[Federal Register Volume 82, Number 224 (Wednesday, November 22, 2017)]
[Notices]
[Pages 55707-55710]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-25282]


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SOCIAL SECURITY ADMINISTRATION

[Docket No: SSA-2017-0064]


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 an extension of an OMB-approved information collection, new 
information collections, 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, 
referencing Docket ID Number [SSA-2017-0064].
    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 
January 22, 2018 Individuals can obtain copies of the collection 
instruments by writing to the above email address.
    1. Fee Agreement for Representation Before the Social Security 
Administration--0960-NEW. SSA requires individuals who represent a 
claimant before the Social Security Administration and want to receive 
a fee for their services to obtain SSA's authorization of the fee under 
the Social Security Act (Act). We currently have two different, but 
mutually exclusive, methods to authorize a fee for a representative's 
services before SSA. SSA authorizes the fee either via the agreement 
process, if the representative submits the fee agreement before the 
first favorable decision, or the fee petition process, if the 
representative submits the request after the favorable decision. 
Currently SSA has no standardized form for the fee agreement process. 
Therefore, we created the SSA-1693 to make it easier for 
representatives to obtain the authorization for a fee agreement. SSA 
will use the information we collect on the SSA-1693 to review the 
request and authorize any fee to representatives who seek to charge and 
collect from a claimant. The respondents are the representatives who 
help claimants through the application process.
    Type of Request: Request for a new information collection.

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                                                                                               Estimated total
   Modality of  completion         Number of           Frequency of     Average burden  per     annual burden
                                  respondents            response       response  (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1693....................             600,000                    1                   12              120,000
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    2. Statement of Interpreter--0960-NEW. SSA and the Disability 
Determination Services (DDS) will use Form SSA-4321, Statement of 
Interpreter, when a person requiring an interpreter prefers to provide 
their own interpreter during an interview or conversation between the 
person requiring an interpreter and SSA or DDS. SSA will require the 
interpreter to sign Form SSA-4321, and confirm, among other things, 
that: (1) They will not knowingly give false information; (2) they will 
act as an interpreter and witness, and (3) they will accurately 
interpret the interview to the best of their ability. Section 205(a) of 
the Act, as amended in 42 U.S.C. 405(a), authorizes SSA collect this 
information.
    Type of Request: Request for a new information collection.

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                                                                                               Estimated total
   Modality of  completion         Number of           Frequency of     Average burden  per     annual burden
                                  respondents            response       response  (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4321....................           5,170,399                    1                    5              430,867
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    3. Statement of Living Arrangements, In-Kind Support, and 
Maintenance--20 CFR 416.1130-416.1148-0960-0174. SSA determines 
Supplemental Security Income (SSI) payment amounts based on applicants' 
and recipients' needs. We measure individuals' needs, in part, by the 
amount of income they receive, including in-kind support and 
maintenance in the form of food and shelter other people provide. SSA 
uses Form SSA-8006-F4 to determine if in-kind support and maintenance 
exists for SSI applicants and recipients. This information also assists 
SSA in determining the income value of in-kind support and maintenance 
SSI applicants and recipients receive. The respondents are individuals 
who apply for SSI payments, or who complete an SSI eligibility 
redetermination.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 55708]]



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                                                                                               Estimated total
   Modality of  completion         Number of           Frequency of     Average burden  per     annual burden
                                  respondents            response       response  (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-8006-F4.................             173,380                    1                    7               20,228
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    4. Claimant's Recent Medical Treatment--20 CFR 404.1512 and 
416.912--0960-0292. When DDSs deny a claim at the reconsideration 
level, the claimant has a right to request a hearing before an 
administrative law judge (ALJ). For the hearing, SSA asks the claimant 
to complete and return the HA-4631 if the claimant's file does not 
reflect a current, complete medical history as the claimant proceeds 
through the appeals process. ALJs must obtain the information to update 
and complete the record and to verify the accuracy of the information. 
Through this process, ALJs can ascertain whether the claimant's 
situation changed. The ALJs and hearing office staff use the response 
to make arrangements for consultative examination(s) and the attendance 
of an expert witness(es), if appropriate. During the hearing, the ALJ 
offers any completed questionnaires as exhibits and may use them to: 
(1) Refresh the claimant's memory, and (2) shape their questions. The 
respondents are claimant's requesting hearings on entitlement to Old 
Age Survivors and Disabilty Insurance benefits or SSI payments.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                               Estimated total
   Modality of completion          Number of           Frequency of      Average burden per     annual burden
                                  respondents            response        response (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
HA-4631.....................             200,000                    1                   10               33,333
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    5. Statement of Funds You Provided to Another and Statement of 
Funds You Received--20 CFR 416.1103(f)--0960-0481. SSA uses Forms SSA-
2854 (Statement of Funds You Provided to Another) and SSA-2855 
(Statement of Funds You Received) to gather information to verify if a 
loan is bona fide for SSI recipients. The SSA-2854 asks the lender for 
details on the transaction, and Form SSA-2855 asks the borrower the 
same basic questions independently. Agency personnel then compare the 
two statements; gather evidence if needed; and make a decision on the 
validity of the bona fide status of the loan.
    For SSI purposes, we consider a loan bona fide if it meets these 
requirements:
     Must be between a borrower and lender with the 
understanding that the borrower has an obligation to repay the money;
     Must be in effect at the time the cash goes to the 
borrower, that is, the agreement cannot come after the cash is paid; 
and
     Must be enforceable under State law, often there are 
additional requirements from the State.
    SSA collects this information at the time of initial application 
for SSI, or at any point when an individual alleges being party to an 
informal loan while receiving SSI. SSA collects information on the 
informal loan through both interviews and mailed forms. The agency's 
field personnel conduct the interviews and mail the form(s) for 
completion, as needed. The respondents are SSI recipients and 
applicants, and individuals who lend money to them.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                                Estimated total
     Modality of completion            Number of         Frequency of     Average burden per     annual burden
                                      respondents          response       response (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-2854........................              20,000                   1                  10               3,333
SSA-2855........................              20,000                   1                  10               3,333
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    Totals......................              40,000  ..................  ..................               6,666
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    6. Filing Claims Under the Federal Tort Claims Act--20 CFR 429.101-
429.110--0960-0667. The Federal Tort Claims Act is the legal mechanism 
for compensating people injured by negligent or wrongful acts that 
occur during the performance of Federal employees' official duties. In 
accordance with the law, SSA accepts monetary claims filed under the 
Federal Tort Claims Act for damages against the United States; loss of 
property; personal injury; or death resulting from an SSA employee's 
wrongful act or omission. The regulation sections cleared under this 
information collection request require claimants to provide information 
SSA can use to investigate and determine whether to make an award, 
compromise, or settlement under the Federal Tort Claims Act. The 
respondents are individuals or entities making a claim under the 
Federal Tort Claims Act.
    Type of Request: Extension of an OMB-approved information 
collection.

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                                                                                                Estimated total
     Modality of completion            Number of         Frequency of     Average burden per     annual burden
                                      respondents          response       response (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
429.102; 429.103\1\.............                   1                   1                   1                   1
429.104(a)......................                  11                   1                   5                   1
429.104(b)......................                  43                   1                   5                   4
429.104(c)......................                   1                   1                   5                   0

[[Page 55709]]

 
429.106(b)......................                   8                   1                  10                   1
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    Totals......................                  64  ..................  ..................                   7
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\1\ The 1 hour represents a placeholder burden. We are not reporting a burden for this collection because
  respondents complete OMB-approved Form SF-95.

    7. Application for Extra Help with Medicare Prescription Drug Plan 
Costs--20 CFR 418.3101--0960-0696. The Medicare Modernization Act of 
2003 mandated the creation of the Medicare Part D prescription drug 
coverage program and the provision of subsidies for eligible Medicare 
beneficiaries. SSA uses Form SSA-1020 or the Internet i1020, the 
Application for Extra Help with Medicare Prescription Drug Plan Costs, 
to obtain income and resource information from Medicare beneficiaries, 
and to make a subsidy decision. The respondents are Medicare 
beneficiaries applying for the Part D low-income subsidy.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                          Average burden per    Estimated total
     Modality of completion            Number of         Frequency of          response          annual burden
                                      respondents          response            (minutes)            (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1020 (paper application                  531,715                   1                  30             265,858
 form)..........................
i1020 (online application)......             346,642                   1                  25             144,434
Field office interview..........             108,194                   1                  30              54,097
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    Totals......................             986,551  ..................  ..................             464,389
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    II. SSA submitted the information collections below to OMB for 
clearance. Your comments regarding these 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 December 22, 2017. Individuals can obtain copies of 
the OMB clearance packages by writing to [email protected].
    1. Partnership Questionnaire--20 CFR 404.1080-404.1082(e)--0960-
0025. SSA considers partnership income in determining entitlement to 
Social Security benefits. SSA uses information from Form SSA-7104 to 
determine several aspects of eligibility for benefits, including the 
accuracy of reported partnership earnings; the veracity of a 
retirement; and lag earnings where SSA needs this information to 
determine the status of the insured. The respondents are applicants 
for, and recipients of, Title II Social Security benefits who are 
reporting partnership earnings,
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                               Estimated total
   Modality of completion          Number of          Frequency  of     Average burden  per     annual burden
                                  respondents            response       response  (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-7104....................              12,350                    1                   30                6,175
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    2. Supplement to Claim of Person Outside the United States--20 CFR 
422.505(b), 404.460, 404.463, and 42 CFR 407.27(c)--0960-0051. 
Claimants or beneficiaries (both United States (U.S.) citizens and 
aliens entitled to benefits) living outside the U.S. complete Form SSA-
21 as a supplement to an application for benefits. SSA collects the 
information to determine eligibility for U.S. Social Security benefits 
for those months an alien beneficiary or claimant is outside the U.S., 
and to determine if tax withholding applies. In addition, SSA uses the 
information to: (1) Allow beneficiaries or claimants to request a 
special payment exception in an SSA restricted country; (2) terminate 
supplemental medical insurance coverage for recipients who request it, 
because they are, or will be, out of the U.S.; and (3) allow claimants 
to collect a lump sum death benefit if the number holder died outside 
the United States and we do not have information to determine whether 
the lump sum death benefit is payable under the Social Security Act. 
The respondents are Social Security claimants, or individuals entitled 
to Social Security benefits, who are, were, or will be residing outside 
the United States for three months or longer.
    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)
----------------------------------------------------------------------------------------------------------------
Paper SSA-21--U.S. Residents....                 510                   1                  14                 119
Paper SSA-21--Residents of a Tax               2,751                   1                   9                 413
 Treaty Country.................
Paper SSA-21--Nonresident aliens               1,835                   1                   8                 245
Modernized Claims System (MCS)                 1,325                   1                  11                 243
 Macros SSA[dash]21--U.S.
 Residents......................

[[Page 55710]]

 
MCS Macros SSA 21--Residents of                7,153                   1                   6                 715
 a Tax Treaty Country...........
MCS Macros SSA 21--Nonresident                 4,769                   1                   5                 397
 aliens.........................
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    Totals......................              18,343  ..................  ..................               2,132
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    Dated: November 17, 2017.
Naomi R. Sipple,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2017-25282 Filed 11-21-17; 8:45 am]
 BILLING CODE 4191-02-P