[Federal Register Volume 80, Number 99 (Friday, May 22, 2015)]
[Notices]
[Pages 29787-29789]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-12454]


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SOCIAL SECURITY ADMINISTRATION

[Docket No: SSA-2015-0030]


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 of OMB-approved information collections, and 
reinstatements of previously 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-
0029].
    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 July 
21, 2015. Individuals can obtain copies of the collection instruments 
by writing to the above email address.
    1. Statement of Funds You Provided to Another and Statement of 
Funds You Received--20 CFR 404.1520(b), 404.1571-404.1576, 404.1584-
404.1593 and 416.971-416.976--0960-0059. SSA uses Form SSA-821-BK to 
collect recipient employment information to determine whether 
recipients worked after becoming disabled and, if so, whether the work 
is substantial gainful activity. SSA's field offices use Form SSA-821-
BK to obtain work information during the initial claims process, the 
continuing disability review process, and for Supplemental Security 
Income (SSI) claims involving work issues. SSA's processing centers and 
the Office of Disability and International Operations use the form to 
obtain post-adjudicative work issue from recipients. SSA reviews and 
evaluates the data to determine if the applicant or recipient meets the 
disability requirements of the law. The respondents are applicants and 
recipients of Title II Social Security and SSI disability payments.
    Type of Request: Reinstatement with change of a previous OMB-
approved information collection.

[[Page 29788]]



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                                                                                 Average burden  Estimated total
           Modality of completion                Number of       Frequency of     per response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-821-BK..................................         300,000                1               30          150,000
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    2. Coverage of Employees of State and Local Governments--20 CFR 
404, Subpart M--0960-0425. The Code of Federal Regulations at 20 CFR 
404, Subpart M, prescribes the rules for States submitting reports of 
deposits and recordkeeping to SSA. States (and interstate 
instrumentalities) are required to provide wage and deposit 
contribution information for pre-1987 periods. Not all states have 
completely satisfied their pending wage report and contribution 
liability with SSA for pre-1987 tax years. These regulations are needed 
until all pending items with all states are closed out, and to provide 
for collection of this information in the future, if necessary. The 
respondents are State and local governments or interstate 
instrumentalities.
    Type of Request: Reinstatement without change of a previously 
approved collection.

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                                                                                  Average burden     Estimated
               Regulation section                    Number of     Frequency of    per response    total annual
                                                    respondents      response        (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
404.1204 (a) & (b)..............................              52               1              30              26
404.1215........................................              52               1              60              52
404.1216 (a) & (b)..............................              52               1              60              52
                                                 ---------------------------------------------------------------
    Total.......................................             156  ..............  ..............             130
----------------------------------------------------------------------------------------------------------------

    3. Credit Card Payment Form--0960-0648. SSA uses Form SSA-1414 to 
process: (1) Credit card payments from former employees and vendors 
with outstanding debts to the agency; (2) advance payments for 
reimbursable agreements; and (3) credit card payments for all Freedom 
of Information Act (FOIA) requests requiring payment. The respondents 
are former employees and vendors who have outstanding debts to the 
agency, entities who have reimbursable agreements with SSA, and 
individuals who request information through FOIA.
    Type of Request: Reinstatement without change of a previous 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-1414....................................           6,000                1                2              200
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    4. Social Security Administration Health IT Partner Program 
Assessment--Participating Facilities and Available Content Form--20 CFR 
404.1614, 416.1014, 24 CFR 495.300-495.370--0960-0798. The Health 
Information Technology for Economic and Clinical Health (HITECH) Act 
promotes the adoption and meaningful use of health information 
technology (IT), particularly in the context of working with government 
agencies. Similarly, section 3004 of the Public Health Service Act 
requires health care providers or health insurance issuers with 
government contracts to implement, acquire, or upgrade their health IT 
systems and products to meet adopted standards and implementation 
specifications. To support expansion of SSA's health IT initiative as 
defined under HITECH, SSA developed Form SSA-680, the Health IT Partner 
Program Assessment--Participating Facilities and Available Content 
Form. The SSA-680 allows healthcare providers to provide the 
information SSA needs to determine their ability to exchange health 
information with us electronically. We evaluate potential partners 
(i.e., healthcare providers and organizations) on (1) the accessibility 
of health information they possess, and (2) the content value of their 
electronic health records' systems for our disability adjudication 
processes. SSA reviews the completeness of organizations' SSA-680 
responses as one part of our careful analysis of their readiness to 
enter into a health IT partnership with us. The respondents are 
healthcare providers and organizations exchanging information with the 
agency.
    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         (hours)          (hours)
----------------------------------------------------------------------------------------------------------------
SSA-680.....................................              30                1                5              150
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    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.

[[Page 29789]]

To be sure we consider your comments, we must receive them no later 
than June 22, 2015. Individuals can obtain copies of the OMB clearance 
packages by writing to [email protected].
    1. Application for Supplemental Security Income--20 CFR 416.305-
416.335, Subpart C--0960-0444. SSA uses Form SSA-8001-BK to determine 
an applicant's eligibility for SSI and SSI payment amounts. SSA 
employees also collect this information during interviews with members 
of the public who wish to file for SSI. SSA uses the information for 
two purposes: (1) Formally deny SSI for non-medical reasons when 
information the applicant provides results in ineligibility; or (2) 
establish a disability claim, but defer the complete development of 
non-medical issues until SSA approves the disability. The respondents 
are applicants for SSI.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                                     Estimated
                                                     Number of     Frequency of   Average burden   total annual
             Modality of completion                 respondents      response      per response       burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
MSSICS/Signature Proxy..........................       1,195,521               1              20         398,507
Non-MSSICS (Paper)..............................         140,145               1              20          46,715
                                                 ---------------------------------------------------------------
    Totals......................................       1,335,666  ..............  ..............         445,222
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    2. Statement of Reclamation Action--31 CFR 210--0960-0734. 
Regulations governing the Federal Government Participation in the 
Automated Clearing House (1) allow SSA to send Social Security payments 
to Canada, and (2) mandate the reclamation of funds paid erroneously to 
a Canadian bank or financial institution after the death of a Social 
Security beneficiary. SSA uses Form SSA-1713, Notice of Reclamation 
Action, to determine if, how, and when the Canadian bank or financial 
institution is going to return erroneous payments after the death of a 
Social Security beneficiary who elected to have payments sent to 
Canada. Form SSA-1712 (or SSA-1712 CN), Notice of Reclamation-Canada 
Payment Made in the United States, is the cover sheet SSA prepares to 
request return of the payment. The respondents are Canadian banks and 
financial institutions who erroneously received Social Security 
payments.
    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-1713....................................              15                1                5                1
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    Dated: May 19, 2015.
Faye I. Lipsky,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2015-12454 Filed 5-21-15; 8:45 am]
BILLING CODE 4191-02-P