
applicants for and recipients of SSI payments.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                 Average burden  Total estimated
           Modality of completion                Number of       Frequency of     per response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4178....................................           5,100                1                5              425
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    2. SSI Notice of Interim Assistance Reimbursement (IAR)--0960-0546. 
Section 1631(g) of the Social Security 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 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, agreement, 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

[[Page 56429]]

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.

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                                                                                                       Total
                                   Number of      Frequency of       Number of    Average burden     estimated
    Modality of completion        respondents       response         responses     per response    annual burden
                                   (States)                                          (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
                                             Reporting Requirements
----------------------------------------------------------------------------------------------------------------
(a) State notification of                   11  Once per SSI              97,330               1           1,622
 receipt of authorization                        Claimant.
 (Electronic Process).
(b) State submission of copy                27  Once per SSI              68,405               3           3,420
 of authorization (Manual                        Claimant.
 Process).
(c) State submission of amount              38  Once per SSI             101,352               8          13,514
 of IA paid to recipients                        Claimant.
 (using eIAR).
(d) State request for                    (\1\)  As needed.......               2              30               1
 determination--dispute
 resolution.
(e) State computation of                    38  Once per SSI               1,524              30             762
 reimbursement due from SSA                      Claimant.
 using paper Form SSA-L8125-F6.
(f) State notification to SSA               20  As needed when                40              15              10
 of deceased claimant.                           SSI claimant
                                                 dies while
                                                 claim is
                                                 pending.
(g) State reviewing/signing of              38  Once during life              38           \2\12             456
 IAR Agreement.                                  of the IAR
                                                 agreement.
----------------------------------------------------------------------------------------------------------------
                                           Recordkeeping Requirements
----------------------------------------------------------------------------------------------------------------
(h) Maintenance of                          38  One form per SSI      \3\165,735               3           8,287
 authorization forms.                            claimant.
(i) Maintenance of accounting               38  One set per SSI          101,352               3           5,068
 forms and notices.                              claimant.
----------------------------------------------------------------------------------------------------------------
                                       Third Party Disclosure Requirements
----------------------------------------------------------------------------------------------------------------
(j) Written notice from State               38  One per SSI              101,352               7          11,824
 to recipient regarding amount                   claimant.
 of payment.
----------------------------------------------------------------------------------------------------------------
                                  Periodic Review of Agency Accounting Process
----------------------------------------------------------------------------------------------------------------
(k) Retrieve and consolidate                12  One set of forms              12               3              36
 authorization and accounting                    per SSI
 forms.                                          claimant for
                                                 review by SSA
                                                 once every 2 to
                                                 3 years.
(l) Participate in periodic                 12  For review by                 12              16             192
 review.                                         SSA once every
                                                 2 to 3 years.
(m) Correct administrative and               6  To correct                     6               4              24
 accounting discrepancies.                       errors
                                                 discovered by
                                                 SSA in periodic
                                                 review.
----------------------------------------------------------------------------------------------------------------
                                           Total Administrative Burden
----------------------------------------------------------------------------------------------------------------
    Totals....................              38  Varies..........         639,161          Varies          45,217
----------------------------------------------------------------------------------------------------------------
 \1\Average of about 2 States per year.
 \2\Hours.
 \3\Includes both denied and approved SSI claims.

    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.

[[Page 56430]]



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                                                                                                       Total
                                     Number of     Frequency of      Number of    Average burden     estimated
     Modality of completion         respondents      response        responses     per response    annual burden
                                                                                                      (hours)
----------------------------------------------------------------------------------------------------------------
HA-1151.........................           5,000              30         150,000              15          37,500
HA-1152.........................           5,000              30         150,000              15          37,500
                                 -------------------------------------------------------------------------------
    Totals......................          10,000  ..............         300,000  ..............          75,000
----------------------------------------------------------------------------------------------------------------

    4. Electronic Records Express--20 CFR 404.1512 and 416.912--0960-
0753. Electronic Records Express (ERE) is a Web-based SSA program that 
allows medical and educational providers to electronically submit 
disability claimant data to SSA. Both medical providers and other third 
parties with connections to disability applicants or recipients (e.g., 
teachers and school administrators for child disability applicants) use 
this system once they complete the registration process. SSA employees 
and State agency employees request the medical and educational records 
collected through the ERE Web site. The agency uses the information 
collected through ERE to make a determination on an Application for 
Benefits. We also use the ERE Web site to order and receive 
consultative examinations when we are unable to collect enough medical 
records to determine disability findings. The respondents are medical 
providers who evaluate or treat disability claimants or recipients, and 
other third parties with connections to disability applicants or 
recipients (ex: Teachers and school administrators for child disability 
applicants), who voluntarily choose to use ERE for submitting 
information.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden  Total estimated
           Modality of completion                Number of       Frequency of     per response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
ERE.........................................       4,508,968                1               10          751,495
----------------------------------------------------------------------------------------------------------------

    5. 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.

----------------------------------------------------------------------------------------------------------------
                                                                                                       Total
                                                     Number of     Frequency of   Average burden     estimated
             Modality of completion                 respondents      response      per response    annual 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
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    Dated: September 16, 2014.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2014-22341 Filed 9-18-14; 8:45 am]
BILLING CODE 4191-02-P