[Federal Register Volume 83, Number 55 (Wednesday, March 21, 2018)]
[Notices]
[Pages 12455-12458]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-05627]


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SOCIAL SECURITY ADMINISTRATION

[Docket No: SSA-2018-0008]


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, 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-2018-0008].
    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 May 
21, 2018. Individuals can obtain copies of the collection instruments 
by writing to the above email address.
    1. Application for Parent's Insurance Benefits--20 CFR 404.370-
404.374 and 20 CFR 404.601-404.603--0960-0012. Section 202(h) of the 
Social Security Act (Act) establishes the conditions of eligibility a 
claimant must meet to receive monthly benefits as a parent of a 
deceased worker. SSA uses information from Form SSA-7-F6 to determine 
if the claimant meets the eligibility and application criteria. The 
respondents are applicants for, and recipients of, Social Security Old 
Age, Survivors, and Disability Insurance (OASDI).
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                      Average        Estimated
                                                     Number of     Frequency  of    burden  per    total  annual
             Modality of completion                 respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
Modernized Claims System (MCS)/Signature Proxy..             164               1              15              41
Paper...........................................               4               1              15               1
                                                 ---------------------------------------------------------------
    Total.......................................             168  ..............  ..............              42
----------------------------------------------------------------------------------------------------------------

    2. Request for Withdrawal of Application--20 CFR 404.640--0960-
0015. Form SSA-521 documents the information SSA needs to process the 
withdrawal of an application for benefits. A paper SSA-521 is our 
preferred instrument for executing a withdrawal request; however, any 
written request for withdrawal the claimant signs, or proper applicant 
signs on the claimant's behalf, will suffice. Individuals who wish to 
withdraw their applications for benefits complete Form SSA-521, or sign 
the completed form for each request to withdraw. SSA uses the 
information from the SSA-521 to process the request for withdrawal. The 
respondents are applicants or claimants for Retirement, Survivors, 
Disability, and Health Insurance benefits.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 12456]]



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                                                                                Average  burden     Estimated
           Modality of completion                Number of      Frequency  of     per response    total  annual
                                                respondents        response        (minutes)     burden  (hours)
----------------------------------------------------------------------------------------------------------------
SSA-521.....................................          31,827                1                5            2,652
----------------------------------------------------------------------------------------------------------------

    3. Statement of Self-Employment Income--20 CFR 404.101, 404.110, 
404.1096(a)(d)--0960-0046. To qualify for insured status, and collect 
Social Security benefits, self-employed individuals must demonstrate 
they earned the minimum amount of self-employment income (SEI) in a 
current year. SSA uses Form SSA-766, Statement of Self-Employment 
Income, to collect the information we need to determine if the 
individual earned at least the minimum amount of SEI needed for one or 
more quarters of coverage in the current year. Based on the information 
we obtain, we may credit additional quarters of coverage to give the 
individual insured status, expediting benefit payments. Respondents are 
self-employed individuals potentially eligible for Social Security 
benefits.
    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)
----------------------------------------------------------------------------------------------------------------
SSA-766.....................................           2,500                1                5              208
----------------------------------------------------------------------------------------------------------------

    4. Request for Workers' Compensation/Public Disability Benefit 
Information--20 CFR 404.408(e)--0960-0098. Claimants for Social 
Security disability payments who are also receiving Worker's 
Compensation/Public Disability Benefits (WC/PDB) must notify SSA about 
their WC/PDB, so the agency can reduce claimants' Social Security 
disability payments accordingly. If claimants provide necessary 
evidence, such as a copy of their award notice, benefit check, etc., 
that is sufficient verification. In cases where claimants cannot 
provide such evidence, SSA uses Form SSA-1709. The entity paying the 
WC/PDB benefits, its agent (such as an insurance carrier), or an 
administering public agency complete this form. The respondents are 
Federal, State, and local agencies; insurance carriers; and public or 
private self-insured companies administering WC/PDB benefits to 
disability claimants.
    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)
----------------------------------------------------------------------------------------------------------------
SSA-1709....................................         120,000                1               15           30,000
----------------------------------------------------------------------------------------------------------------

    5. Third Party Liability Information Statement--42 CFR 433.136-
433.139--0960-0323. To reduce Medicaid costs, Medicaid state agencies 
identify third party insurers liable for medical care or services for 
Medicaid beneficiaries. Regulations at 42 CFR 433.136-433.139 of the 
Code of Federal Regulations, require Medicaid state agencies to obtain 
this information on Medicaid applications and redeterminations as a 
condition of Medicaid eligibility. States may enter into agreements 
with the Commissioner of Social Security to make Medicaid eligibility 
determinations for aged, blind, and disabled beneficiaries in those 
states. Applications for and redeterminations of Supplemental Security 
Income (SSI) eligibility in jurisdictions with such agreements are 
applications and redeterminations of Medicaid eligibility. Under these 
agreements, SSA obtains third party liability information using Form 
SSA-8019-U2, and provides that information to the Medicaid state 
agencies. The Medicaid state agencies use the information to bill third 
parties liable for medical care, support, or services for a beneficiary 
to guarantee that Medicaid remains the payer of last resort. The 
respondents are SSI claimants and recipients.
    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-8019-U2 Paper form..........................             200               1               5              17
SSI Claims System...............................          49,621               1               5           4,135
                                                 ---------------------------------------------------------------
    Totals......................................          49,821  ..............  ..............           4,152
----------------------------------------------------------------------------------------------------------------


[[Page 12457]]

    6. Permanent Residence in the United States Under Color of Law 
(PRUCOL)--20 CFR 416.1615 and 416.1618--0960-0451. As per 20 CFR 
416.1415 and 416.1618 of the Code of Federal Regulations, SSA requires 
claimants or recipients to submit evidence of their alien status when 
they apply for SSI payments, and periodically thereafter as part of the 
eligibility determination process for SSI. When SSA cannot verify 
evidence of alien status through the regular claimant interview 
process, SSA verifies the validity of the evidence of PRUCOL for 
grandfathered nonqualified aliens with the Department of Homeland 
Security (DHS), and determines if the individual qualifies for PRUCOL 
status based on the DHS response. SSA does not maintain any forms or 
applications for respondents to use, rather, the regulations listed in 
20 CFR 416.1615 and 416.1618 specify the information respondents need 
to submit to SSA to show evidence of PRUCOL. Without this information, 
SSA is unable to determine whether the PRUCOL individual is eligible 
for SSI payments. Respondents are qualified and unqualified aliens who 
apply for SSI payments under PRUCOL.
    Type of Request: Extension of an OMB-approved information 
collection.

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                                                                                Average  burden     Estimated
           Modality of completion                Number of      Frequency  of     per response    total  annual
                                                respondents        response        (minutes)     burden  (hours)
----------------------------------------------------------------------------------------------------------------
Personal or Telephone Interview.............           1,049                1                5               87
----------------------------------------------------------------------------------------------------------------

    7. Authorization for the Social Security Administration to Obtain 
Account Records from a Financial Institution and Request for Records 
(Medicare)--20 CFR 418.3420--0960-0729. The Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (MMA) established the 
Medicare Part D program for voluntary prescription drug coverage of 
premium, deductible, and copayment costs for individuals with limited 
income and resources. The MMA mandates that the Government provide 
subsidies for those individuals who qualify for the program, and who 
meet eligibility criteria for help with premium, deductible, or co-
payment costs. SSA uses the SSA-4640, Authorization for the Social 
Security Administration to Obtain Account Records from a Financial 
Institution and Request for Records (Medicare), to determine if subsidy 
applicants or recipients qualify, or continue to qualify, for the 
subsidy. SSA uses Form SSA-4640 to: (1) Obtain the individual's consent 
to verify balances of financial institution (FI) accounts; and (2) 
obtain verification of such balances from the FI. Respondents are 
Medicare Part D program subsidy applicants or claimants, and their 
financial institutions.
    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)
----------------------------------------------------------------------------------------------------------------
Medicare Part D Subsidy Applicants..............           5,000               1               1              83
Financial Institutions..........................           5,000               1               4             333
                                                 ---------------------------------------------------------------
    Total.......................................          10,000  ..............  ..............             416
----------------------------------------------------------------------------------------------------------------

    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 April 20, 2018. Individuals can obtain copies of the 
OMB clearance packages by writing to [email protected].
    1. 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 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 paper Form HA-
520, or the internet application, i520. SSA uses the information we 
collect 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 then 
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: A New Information Collection Request.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency  of    burden  per    total  annual
             Modality of completion                 respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
HA-520--Paper...................................         105,000               1              10          17,500
i520--Internet..................................          70,000               1              15          17,500
                                                 ---------------------------------------------------------------

[[Page 12458]]

 
    Total.......................................         175,000  ..............  ..............          35,000
----------------------------------------------------------------------------------------------------------------

    2. 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 claimants requesting hearings on entitlement to OASDI 
benefits or SSI payments.
    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-4631.....................................         200,000                1               20           33,333
----------------------------------------------------------------------------------------------------------------


    Dated: March 15, 2018.
Naomi R. Sipple,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2018-05627 Filed 3-20-18; 8:45 am]
BILLING CODE 4191-02-P