[Federal Register Volume 81, Number 98 (Friday, May 20, 2016)]
[Notices]
[Pages 31999-32001]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-11851]


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SOCIAL SECURITY ADMINISTRATION

[Docket No: SSA-2016-0020]


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 one 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-2016-0020].
    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 
19, 2016. Individuals can obtain copies of the collection instruments 
by writing to the above email address.
    1. Application for Supplemental Security Income--20 CFR 416.207 and 
416.305-416.335, Subpart C--0960-0229. The Supplemental Security Income 
(SSI) program provides aged, blind, and disabled individuals who have 
little or no income, with funds for food, clothing, and shelter. 
Individuals complete Form SSA-8000-BK to apply for SSI. SSA uses the 
information from Form SSA-8000-BK and its electronic Intranet 
counterpart, the Modernized SSI Claims Systems (MSSICS), to determine: 
(1) Whether SSI claimants

[[Page 32000]]

meet all statutory and regulatory eligibility requirements; and (2) SSI 
payment amounts. The respondents are applicants for SSI or their 
representative payees.
    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-8000-BK (Paper Version).....................          17,541               1              41          11,986
MSSICS/Signature Proxy..........................       1,373,401               1              35         801,151
                                                 ---------------------------------------------------------------
    Totals......................................       1,390,942  ..............  ..............         813,137
----------------------------------------------------------------------------------------------------------------

    2. 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) To deny SSI formally, for non-medical reasons when 
information the applicant provides results in ineligibility; or (2) to 
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.

----------------------------------------------------------------------------------------------------------------
                                                                                  Average burden     Estimated
             Modality of completion                  Number of     Frequency of    per response    total annual
                                                    respondents      response        (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
MSSICS/Signature Proxy..........................         937,207               1              20         312,402
SSA-8001-BK (Paper Version).....................           1,033               1              20             344
                                                 ---------------------------------------------------------------
    Totals......................................         938,240  ..............  ..............         312,746
----------------------------------------------------------------------------------------------------------------

    3. Function Report--Child (Birth to 1st Birthday, Age 1 to 3rd 
Birthday, Age 3 to 6th Birthday, Age 6 to 12th Birthday, Age 12 to 18th 
Birthday)--20 CFR 416.912 and 416.924a(a)(2)--0960-0542. As part of 
SSA's disability determination process, we use Forms SSA-3375-BK 
through SSA-3379-BK to request information from a child's parent or 
guardian for children applying for SSI. The five different versions of 
the form contain questions about the child's day-to-day functioning 
appropriate to a particular age group; thus, respondents use only one 
version of the form for each child. The adjudicative team (disability 
examiners and medical or psychological consultants) of State disability 
determination services offices collect the information on the 
appropriate version of this form (in conjunction with medical and other 
evidence) to form a complete picture of the children's ability to 
function and their impairment-related limitations. The adjudicative 
team uses the completed profile to determine: (1) If each child's 
impairment(s) results in marked and severe functional limitations; and 
(2) whether each child is disabled. The respondents are parents and 
guardians of child applicants for SSI.
    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-3375; SSA-3376; SSA-3377; SSA-3378; SSA-         532,000                1               20          177,333
 3379 *.....................................
----------------------------------------------------------------------------------------------------------------
* Respondents complete only one form per child.

    4. Government-to-Government Services Online Web site Registration; 
Government-to-Government Services Online Web site Account Modification/
Deletion Form--20 CFR 401.45--0960-0757. The Government-to-Government 
Services Online (GSO) Web site allows various external organizations to 
submit files to a variety of SSA systems and, in some cases, receive 
files in return. The SSA systems that process data transferred via GSO 
include, but are not limited to, systems responsible for disability 
processing and benefit determination or termination. SSA uses the 
information on Form SSA-159, Government-to-Government Online Web site 
Registration Form, to register the requestor to use the GSO Web site. 
Once we receive the SSA-159, SSA provides the user with account 
information and conducts a walkthrough of the GSO Web site as 
necessary. Established organizations may submit Form SSA-159 to 
register additional users as well. The established requesting 
organizations can also complete Form SSA-160, Government-to-Government 
Online Web site Account Modification/Deletion Form, to modify their 
online accounts (e.g., address change). Respondents are State and local 
government agencies, and some private sector business entities.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 32001]]



----------------------------------------------------------------------------------------------------------------
                                                                                  Average burden     Estimated
             Modality of completion                  Number of     Frequency of    per response    total annual
                                                    respondents      response        (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-159.........................................           1,543               1              15             386
SSA-160.........................................             130               1              15              33
                                                 ---------------------------------------------------------------
    Totals......................................           1,673  ..............  ..............             419
----------------------------------------------------------------------------------------------------------------

    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 June 20, 2016. Individuals can obtain copies of the OMB 
clearance packages by writing to [email protected].
    1. Agency/Employer Government Pension Offset Questionnaire--20 CFR 
404.408(a)--0960-0470. When an individual is concurrently receiving 
Social Security spousal, or surviving spousal, benefits and a 
government pension, the individual may have the amount of Social 
Security benefits reduced by the government pension amount. This is the 
Government Pension Offset (GPO). SSA uses Form SSA-L4163 to collect 
accurate pension information from the Federal or State government 
agency paying the pension for purposes of applying the pension offset 
provision. SSA uses this form only when (1) the claimant does not have 
the information; and (2) the pension-paying agency has not cooperated 
with the claimant. Respondents are State government agencies which have 
information SSA needs to determine if the GPO applies and the amount of 
offset.
    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)
----------------------------------------------------------------------------------------------------------------
SSA-L4163...................................            1000                1                3               50
----------------------------------------------------------------------------------------------------------------

    2. Real Property Current Market Value Estimate--0960-0471. SSA 
considers an individual's resources when evaluating eligibility for SSI 
payments. The value of an individual's resources, including non-home 
real property, is one of the eligibility requirements for SSI payments. 
SSA obtains current market value estimates of the claimant's real 
property through Form SSA-L2794. We allow respondents to use readily 
available records to complete the form, or we can accept their best 
estimates. We use this form as part of initial applications and in 
post-entitlement situations. The respondents are small business 
operators in real estate; state and local government employees tasked 
with assessing real property values; and other individuals 
knowledgeable about local real estate values.
    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-L2794...................................             250                1               20               83
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    Dated: May 16, 2016.
Naomi R. Sipple,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2016-11851 Filed 5-19-16; 8:45 am]
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