[Federal Register Volume 80, Number 45 (Monday, March 9, 2015)]
[Notices]
[Pages 12542-12544]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-05351]


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SOCIAL SECURITY ADMINISTRATION

[Docket No: SSA-2015-0008]


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 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-2015-0008].
    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 May 
8, 2015. Individuals can obtain copies of the collection instruments by 
writing to the above email address.
    1. Application for Parent's Insurance Benefits--20 CFR 404.370-
404.374, and 404.601-404.603--0960-0012. Section 202(h) of the Social 
Security Act establishes the conditions of eligibility a claimant must 
meet to receive monthly benefits as a parent of a deceased worker. SSA 
uses information from Form SSA-7-F6 to determine if the claimant meets 
the eligibility and application criteria. The respondents are 
applicants for, and recipients of, Social Security Old Age, Survivors, 
and Disability Insurance (OASDI).
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 12543]]



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                                                                                      Average
                                                     Number of     Frequency of     burden per       Estimated
             Modality of completion                 respondents      response        response      total annual
                                                                                     (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
Modernized Claims System (MCS)..................             153               1              15              38
MCS/Signature Proxy.............................             158               1              14              37
Paper Form......................................               4               1              15               1
                                                 ---------------------------------------------------------------
    Total.......................................             315  ..............  ..............              76
----------------------------------------------------------------------------------------------------------------

    2. Claimant's Medication--20 CFR 404.1512, 416.912--0960-0289. In 
cases where claimants request a hearing after denial of their 
disability claim for Social Security, SSA uses Form HA-4632 to request 
information from the claimant regarding the medications they use. This 
information helps the administrative law judge overseeing the case to 
fully investigate: (1) The claimant's medical treatment and (2) the 
effects of the medications on the claimant's medical impairments and 
functional capacity. The respondents are applicants (or their 
representatives) for OASDI benefits or Supplemental Security Income 
(SSI) payments who request a hearing to contest an agency denial of 
their claim.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Frequency of     burden per       Estimated
             Modality of completion                 respondents      response        response      total annual
                                                                                     (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
HA-4632 (paper).................................          20,000               1              15           5,000
Electronic Records Express......................         180,000               1              15          45,000
                                                 ---------------------------------------------------------------
    Total.......................................         200,000  ..............  ..............          50,000
----------------------------------------------------------------------------------------------------------------

    3. Permanent Residence in the United States Under Color of Law 
(PRUCOL)--20 CFR 416.1615 and 416.1618--0960-0451. As per 20 CFR 
416.1415 and 416.1618 of the Code of Federal Regulations, SSA requires 
claimants or recipients to submit evidence of their alien status when 
they apply for SSI payments, and periodically thereafter as part of the 
eligibility determination process for SSI. When SSA cannot verify 
evidence of alien status through the regular claimant interview 
process, SSA verifies the validity of the evidence of PRUCOL for 
grandfathered nonqualified aliens with the Department of Homeland 
Security (DHS), and determines if the individual qualifies for PRUCOL 
status based on the DHS response. SSA does not maintain any forms or 
applications for respondents to use, rather, the regulations listed in 
20 CFR 416.1615 and 416.1618 specify the information respondents need 
to submit to SSA to show evidence of PRUCOL. Without this information, 
SSA is unable to determine whether the PRUCOL individual is eligible 
for SSI payments. Respondents are qualified and unqualified aliens who 
apply for SSI payments under PRUCOL.
    Type of Request: Extension of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Frequency of     burden per       Estimated
             Modality of completion                 respondents      response        response      total annual
                                                                                     (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
Personal or Telephone Interview.................           1,049               1               5              87
----------------------------------------------------------------------------------------------------------------

    4. Authorization for the Social Security Administration to Obtain 
Account Records from a Financial Institution and Request for Records 
(Medicare)--0960-0729. The Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (MMA) established the Medicare Part D program 
for voluntary prescription drug coverage of premium, deductible, and 
co-payment costs for individuals with limited income and resources. The 
MMA mandates that the Government provide subsidies for those 
individuals who qualify for the program, and who meet eligibility 
criteria for help with premium, deductible, or co-payment costs. SSA 
uses the SSA-4640, Authorization for the Social Security Administration 
to Obtain Account Records from a Financial Institution and Request for 
Records (Medicare) to determine if subsidy applicants or recipients 
qualify, or continue to qualify, for the subsidy. SSA uses Form SSA-
4640 to: (1) Obtain the individual's consent to verify balances of 
financial institution (FI) accounts; and (2) obtain verification of 
such balances from the FI. Respondents are Medicare Part D program 
subsidy applicants or claimants, and their financial institutions.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Frequency of     burden per       Estimated
                 Respondent type                    respondents      response        response      total annual
                                                                                     (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4640--Medicare Part D Subsidy Claimants.....           5,000               1               1              83
SSA-4640--Financial Institutions................           5,000               1               4             333
                                                 ---------------------------------------------------------------

[[Page 12544]]

 
    Totals......................................          10,000  ..............  ..............             416
----------------------------------------------------------------------------------------------------------------


    Dated: March 4, 2015.
Faye Lipsky,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2015-05351 Filed 3-6-15; 8:45 am]
 BILLING CODE 4191-02-P