[Federal Register Volume 82, Number 38 (Tuesday, February 28, 2017)]
[Notices]
[Pages 12159-12161]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-03850]


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SOCIAL SECURITY ADMINISTRATION

[Docket No: SSA-2017-0008]


Agency Information Collection Activities: Proposed 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-
0008].
    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 May 
1, 2017. Individuals can obtain copies of the collection instruments by 
writing to the above email address.
    1. Statement Regarding Marriage--20 CFR 404.726--0960-0017. 
According to Section 216(h)(1)(A) of the Social Security Act (Act), SSA 
must apply state law when determining an individual's marital status. 
Some state laws recognize marriages without a ceremony (i.e., common-
law marriages). In such cases, SSA provides the same spouse or 
widow(er) benefits to the common-law spouses as it does to ceremonially 
married spouses. To determine common-law spouses, SSA must elicit 
information from blood relatives or other persons who are knowledgeable 
about the alleged common-law relationship. SSA uses Form SSA-753, 
Statement Regarding Marriage, to collect information from third parties 
to verify the applicant's statements about intent, cohabitation, and 
holding out to the public as married, which are the basic tenets of a 
common-law marriage. SSA uses the information to determine if a valid 
marital relationship exists, and if the common-law spouse is entitled 
to Social Security spouse or widow(er) benefits. The respondents are 
third parties who can confirm or deny the alleged common-law marriage.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 12160]]



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                                                                                Average  burden  Estimated total
           Modality of completion                Number of       Frequency of    per  response     annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-753.....................................          40,000                1                9            6,000
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    2. Statement of Income and Resources--20 CFR 416.207, 146.301-
416.310, 416.704, and 416.708-0960-0124. SSA collects information about 
income and resources for Supplemental Security Income (SSI) claims and 
redeterminations on the SSA-8010-BK. SSA uses the information to make 
initial or continuing eligibility determinations for SSI claimants or 
recipients who are subject to deeming. The respondents are people whose 
income and resources SSA may deem (consider to be available) to SSI 
applicants or 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-8010-BK.................................         341,000                1               26          147,767
----------------------------------------------------------------------------------------------------------------

    3. Claimant's Work Background--20 CFR 404.1512(a); 404.1520(a)(4); 
404.1565(b); 416.912(a); 416.920(a)(4); 416.965(b)--0960-0300. Sections 
205(a) and 1631(e) of the Act provide the Commissioner of Social 
Security with the authority to establish procedures for determining if 
a claimant is entitled to disability benefits. An administrative law 
judge (ALJ) may ask individuals to provide background information on 
Form HA-4633 about work they performed in the past 15 years. When a 
claimant requests a hearing before an ALJ to establish an entitlement 
to disability benefits, the ALJ may request that the claimant provide a 
work history to assist the ALJ in fully inquiring into statutory issues 
related to the disability. The ALJ uses the information collected from 
the claimants on Form HA-4633 to: (1) Identify the claimant's relevant 
work history; (2) decide if SSA requires expert vocational testimony 
and, if so, have a vocational expert available to testify during the 
hearing; and (3) provide a reference for the ALJ to discuss the 
claimant's work history. The ALJ makes the completed HA-4633 part of 
the documentary evidence of record. The respondents are claimants for 
disability benefits under Title II or Title XVI who requested a hearing 
before an ALJ after SSA denied their application for disability 
payments.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Frequency of     burden per       Estimated
             Modality of completion                 respondents      response        response      total  annual
                                                                                     (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
HA-4633 PDF/paper version.......................          20,000               1              15           5,000
Electronic Records Express......................         180,000               1              15          45,000
                                                 ---------------------------------------------------------------
    Total.......................................         200,000  ..............  ..............          50,000
----------------------------------------------------------------------------------------------------------------

    4. Letter to Landlord Requesting Rental Information--20 CFR 
416.1130(b)--0960-0454. SSA uses Form SSA-L5061 to obtain rental 
subsidy information, which enables SSA to determine and verify an 
income value for such subsidies. SSA uses this income value as part of 
determining eligibility for SSI and the correct amount of SSI payable 
to the claimant. SSA bases an individual's eligibility for SSI 
payments, in part, on the amount of countable income the individual 
receives. Income includes in-kind support and maintenance in the form 
of room or rent, such as a subsidized rental arrangement. SSA requires 
claimants to assist in obtaining this information to prevent a delay or 
overpayment with their SSI payments. We collect this information only 
if the SSI applicant or recipient is the parent or child of the 
landlord (respondent). For most respondents, we collect this 
information once per year or less, via telephone, or face-to-face 
personal interview. The claims representative records the information 
in our Modernized SSI Claims System (MSSICS), and we require verbal 
attestation in lieu of a wet signature. However, if the claims 
representative is unable to contact the respondent via the telephone or 
face-to-face, we print and mail a paper form to the respondent for 
completion. The respondent completes, signs, and returns the form to 
the claims representative. Upon receipt, the claims representative 
documents the information in MSSICS or, for non-MSSICS cases, faxes the 
form into the appropriate electronic folder and shreds the paper form. 
The respondents are landlords related to the SSI beneficiaries as a 
parent or child.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 12161]]



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                                                                                Average  burden  Estimated total
           Modality of completion                Number of       Frequency of    per  response     annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L5061...................................          72,000                1               10           12,000
----------------------------------------------------------------------------------------------------------------

    5. Request for Evidence From Doctor and Request for Evidence From 
Hospital--20 CFR 404 Subpart P and 20 CFR 416 Subpart I--0960-0722. 
Sections 223(d)(5) and 1614(a)(3)(H)(i) of the Act require claimants to 
furnish medical evidence of their disability when filing a disability 
claim. SSA uses Forms HA-66 and HA-67 to request evidence from medical 
sources, which claimants identify as having information relative to 
their impairments, or ability to do work-related activities. In 
addition to accepting manual paper responses, SSA sends a barcode with 
the HA-66 and HA-67, allowing respondents to fax the information 
directly into the electronic claims folder rather than submitting it 
manually. SSA uses the information to determine eligibility for 
benefits, and to pay medical sources for furnishing the information. 
The respondents are medical sources, doctors, and hospitals that 
evaluate the claimants.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                      Average
                                                     Number of     Frequency of     burden per       Estimated
             Modality of completion                 respondents      response        response      total  annual
                                                                                     (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
HA-66--Paper Version............................           3,060              22              15          16,830
HA-66--Electronic Version.......................           8,940              22              15          49,170
HA-67--Paper Version............................           3,060              22              15          16,830
HA-67--Electronic Version.......................           8,940              22              15          49,170
                                                 ---------------------------------------------------------------
    Totals......................................          24,000  ..............  ..............         132,000
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    Dated: February 23, 2017.
Naomi R. Sipple,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2017-03850 Filed 2-27-17; 8:45 am]
 BILLING CODE 4191-02-P