[Federal Register Volume 79, Number 234 (Friday, December 5, 2014)]
[Notices]
[Pages 72237-72239]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-28562]


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SOCIAL SECURITY ADMINISTRATION

[Docket No. SSA-2014-0074]


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 and an extension 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].

    Or you may submit your comments online through www.regulations.gov, 
referencing Docket ID Number [SSA-2014-0074].
    I. The information collection below is pending at SSA. SSA will 
submit it 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 
February 3, 2015. Individuals can obtain copies of the collection 
instruments by writing to the above email address.
    Application for Mother's or Father's Insurance Benefits--20 CFR 
404.339-404.342, 20 CFR 404.601-404.603--0960-0003. Section 202(g) of 
the Social Security Act provides for the payment of monthly benefits to 
the widow or widower of an insured individual if the surviving spouse 
is caring for the deceased worker's child (who is entitled to Social 
Security benefits). SSA uses the information on Form SSA-5-BK to 
determine an individual's eligibility for mother's or father's 
insurance benefits. The respondents are individuals caring for a child 
of the deceased worker who is applying for mother's or father's 
insurance benefits under the Old Age, Survivors, and Disability 
Insurance program (OASDI).
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                      Average          Total
                                                     Number of     Frequency of     burden per       estimated
             Modality of completion                 respondents      response        response     annual  burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-5-F6 (paper)................................           1,611               1              15             403
MCS.............................................          26,045               1              15           6,511
MCS/Signature Proxy.............................          26,044               1              14            6077
                                                 ---------------------------------------------------------------
    Total.......................................          53,700  ..............  ..............          12,991
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[[Page 72238]]

    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 January 5, 2015. Individuals can obtain copies of the OMB 
clearance package by writing to [email protected].
    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.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden     Estimated
           Modality of completion                Number of       Frequency of    per  response    total  annual
                                                respondents        response        (minutes)     burden  (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.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden     Estimated
           Modality of completion                Number of       Frequency of    per  response    total  annual
                                                respondents        response        (minutes)     burden  (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L4201...................................         133,000                1               30           66,500
----------------------------------------------------------------------------------------------------------------

    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.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden     Estimated
           Modality of completion                Number of       Frequency of    per  response    total  annual
                                                respondents        response        (minutes)     burden  (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 has 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 OASDI benefits or 
SSI payments.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 72239]]



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                                                                                Average  burden  Estimated total
           Modality of completion                Number of       Frequency of    per  response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
HA-4631.....................................         200,000                1               10           33,333
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    5. 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 the DDS 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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                                                                                Average  burden  Estimated total
           Modality of completion                Number of       Frequency of    per  response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3380....................................          28,125                1               15            7,031
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    6. Request to Show Cause for Failure to Appear--20 CFR 404.938, 20 
CFR 416.1438, and 20 CFR 404.957(a)(ii)--0960-0794. When claimants who 
requested a hearing before an ALJ fail to appear at their scheduled 
hearing, the ALJ may reschedule the hearing if the claimants establish 
good cause for missing the hearings. To establish good cause, claimants 
must show one of the following: (1) SSA did not properly notify the 
claimant of the hearing, or (2) an unexpected event occurred without 
sufficient time for the claimant to request a postponement. The 
claimants can use paper Form HA-L90 to provide their reason for not 
appearing at their scheduled hearings; or the claimants' 
representatives can use Electronic Records Express to submit the HA-L90 
online. If the ALJ determines the claimants established good cause for 
failure to appear at the hearing, the ALJ will schedule a supplemental 
hearing; if not, the ALJ will make a claims eligibility determination 
based on the claimants' evidence of record. Respondents are claimants, 
or their representatives, seeking to establish good cause for failure 
to appear at a scheduled hearing before an ALJ.
    Type of Request: Extension 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)
----------------------------------------------------------------------------------------------------------------
HA-L90 (paper or Electronic Records Express)          40,000                1               10            6,667
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    Dated: December 2, 2014.
Faye Lipsky,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2014-28562 Filed 12-4-14; 8:45 am]
BILLING CODE 4191-02-P