[Federal Register Volume 79, Number 186 (Thursday, September 25, 2014)]
[Notices]
[Pages 57650-57653]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-22809]


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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

[[Page 57651]]

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 
November 24, 2014. Individuals can obtain copies of the collection 
instruments by writing to the above email address.
    1. Letter to Employer Requesting Information About Wages Earned By 
Beneficiary--20 CFR 416.703, 404.801 & 404.820--0960-0034. Social 
Security disability recipients receive payments based on their 
inability to engage in substantial gainful activity (SGA) because of a 
physical or mental condition. If the recipients work, SSA must evaluate 
and determine if they continue to meet the disability requirements of 
the law. Therefore, we use Form SSA-L725 to request monthly earnings 
information from the recipient's employer. We then use the earnings 
data to determine whether the recipient is engaging in SGA, since work 
after a recipient becomes entitled to benefits can cause a cessation of 
disability. The respondents are businesses that employ Social Security 
disability recipients.
    Type of Request: Revision of an OMB-approved information 
collection.

 
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                                                                                                Estimated total
     Modality of completion            Number of         Frequency of     Average burden per     annual burden
                                      respondents          response       response (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L725........................            150,000                   1                  40             100,000
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    2. Letter to Employer Requesting Wage Information--0960-0138. SSA 
must establish and verify wage information for Supplemental Security 
Income (SSI) applicants and recipients when determining SSI eligibility 
and payment amounts. SSA uses Form SSA-L4201 to collect wage data from 
employers. SSA uses the information to determine eligibility and proper 
payment amounts for SSI applicants and recipients. The respondents are 
employers of SSI applicants and recipients.
    Type of Request: Revision of an OMB-approved information 
collection.

 
----------------------------------------------------------------------------------------------------------------
                                                                                                Estimated total
     Modality of completion            Number of         Frequency of     Average burden per     annual burden
                                      respondents          response       response (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L4201.......................            133,000                   1                  30              66,500
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    3. Statement of Living Arrangements, In-Kind Support, and 
Maintenance--20 CFR 416.1130-416.1148--0960-0174. SSA determines SSI 
payment amounts based on applicants' and recipients' needs. We measure 
individuals' needs, in part, by the amount of income they receive, 
including in-kind support and maintenance in the form of food and 
shelter provided by other persons. SSA uses Form SSA-8006-F4 to 
determine if in-kind support and maintenance exists for SSI applicants 
and recipients. This information also assists SSA in determining the 
income value of in-kind support and maintenance SSI applicants and 
recipients receive. The respondents are individuals who apply for SSI 
payments, or who complete an SSI eligibility redetermination.
    Type of Request: Revision of an OMB-approved information 
collection.

 
----------------------------------------------------------------------------------------------------------------
                                                                                                Estimated total
     Modality of completion            Number of         Frequency of     Average burden per     annual burden
                                      respondents          response       response (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-8006-F4.....................            173,380                   1                   7              20,228
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    4. Claimant's Recent Medical Treatment--20 CFR 404.1512 and 
416.912--0960-0292. When Disability Determinations Services (DDS) deny 
a claim at the reconsideration level, the claimant has a right to 
request a hearing before an administrative law judge (ALJ). For the 
hearing, SSA asks the claimant to complete and return the HA-4631 if 
the claimant's file does not reflect a current, complete medical 
history as the claimant proceeds through the appeals process. ALJs must 
obtain the information to update and complete the record and to verify 
the accuracy of the information. Through this process, ALJs can 
ascertain whether the claimant's situation changed. The ALJs and 
hearing office staff use the response to make arrangements for 
consultative examination(s) and the attendance of an expert 
witness(es), if appropriate. During the hearing, the ALJ offers any 
completed questionnaires as exhibits and may use them to (1) refresh 
the claimant's memory; and (2) shape their questions. The respondents 
are claimant's requesting hearings on entitlement to Old Age, 
Survivors, and Disability Insurance (OASDI) benefits or SSI payments.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 57652]]



 
----------------------------------------------------------------------------------------------------------------
                                                                                                Estimated total
     Modality of completion            Number of         Frequency of     Average burden per     annual burden
                                      respondents          response       response (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
HA-4631.........................            200,000                   1                  10              33,333
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    5. Supplemental Security Income (SSI) Claim Information Notice--20 
CFR 416.210--0960-0324. Section 1611(e)(2) of the Social Security Act 
requires individuals to file for and obtain all payments (annuities, 
pensions, disability benefits, veteran's compensation, etc.) for which 
they are eligible before qualifying for SSI payments. Individuals do 
not qualify for SSI if they do not first apply for all other benefits. 
SSA uses the information on Form SSA-L8050-U3 to verify and establish a 
claimant or recipient's eligibility under the SSI program. Respondents 
are SSI applicants or recipients who may be eligible for other payments 
from public or private programs.
    Type of Request: Revision of an OMB-approved information 
collection.

 
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                                                                                                Estimated total
     Modality of completion            Number of         Frequency of     Average burden per     annual burden
                                       responses           response       response (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L-8050-U3...................             17,044                   1                  10               2,841
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    6. You Can Make Your Payment by Credit Card--0960-0462. Using 
information from Form SSA-4588 and its electronic application, Form 
SSA-4589, SSA updates individuals' Social Security records to reflect 
payments made on their overpayments. In addition, SSA uses this 
information to process payments through the appropriate credit card 
company. SSA provides the SSA-4588 when we inform an individual that we 
detected an overpayment. Individuals may choose to make a one-time 
payment or recurring monthly payments by completing and submitting the 
SSA-4588. SSA uses the SSA-4589 electronic intranet application only 
when individuals choose to telephone the Program Service Centers to 
make a one-time payment in lieu of completing Form SSA-4588. An SSA 
debtor contact representative completes the SSA-4589 electronic 
intranet application. Respondents are OASDI beneficiaries and SSI 
recipients who have outstanding overpayments.
    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-4588 paper form.................             13,200                  1                 10              2,200
SSA-4589 electronic intranet                    221,316                  1                  5             18,443
 application........................
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    Totals..........................            234,516  .................  .................             20,643
----------------------------------------------------------------------------------------------------------------

    7. Application for Extra Help with Medicare Prescription Drug Plan 
Costs--20 CFR 418.3101--0960-0696. The Medicare Modernization Act of 
2003 mandated the creation of the Medicare Part D prescription drug 
coverage program and the provision of subsidies for eligible Medicare 
beneficiaries. SSA uses Form SSA-1020 or the Internet i1020, the 
Application for Extra Help with Medicare Prescription Drug Plan Costs, 
to obtain income and resource information from Medicare beneficiaries 
and to make a subsidy decision. The respondents are Medicare 
beneficiaries applying for the Part D low-income subsidy.
    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-1020 (paper application form)...            617,070                  1                 30            308,535
i1020 (online application)..........            282,228                  1                 25            117,595
Field Office Interview..............            155,687                  1                 30             77,844
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    Totals..........................          1,054,985  .................  .................            503,974
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[[Page 57653]]

    8. Certification of Low Birth Weight for SSI Eligibility of Funds 
You Provided to Another and Statement of Funds You Received--20 CFR 
416.931, 416.926a(m), and 416.924--0960-0720. Hospitals and claimants 
use Form SSA-3380 to provide medical information to local field offices 
(FO) and DDSs on behalf of infants with low birth weight. FOs use the 
form as a protective filing statement and the medical information to 
make presumptive disability findings, which allow expedited payment to 
eligible claimants. DDSs use the medical information to determine 
disability and continuing disability. The respondents are hospitals and 
claimants who have information identifying low birth weight babies and 
their medical conditions.
    Type of Request: Revision of an OMB-approved information 
collection.

 
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                                                                                                Estimated total
     Modality of completion            Number of         Frequency of     Average burden per     annual burden
                                      respondents          response       response (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3380........................             28,125                   1                  15               7,031
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    Dated: September 22, 2014.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2014-22809 Filed 9-24-14; 8:45 am]
BILLING CODE 4191-02-P