[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]
=======================================================================
-----------------------------------------------------------------------
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.
----------------------------------------------------------------------------------------------------------------
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
----------------------------------------------------------------------------------------------------------------
[[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.
----------------------------------------------------------------------------------------------------------------
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
----------------------------------------------------------------------------------------------------------------
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.
----------------------------------------------------------------------------------------------------------------
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
----------------------------------------------------------------------------------------------------------------
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.
----------------------------------------------------------------------------------------------------------------
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
----------------------------------------------------------------------------------------------------------------
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.
----------------------------------------------------------------------------------------------------------------
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
----------------------------------------------------------------------------------------------------------------
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.
----------------------------------------------------------------------------------------------------------------
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
-------------------------------------------------------------------------------
Totals...................... 100 .............. .............. .............. 15
----------------------------------------------------------------------------------------------------------------
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.
----------------------------------------------------------------------------------------------------------------
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
----------------------------------------------------------------------------------------------------------------
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.
----------------------------------------------------------------------------------------------------------------
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
----------------------------------------------------------------------------------------------------------------
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