[Federal Register Volume 82, Number 8 (Thursday, January 12, 2017)]
[Notices]
[Pages 3838-3840]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-00500]


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SOCIAL SECURITY ADMINISTRATION

[Docket No: SSA-2017-0001]


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.
    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-2017-0001].
    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 
March 13, 2017. Individuals can obtain copies of the collection 
instruments by writing to the above email address.
    1. State Mental Institution Policy Review Booklet--20 CFR 404.2035, 
404.2065, 416.635, & 416.665--0960-0110. SSA uses Form SSA-9584-BK: (1) 
To determine if the policies and practices of a state mental 
institution acting as a representative payee for SSA beneficiaries 
conform to SSA's regulations in the use of benefits; (2) to confirm 
institutions are performing other duties and responsibilities required 
of representative payees; and (3) as the basis for conducting onsite 
reviews of the institutions and preparing subsequent reports of 
findings. The respondents are state mental institutions serving as 
representative payees for Social Security beneficiaries and 
Supplemental Security Income (SSI) recipients.
    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-9584-BK.................................              69                1               60               69
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[[Page 3839]]

    2. Statement of Death by Funeral Director--20 CFR 404.715 and 
404.720--0960-0142. When an SSA-insured worker dies, the funeral 
director or funeral home responsible for the worker's burial or 
cremation completes Form SSA-721 and sends it to SSA. SSA uses this 
information for three purposes: (1) To establish proof of death for the 
insured worker; (2) to determine if the insured individual was 
receiving any pre-death benefits SSA needs to terminate; and (3) to 
ascertain which surviving family member is eligible for the lump-sum 
death payment or for other death benefits. The respondents are funeral 
directors who handled death arrangements for the insured individuals.
    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-721.....................................         703,638                1                4           46,909
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    3. Employee Identification Statement--20 CFR 404.702--0960-0473. 
When two or more individuals report earnings under the same Social 
Security Number (SSN), SSA collects information on Form SSA-4156 to 
credit the earnings to the correct individual and SSN. We send the SSA-
4156 to the employer to: (1) Identify the employees involved; (2) 
resolve the discrepancy; and (3) credit the earnings to the correct 
SSN. The respondents are employers involved in erroneous wage reporting 
for an employee.
    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-4156....................................           4,750                1               10              792
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    4. Employee Work Activity Questionnaire--20 CFR 404.1574, 
404.1592--0960-0483. SSI recipients qualify for payments when a 
verified physical or mental impairment prevents them from working. If 
disability claimants attempt to return to work after receiving 
payments, but are unable to continue working, they submit the SSA-3033, 
Employee Work Activity Questionnaire, so SSA can evaluate their work 
attempt. SSA also uses this form to evaluate unsuccessful subsidy work 
and determine applicants' continuing eligibility for disability 
payments. The respondents are employers of Social Security disability 
beneficiaries and SSI recipients who unsuccessfully attempted to return 
to work.
    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-3033-BK.................................          15,000                1               15            3,750
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    5. Epidemiological Research Report--20 CFR 401.165--0960-0701. 
Section 1106(d) of the Social Security Act directs the Social Security 
Administration (SSA) to provide support to researchers involved in 
epidemiological or similar research. Specifically, when, in 
consultation with the Department of Health and Human Services, we 
determine a study contributes to a national health interest, SSA 
furnishes information to determine if a study subject appears in SSA 
administrative records as alive or deceased (vital status). SSA charges 
a small fee per request for providing this information. SSA's Internet 
application questions solicit the information SSA needs to provide the 
data and to collect the fees. The respondents are qualified health and 
scientific researchers who apply to receive vital status information 
about individuals from Social Security administrative data records.
    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)
----------------------------------------------------------------------------------------------------------------
State & Local Government--Interent Application..              15               1             120              30
Private Entities--Internet Application..........              10               1             120              20
                                                 ---------------------------------------------------------------
    Totals......................................              25  ..............  ..............              50
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    Cost Burden:
     Average annual cost per respondent (based on SSA data): 
$3,500.
     Total estimated annual cost burden: $87,500.
     6.Request for Medical Treatment in an SSA Employee Health 
Facility: Patient Self-Administered or Staff

[[Page 3840]]

Administered Care--0960-0772. SSA operates onsite Employee Health 
Clinics (EHC) in eight different States. These clinics provide health 
care for all SSA employees including treatments of personal medical 
conditions when authorized through a physician. Form SSA-5072 is the 
employee's personal physician's order form. The information we collect 
on Form SSA-5072 gives the nurses the guidance they need by law to 
perform certain medical procedures and to administer prescription 
medications such as allergy immunotherapy. In addition, the form allows 
the medical officer to determine whether they can administer treatment 
safely and appropriately in the SSA EHCs. Respondents are physicians of 
SSA employees who need to have medical treatment in an SSA EHC.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                                     Estimated
                                     Number of     Frequency of      Number of    Average burden   total annual
     Modality of collection         respondents      response        responses     per response       burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-5072 Annually...............              25               1              25               5               2
SSA-5072 Bi-Annually............              75               2             150               5              13
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    Totals......................             100  ..............  ..............  ..............              15
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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. To be sure we consider your comments, we must receive them 
no later than February 13, 2017. Individuals can obtain copies of the 
OMB clearance package by writing to [email protected].
    1. Petition to Obtain Approval of a Fee for Representing a Claimant 
Before the Social Security Administration--20 CFR 404.1720 and 
404.1725; 20 CFR 416.1520 and 416.1525--0960-0104. A Social Security 
claimant's representative, whether an attorney or a non-attorney, uses 
Form SSA-1560-U4 to petition SSA for authorization to charge and 
collect a fee. A claimant may also use the form to agree or disagree 
with the requested fee amount or other information the representative 
provides on the form. The SSA official responsible for setting the fee 
uses the information from the form to determine a reasonable fee amount 
representatives may charge for their services. The respondents are 
attorneys and non-attorneys who represent Social Security claimants.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                 Average burden  Estimated total
           Modality of collection                Number of       Frequency of     per response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1560-U4.................................          44,365                1               30           22,183
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    2. Requests for Self-Employment Information, Employee Information, 
Employer Information--20 CFR 422.120--0960-0508. When SSA cannot 
identify Form W-2 wage data for an individual, we place the data in an 
earnings suspense file and contact the individual (and in certain 
instances the employer) to obtain the correct information. If the 
respondent furnishes the name and SSN information that agrees with 
SSA's records, or provides information that resolves the discrepancy, 
SSA adds the reported earnings to the respondent's Social Security 
record. We use Forms SSA-L2765, SSA-L3365, and SSA-L4002 for this 
purpose. The respondents are self-employed individuals and employees 
whose name and SSN information do not agree with their employer's and 
SSA's records.
    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)
----------------------------------------------------------------------------------------------------------------
SSA-L2765.......................................          12,321               1              10           2,054
SSA-L3365.......................................         179,749               1              10          29,958
SSA-L4002.......................................         121,679               1              10          20,280
                                                 ---------------------------------------------------------------
    Totals......................................         313,749  ..............  ..............          52,292
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    Dated: January 9, 2017.
Naomi R. Sipple,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2017-00500 Filed 1-11-17; 8:45 am]
BILLING CODE 4191-02-P