[Federal Register Volume 82, Number 29 (Tuesday, February 14, 2017)]
[Notices]
[Pages 10623-10627]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-02941]


=======================================================================
-----------------------------------------------------------------------

SOCIAL SECURITY ADMINISTRATION

[Docket No: SSA-2017-0003]


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 a new information collection and 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,

[[Page 10624]]

referencing Docket ID Number [SSA-2017-0003].
    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 
April 17, 2017. Individuals can obtain copies of the collection 
instruments by writing to the above email address.
    1. Supported Employment Demonstration (SED) Project--0960-NEW. 
Sponsored by SSA, the SED project builds on the success of the 
intervention designed for the Mental Health Treatment Study (MHTS) 
previously funded by SSA. The MHTS provides integrated mental health 
and vocational services to disability beneficiaries with mental 
illness. The SED will offer these same services to individuals with 
mental illness for whom SSA denied Social Security disability benefits. 
SSA seeks to determine whether offering this evidence-based package of 
integrated vocational and mental health services to denied disability 
applicants fosters employment that leads to self-sufficiency; improved 
mental health and quality of life; and reduced demand for disability 
benefits. The SED will use a randomized controlled trial to compare the 
outcomes of two treatment groups and a control group. Study 
participation spans 36 months beginning on the day following the date 
of randomization to one of the three study groups. The SED study 
population consists of individuals aged 18 to 50 who apply for 
disability benefits alleging a mental illness, and the initial decision 
is a denial of benefits in the past 60 days. The SED will enroll up to 
1,000 participants in each of the three study arms for a total of 3,000 
participants: 40 participants in each of three study arms for the 20 
urban sites equaling an n of 2,400 urban site participants, and 20 
participants in each of three arms for the 10 rural sites equaling an n 
of 600 rural site participants.
    We randomly select and assign each enrolled participant to one of 
three study arms:
     Full-Service Treatment (n = 1,000). The multi-component 
service model from the MHTS comprises the Full-Service Treatment. At 
its core, it includes an Individual Placement and Support (IPS) 
supported employment specialist and behavioral health specialist 
providing IPS supported employment services integrated with behavioral 
health care. Participants in the full-service treatment group will also 
receive the services of a Nurse Care Coordinator who coordinates 
Systematic Medication Management services, as well assistance with: 
Out-of-pocket expenses associated with prescription behavioral health 
medications; work-related expenses; and services and treatment not 
covered by the participant's health insurance.
     Basic-Service Treatment (n = 1,000). The Basic-Service 
Treatment model leaves intact IPS supported employment integrated with 
behavioral health services as the centerpiece of the intervention arm. 
The Basic-Service Treatment is essentially the Full-Service model 
without the services of the Nurse Care Coordinator; Systematic 
Medication Management; and the funds associated with out-of-pocket 
expenses for prescription behavioral health medications.
     Usual Services (n = 1,000). This study arm represents a 
control group against which we can compare the two treatment groups. 
Participants assigned to this group seek services as they normally 
would (or would not) in their community. However, at the time of 
randomization, each Usual Service participant will receive a 
comprehensive manual describing mental health and vocational services 
in their locale, along with state and national resources.
    This study will test the two treatment conditions against each 
other and against the control group on multiple outcomes of policy 
interest to SSA. The key outcomes of interest include: (1) Employment; 
(2) earnings; (3) income; (4) mental status; (5) quality of life; (6) 
health services utilization; and (7) SSA disability benefit receipt and 
amount. SSA is also interested in the study take up rate 
(participation); knowing who enrolls (and who does not); and fidelity 
to evidence-based treatments; among other aspects of implementation. 
Data collection for the evaluation of the SED will consist of the 
following activities: Baseline in-person participant interviews; 
quarterly participant telephone interviews; receipt of SSA 
administrative record data; and collection of site-level program data. 
Evaluation team members will also conduct site visits involving: (1) 
Pre-visit environmental scans to understand the local context in which 
we embed SED services; (2) independent fidelity assessments in 
conjunction with those carried out by state Mental Health or Vocational 
Rehabilitation staff; (3) key informant interviews with the IPS 
specialist, the nurse care coordinator, the case manager, and facility 
director; (4) focus groups with participants in the Full-Service and 
Basic-Service Treatment groups; and (5) ethnographic data collection 
consisting of observations in the natural environment, and person-
centered interviews with participants and non-participants. The 
respondents are study participants and non-participants; family 
members; IPS specialists; nurse care coordinators; case managers; and 
facility directors.
    Type of Request: Request for a new information collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency  of    burden per     total annual
             Modality of completion                 respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
Competency and CIDI Screener....................           3,000               1              40           2,000
Baseline Interview..............................           3,000               1              45           2,250
Quarterly Interview (Quarters 1, 2, 3, 5, 6, 7,            3,000               9              20           9,000
 9, 10, and 11).................................
Annual Interview (Quarters 4, 8, and 11)........           3,000               3              30           4,500
Fidelity Assessment Participant Interview.......             180               4              60             720
Fidelity Assessment Family Member Interview.....              90               4              60             360
Key Informant Interview.........................             120               4              60             480
Participant Focus Groups........................             600               2              60           1,200
Person-Centered Interview.......................             180               4              60             720
                                                 ---------------------------------------------------------------
    Totals......................................          13,170  ..............  ..............          21,230
----------------------------------------------------------------------------------------------------------------


[[Page 10625]]

    2. Student Reporting Form--20 CFR 404.352(b)(2); 404.367; 404.368; 
404.415; 404.434; 422.135--0960-0088. To qualify for Social Security 
Title II student benefits, student beneficiaries must be in full-time 
attendance status at an educational institution. In addition, SSA 
requires these beneficiaries to report events that may cause a 
reduction, termination, or suspension of their benefits. SSA collects 
this information on Forms SSA-1383 and SSA-1383-FC to determine if the 
changes or events the student beneficiaries report will affect their 
continuing entitlement to SSA benefits. SSA also uses the SSA-1383 and 
SSA-1383-FC to calculate the correct benefit amounts for student 
beneficiaries. The respondents are Social Security Title II student 
beneficiaries.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency  of    burden per     total annual
             Modality of completion                 respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1383........................................          74,887               1               6           7,489
SSA-1383-FC.....................................           1,247               1               6             125
                                                 ---------------------------------------------------------------
    Totals......................................          76,134  ..............  ..............           7,614
----------------------------------------------------------------------------------------------------------------

    3. Advanced Notice of Termination of Child's Benefits & Student's 
Statement Regarding School Attendance--20 CFR 404.350-404.352, 404.367-
404.368--0960-0105. SSA collects information on Forms SSA-1372-BK and 
SSA-1372-BK-FC to determine whether children of an insured worker meet 
the eligibility requirements for student benefits. The data we collect 
allows SSA to determine student entitlement and thether to terminate 
benefits. The respondents are student claimants for Social Security 
benefits; their respective schools; and in some cases; their 
representative payees.
    Type of Request: Revision of an OMB-approved information 
collection.

                                                   SSA-1372-BK
----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency  of    burden per     total annual
               Type of respondent                   respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
Individuals/Households..........................          99,850               1               8          13,313
State/Local/Tribal Government...................          99,850               1               3           4,993
                                                 ---------------------------------------------------------------
    Totals......................................         199,700  ..............  ..............          18,306
----------------------------------------------------------------------------------------------------------------


                                                 SSA-1372-BK-FC
----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency  of    burden per     total annual
               Type of respondent                   respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
Individuals/Households..........................           1,198               1               8             160
State/Local/Tribal Government...................           1,198               1               3              60
                                                 ---------------------------------------------------------------
    Totals......................................           2,396  ..............  ..............             220
                                                 ---------------------------------------------------------------
    Grand Total.................................         200,096  ..............  ..............          18,526
----------------------------------------------------------------------------------------------------------------

    4. Request for Review of Hearing Decision/Order--20 CFR 404.967-
404.981, 416.1467-416.1481--0960-0277. Claimants have a statutory right 
under the Social Security Act and current regulations to request review 
of an administrative law judge's (ALJ) hearing decision or dismissal of 
a hearing request on Title II and Title XVI claims. Claimants may 
request Appeals Council review by filing a written request using Form 
HA-520. SSA uses the information to establish the claimant filed the 
request for review within the prescribed time and to ensure the 
claimant completed the requisite steps permitting the Appeals Council 
review. The Appeals Council uses the information to: (1) Document the 
claimant's reason(s) for disagreeing with the ALJ's decision or 
dismissal; (2) determine whether the claimant has additional evidence 
to submit; and (3) determine whether the claimant has a representative 
or wants to appoint one. The respondents are claimants requesting 
review of an ALJ's decision or dismissal of hearing.
    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)
----------------------------------------------------------------------------------------------------------------
HA-520......................................         175,000                1               10           29,167
----------------------------------------------------------------------------------------------------------------


[[Page 10626]]

    5. Disability Update Report--20 CFR 404.1589-404.1595 and 416.988-
416.996--0960-0511. As part of our statutory requirements, SSA 
periodically uses Form SSA-455, the Disability Update Report, to 
evaluate current Title II disability beneficiaries' and Title XVI 
disability payment recipients' continued eligibility for Social 
Security disability payments. Specifically, SSA uses the form to 
determine if: (1) There is enough evidence to warrant referring the 
respondent for a full medical Continuing Disability Review (CDR); (2) 
the respondent's impairments are still present and indicative of no 
medical improvement, precluding the need for a CDR; or (3) the 
respondent has unresolved work-related issues. SSA mails Form SSA-455 
to specific disability recipients, whom we select as possibly 
qualifying for the CDR process. SSA pre-fills the form with data 
specific to the disability recipient, except for the sections we ask 
the recipients to complete. When SSA receives the completed form, we 
scan it into SSA's system. This allows us to gather the information 
electronically, and enables SSA to process the returned forms through 
automated decision logic to decide the proper course of action to take. 
The respondents are recipients of Title II and Title XVI Social 
Security disability payments.
    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-455.....................................       1,500,000                1               15          375,000
----------------------------------------------------------------------------------------------------------------

    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 March 16, 2017. Individuals can obtain copies of the OMB 
clearance package by writing to [email protected].
    1. Agreement to Sell Property--20 CFR 416.1240-1245--0960-0127. 
Individuals or couples who are otherwise eligible for Supplemental 
Security Income (SSI) payments, but whose resources exceed the 
allowable limit may receive conditional payments if they agree to 
dispose of the excess non-liquid resources and make repayments. SSA 
uses Form SSA-8060-U3 to document this agreement, and to ensure the 
individuals understand their obligations. Respondents are applicants 
for and recipients of SSI payments who will be disposing of excess non-
liquid resources.
    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-8060-U3.................................          20,000                1               10            3,333
----------------------------------------------------------------------------------------------------------------

    2. Development of Participation in a Vocational Rehabilitation or 
Similar Program--20 CFR 404.316(c), 404.337(c), 404.352(d), 
404.1586(g), 404.1596, 404.1597(a), 404.327, 404.328, 416.1321(d), 
416.1331(a)-(b), and 416.1338, 416.1402--0960-0282. State Disability 
Determination Services (DDS) must determine if Social Security 
disability payment recipients whose disability ceased and who 
participate in vocational rehabilitation programs may continue to 
receive disability payments. To do this, DDSs need information about 
the recipients; the types of program participation; and the services 
they receive under the rehabilitation program. SSA uses Form SSA-4290 
to collect this information. The respondents are State employment 
networks; vocational rehabilitation agencies; or other providers of 
educational or job training services.
    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-4290....................................           3,000                1               15              750
----------------------------------------------------------------------------------------------------------------

    3. Appointment of Representative--20 CFR 404.1707, 404.1720, 
408.1101, 416.1507, and 416.1520--0960-0527. Individuals claiming 
rights or benefits under the Social Security Act (Act) must notify SSA 
in writing when they appoint an individual to represent them in dealing 
with SSA. SSA collects the information on Form SSA-1696-U4 to verify 
the appointment of these representatives. The SSA-1696-U4 allows SSA to 
inform representatives of items that affect the recipient's claim, and 
allows claimants to give permission to their appointed representatives 
to designate a person to receive their claims files. Respondents are 
applicants for, or recipients of, Social Security disability benefits 
(SSDI) or SSI payments who are notifying SSA they have appointed a 
person to represent them in their dealings with SSA.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 10627]]



----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden  Estimated total
           Modality of completion                Number of       Frequency of     per response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1696-U4.................................         800,000                1               10          133,333
----------------------------------------------------------------------------------------------------------------

    4. Work Activity Report (Self-Employment)--20 CFR 404.1520(b), 20 
CFR 404.1571-404.1576, 20 CFR 404.1584-404.1593, and 20 CFR 416.971-
416.976--0960-0598. SSA uses Form SSA-820-U4 to determine initial or 
continuing eligibility for (1) Title II SSDI, or (2) Title XVI SSI 
payments. Under Titles II and XVI of the Act, recipients receive 
disability benefits and SSI payments based on their inability to engage 
in substantial gainful activity (SGA) due to a physical or mental 
condition. Therefore, when the recipients resume work, they must report 
their work so SSA can evaluate and determine by law whether they 
continue to meet the disability requirements. SSA uses Form SSA-820-U4 
to obtain information on self-employment activities of Social Security 
Title II and XVI disability applicants and recipients. We use the data 
we obtain to evaluate disability claims, and to help us determine if 
the claimant meets current disability provisions under Titles II and 
XVI. Since applicants for disability benefits or payments must prove an 
inability to perform any kind of SGA generally available in the 
national economy for which we expect them to qualify based on age, 
education, and work experience, any work an applicant performed until, 
or subsequent to, the date the disability allegedly began, affects our 
disability determination. The respondents are applicants and claimants 
for SSI payments or SSDI benefits.
    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-820-BK..................................         100,000                1               30           50,000
----------------------------------------------------------------------------------------------------------------


    Dated: February 9, 2017.
Naomi R. Sipple,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2017-02941 Filed 2-13-17; 8:45 am]
 BILLING CODE 4191-02-P