[Federal Register Volume 84, Number 17 (Friday, January 25, 2019)]
[Notices]
[Pages 371-377]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-00194]


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SOCIAL SECURITY ADMINISTRATION

[Docket No: SSA-2018-0072]


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

[[Page 372]]

1, 1995. This notice includes revisions of OMB-approved information 
collections, and one new information collection.
    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-2018-0072].
    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 26, 2019. Individuals can obtain copies of the collection 
instruments by writing to the above email address.
    1. Tribal Council Coverage Agreement--0960-NEW. Section 218A of the 
Social Security Act (Act) grants voluntary Social Security coverage to 
Indian tribal council members. The coverage is voluntary for tribal 
council members; however, if the tribe wishes to obtain Social Security 
coverage, they must complete the agreement. Each tribe requesting 
coverage fills out one agreement. SSA employees collect this 
information via the paper form. The respondents are Indian tribal 
councils who wish to receive Social Security coverage for their 
members.
    Type of Request: Request for a new information collection.

----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden  Estimated total
           Modality of completion                Number of       Frequency of     per response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
Tribal Council Coverage Agreement Form......             100                1               10               17
----------------------------------------------------------------------------------------------------------------

    2. Request to be Selected as a Payee--20 CFR 404.2010-404.2055, 
416.601-416.665--0960-0014. SSA requires an individual applying to be a 
representative payee for a Social Security beneficiary or Supplemental 
Security Income (SSI) recipient to complete Form SSA-11-BK, or supply 
the same information to a field office technician through a personal 
ingerview. SSA obtains information from applicant payees regarding 
their relationship to the beneficiary; personal qualifications; concern 
for the beneficiary's well-being; and intended use of benefits if 
appointed as payee. The respondents are individuals; private sector 
businesses and institutions; and State and local government 
institutions and agencies applying to become representative payees.
    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)
----------------------------------------------------------------------------------------------------------------
                                          Individuals/Households (90%)
----------------------------------------------------------------------------------------------------------------
Representative Payee System (RPS)...............       1,710,000               1              12         342,000
Paper Version...................................          68,400               1              12          13,680
                                                 ---------------------------------------------------------------
    Total.......................................       1,778,400  ..............  ..............         355,680
----------------------------------------------------------------------------------------------------------------
                                               Private Sector (9%)
----------------------------------------------------------------------------------------------------------------
Representative Payee System (RPS)...............         171,000               1              12          34,200
Paper Version...................................           6,840               1              12           1,368
                                                 ---------------------------------------------------------------
    Total.......................................         177,840  ..............  ..............          35,568
----------------------------------------------------------------------------------------------------------------
                                       State/Local/Tribal Government (1%)
----------------------------------------------------------------------------------------------------------------
Representative Payee System (RPS)...............          19,000               1              12           3,800
Paper Version...................................             340               1              12              68
                                                 ---------------------------------------------------------------
    Total.......................................          19,340  ..............  ..............           3,868
                                                 ---------------------------------------------------------------
        Grand Total.............................       1,975,580  ..............  ..............         395,116
----------------------------------------------------------------------------------------------------------------

    3. Statement for Determining Continuing Eligibility for 
Supplemental Security Income Payment--20 CFR 416.204--0960-0145. SSA 
uses Form SSA-8202-BK to conduct low and middle-error profile (LEP/MEP) 
telephone, or face-to-face redetermination interviews with SSI 
recipients and representative payees, if applicable. SSA conducts LEP 
redeterminations interviews on a 6-year cycle, and MEP redeterminations 
annually. SSA requires the information we collect during the interview 
to determine whether: (1) SSI recipients

[[Page 373]]

met, and continue to meet, all statutory and regulatory requirements 
for SSI eligibility; and (2) the SSI recipients received, and are still 
receiving, the correct payment amounts. This information includes non-
medical eligibility factors such as income, resources, and living 
arrangements. To complete Form SSA-8202, the respondents may need to 
obtain information from employers or financial institutions. The 
respondents are SSI recipients and their representatives, if 
applicable.
    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-8202-BK.....................................           9,954               1              21           3,484
SSI Claims System...............................       2,021,883               1              20         673,944
                                                 ---------------------------------------------------------------
    Totals......................................       2,031,787  ..............  ..............         677,428
----------------------------------------------------------------------------------------------------------------

    4. Internet Direct Deposit Application--31 CFR part 210--0960-0634. 
SSA requires all applicants and recipients of Social Security Old Age, 
Survivors, and Disability Insurance (OASDI) benefits, or SSI payments, 
to receive these benefits and payments via direct deposit at a 
financial institution. SSA receives Direct Deposit/Electronic Funds 
Transfer (DD/EFT) enrollment information from OASDI beneficiaries and 
SSI recipients to facilitate DD/EFT of their funds with their chosen 
financial institution. We also use this information when an enrolled 
individual wishes to change their DD/EFT information. For the 
convenience of the respondents, we collect this information through 
several modalities, including an internet application; in-office or 
telephone interviews; and our automated telephone system. In addition 
to using the direct deposit information to enable DD/EFT of funds to 
the recipient's chosen financial institution, we also use the 
information through our Direct Deposit Fraud Indicator to ensure the 
correct recipient receives the funds. Respondents are OASDI 
beneficiaries and SSI recipients requesting that we enroll them in the 
Direct Deposit program, or change their direct deposit banking 
information.
    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)
----------------------------------------------------------------------------------------------------------------
Internet DD.....................................         432,482               1              10          72,080
Non-Electronic Services (FO, 800#- ePath, SSI          3,227,426               1              12         645,485
 Claims System, SPS, MACADE, POS, RPS)..........
Direct Deposit Fraud Indicator..................          33,238               1               2           1,108
                                                 ---------------------------------------------------------------
    Totals......................................       3,693,146  ..............  ..............         718,673
----------------------------------------------------------------------------------------------------------------

    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 February 25, 2019. Individuals can obtain copies of 
the OMB clearance packages by writing to [email protected].
    1. Certificate of Responsibility for Welfare and Care of Child Not 
in Applicant's Custody--20 CFR 404.330, 404.339-404.341 and 404.348-
404.349--0960-0019. SSA uses Form SSA-781 to determine if non-custodial 
parents who file for spouse, mother's, father's, or surviving divorced 
mother's or father's benefits based on having a child in their care 
meet the in-care requirements. The in-care provision requires claimants 
to have an entitled child under age 16 or disabled in their care. The 
respondents are applicants for spouse, mother's, father's, or surviving 
divorced mother or father Social Security 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-781.....................................          14,000                1               10            2,333
----------------------------------------------------------------------------------------------------------------

    2. Farm Self-Employment Questionnaire--20 CFR 404.1082(c) & 
404.1095--0960-0061. SSA collects the information on Form SSA-7156 on a 
voluntary and as-needed basis to determine the existence of an 
agriculture trade or business which may affect the monthly benefit, or 
insured status, of the applicant. SSA requires the existence of a trade 
or business before determining if an individual or partnership has net 
earnings from self-employment. When an applicant indicates self-
employment as a farmer, SSA uses the SSA-7165 to obtain the information 
we need to determine the existence of an agricultural trade or 
business, and subsequent covered earnings for Social Security 
entitlement purposes. As part of the application process, we conduct a 
personal

[[Page 374]]

interview, either face-to-face or via telephone, and document the 
interview using Form SSA-7165. We also allow applicants to complete a 
fillable version of the form available on our website, which they can 
complete, print, and sign. The respondents are applicants for Social 
Security benefits whose entitlement depends on whether the worker 
received covered earnings from self-employment as a farmer.
    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-7156....................................          47,500                1               10            7,917
----------------------------------------------------------------------------------------------------------------

    3. Child Relationship Statement--20 CFR 404.355 & 404.731--0960-
0116. To help determine a child's entitlement to Social Security 
benefits, SSA uses criteria under section 216(h)(3) of the Act, deemed 
child provision. SSA may deem a child to an insured individual if: (1) 
The insured individual presents SSA with satisfactory evidence of 
parenthood, and was living with or contributing to the child's support 
at certain specified times; or (2) the insured individual: (a) 
Acknowledged the child in writing; (b) was court decreed as the child's 
parent; or (c) was court ordered to support the child. To obtain this 
information, SSA uses Form SSA-2519, Child Relationship Statement. The 
respondents are people with knowledge of the relationship between 
certain individuals filing for Social Security benefits and their 
alleged biological children.
    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-2519....................................          50,000                1               15           12,500
----------------------------------------------------------------------------------------------------------------

    4. Pre-1957 Military Service Federal Benefit Questionnaire--20 CFR 
404.1301 -404.1371--0960-0120. SSA may grant gratuitous military wage 
credits for active military or naval service (under certain conditions) 
during the period September 16, 1940 through December 31, 1956, if no 
other Federal agency (other than the Veterans Administration) credited 
the service for benefit eligibility or computation purposes. We use 
Form SSA-2512 to collect specific information about other Federal, 
military, or civilian benefits the wage earner may receive when the 
applicant indicates both pre-1957 military service and the receipt of a 
Federal benefit. SSA uses the data in the claims adjudication process 
to grant gratuitous military wage credits when applicable, and to 
solicit sufficient information to determine eligibility. Respondents 
are applicants for Social Security benefits on a record where the wage 
earner claims pre-1957 military service.
    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-2512....................................           5,000                1               10              833
----------------------------------------------------------------------------------------------------------------

    5. Authorization for the Social Security Administration to Obtain 
Account Records from a Financial Institution--20 CFR 416.200, 416.203, 
404.508, & 416.553--0960-0293. SSA collects and verifies financial 
information from individuals applying for Title II and Title XVI waiver 
determinations, as well as those who apply for, or currently receive 
(in the case of redetermination), SSI payments. We require the 
financial information from these applicants to: (1) Determine the 
eligibility of the applicant or recipient for SSI benefits; or (2) 
determine if a request to waive a Social Security overpayment defeats 
the purpose of the Act. If the Title II and Title XVI waiver 
applicants, or the SSI claimants, provide incomplete, unavailable, or 
seemingly altered records, SSA contacts their financial institutions to 
verify the existence, ownership, and value of accounts owned. Financial 
institutions need individuals to sign Form SSA-4641-F4, or work with 
SSA staff to complete one of SSA's electronic applications, e4641 or 
the Access to Financial Institutions (AFI) screens, to authorize the 
individual's financial institution to disclose records to SSA. The 
respondents are Title II and Title XVI recipients applying for waivers, 
or SSI applicants, recipients, and their to determine SSI eligibility.
    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-4641 (paper)................................         140,000               1               6          14,000

[[Page 375]]

 
e4641 and AFI (Internet)........................      15,860,000               1               2         528,667
                                                 ---------------------------------------------------------------
    Totals......................................      16,000,000  ..............  ..............         542,667
----------------------------------------------------------------------------------------------------------------

    6. Vocational Rehabilitation Provider Claim--20 CFR 404.2108(b), 
404.2117(c)(1)&(2), 404.2101(b)&(c), 404.2121(a), 416.2208(b), 
416.2217(c)(1) & (2), 416.2201(b)&(c), 416.2221(a)--0960-0310. State 
vocational rehabilitation (VR) agencies submit Form SSA-199 to SSA to 
obtain reimbursement of costs incurred for providing VR services. SSA 
requires state VR agencies to submit reimbursement claims for the 
following categories: (1) Claiming reimbursement for VR services 
provided; (2) certifying adherence to cost containment policies and 
procedures; and (3) preparing causality statements. The respondents 
provide the information requested through a web-based Secure Ticket 
Portal, in lieu of submitting forms. This Portal allows VRs to retrieve 
reports, and enter and submit information electronically, minimizing 
the use of the paper form to SSA for consideration and approval of the 
claim for reimbursement of costs incurred for SSA beneficiaries. SSA 
uses the information on the SSA-199, along with the written 
documentation, to determine whether, and how much, to pay State VR 
agencies under SSA's VR program. Respondents are State VR agencies 
offering vocational and employment services to Social Security and SSI 
recipients.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                  Average burden     Estimated
 Modality of completion (type of     Number of     Frequency of      Number of     per response    total annual
  response as indicated below)      respondents      response        responses       (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-199 CFR 404.2108 & 416.2208.              80             160          12,800              23           4,907
CFR 404.2117 & 416.2217 Written               80               1              80              60              80
 requests.......................
CFR 404.2121 & 416.2221 Written               80             2.5             200             100             333
 requests.......................
                                 -------------------------------------------------------------------------------
    Total.......................              80  ..............          13,080  ..............           5,320
----------------------------------------------------------------------------------------------------------------

    7. Response to Notice of Revised Determination--20 CFR 404.913-
404.914, 404.992(b), 416.1413-416.1414, and 416.1492(d)--0960-0347. 
When SSA determines: (1) Claimants for initial disability benefits do 
not actually have a disability; or (2) current disability recipients' 
records show their disability ceased, SSA notifies the disability 
claimants, or recipients of this decision. In response to this notice, 
the affected claimants and disability recipients have the following 
recourse: (1) They may request a disability hearing to contest SSA's 
decision; and (2) they may submit additional information or evidence 
for SSA to consider. Disability claimants, recipients, and their 
representatives use Form SSA-765 to accomplish these two actions. If 
respondents request the first option, SSA's Disability Hearings Unit 
uses the form to schedule a hearing; ensure an interpreter is present, 
if required; and ensure the disability recipients or claimants, and 
their representatives, receive a notice about the place and time of the 
hearing. If respondents choose the second option, SSA uses the form and 
other evidence to reevaluate the claimant's or recipients' case, and 
determine if the new information or evidence will change SSA's 
decision. The respondents are disability claimants, current disability 
recipients, or their representatives.
    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-765.....................................           1,925                1               30              963
----------------------------------------------------------------------------------------------------------------

    8. Request for Change in Time/Place of Disability Hearing--20 CFR 
404.914(c)(2) and 416.1414(c)(2)--0960-0348. At the request of the 
claimants or their representatives, SSA schedules evidentiary hearings 
at the reconsideration level for claimants of Title II benefits or 
Title XVI payments when we deny their claims for disability. When 
claimants or their representatives find they are unable to attend the 
scheduled hearing, they complete Form SSA-769 to request a change in 
time or place of the hearing. SSA uses the information as a basis for 
granting or denying requests for changes and for rescheduling 
disability hearings. Respondents are claimants or their representatives 
who wish to request a change in the time or place of their hearing.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 376]]



----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden  Estimated total
           Modality of completion                Number of       Frequency of     per response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-769.....................................           7,483                1                8              998
----------------------------------------------------------------------------------------------------------------

    9. Application for Supplemental Security Income--20 CFR 416.305-
416.335, Subpart C--0960-0444. SSA uses Form SSA-8001-BK to determine 
an applicant's eligibility for SSI and SSI payment amounts. SSA 
employees also collect this information during interviews with members 
of the public who wish to file for SSI. SSA uses the information for 
two purposes: (1) To formally deny SSI for nonmedical reasons when 
information the applicant provides results in ineligibility; or (2) to 
establish a disability claim, but defer the complete development of 
non-medical issues until SSA approves the disability. The respondents 
are applicants for 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)
----------------------------------------------------------------------------------------------------------------
SSI Claims System...............................         802,368               1              20         267,456
iClaim/SSI Claims System........................         168,661               1              20          56,220
SSA-8001-BK (Paper Version).....................           2,588               1              20             863
                                                 ---------------------------------------------------------------
    Totals......................................         973,617  ..............  ..............         324,539
----------------------------------------------------------------------------------------------------------------

    10. Wage Reports and Pension Information--20 CFR 422.122(b)--0960-
0547. Pension plan administrators annually file plan information with 
the Internal Revenue Service, which then forwards the information to 
SSA. SSA maintains and organizes this information by plan number, plan 
participant's name, and Social Security number. Under Section 1131(a) 
of the Act, pension plan participants are entitled to request this 
information from SSA. The Wage Reports and Pension Information 
regulation, 20 CFR 422.122(b) of the Code of Federal Regulations, 
requires requestors submit a written request with identifying 
information to SSA, before SSA disseminates this information. The 
respondents are requestors of pension plan information.
    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)
----------------------------------------------------------------------------------------------------------------
Requests for pension plan information.......             580                1               30              290
----------------------------------------------------------------------------------------------------------------

    11. International Direct Deposit--31 CFR part 210--0960-0686. SSA's 
International Direct Deposit (IDD) Program allows beneficiaries living 
abroad to receive their payments via direct deposit to an account at a 
financial institution outside the United States. SSA uses Form SSA-
1199-(Country) to enroll Title II beneficiaries residing abroad in IDD, 
and to obtain the direct deposit information for foreign accounts. 
Routing account number information varies slightly for each foreign 
country, so we use a variation of the Treasury Department's Form SF-
1199A for each country. The respondents are Social Security 
beneficiaries residing abroad who want SSA to deposit their Title II 
benefit payments directly to a foreign financial institution.
    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-1199-(Country)..........................          13,750                1                5            1,146
----------------------------------------------------------------------------------------------------------------

    12. Representative Payment Policies and Administrative Procedures 
for Imposing Penalties for False or Misleading Statements or 
Withholding of Information--0960-0740. This information collection 
request comprises several regulation sections that provide additional 
safeguards for Social Security beneficiaries' whose representative 
payees receive their payment. SSA requires representative payees to 
notify them of any event or change in circumstances that would affect 
receipt of benefits or performance of payee duties. SSA uses the 
information to determine continued eligibility for benefits, the amount 
of benefits due and if the payee is suitable to continue servicing as 
payee. The respondents are representative payees who receive and use 
benefits on behalf of Social Security beneficiaries.
    Type of Collection: Revision of an OMB-approved information 
collection.

[[Page 377]]



----------------------------------------------------------------------------------------------------------------
                                                                                  Average burden     Estimated
               Regulation section                    Number of     Frequency of    per response    total annual
                                                    respondents      response        (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
404.2035(d)--Paper/Mail.........................          29,601               1               5           2,467
404.2035(d)--Office interview/Intranet..........         562,419               1               5          46,868
404.2035(f)--Paper/Mail.........................             296               1               5              25
404.2035(f)--Office interview/Intranet..........           5,624               1               5             469
416.635(d)--Paper/Mail..........................          16,146               1               5           1,346
416.635(d)--Office interview/Intranet...........         296,424               1               5          24,702
416.635(f)--Paper/Mail..........................             162               1               5              14
416.635(f)--Office interview/Intranet...........           3,067               1               5             256
                                                 ---------------------------------------------------------------
    Totals......................................         913,739  ..............  ..............          76,147
----------------------------------------------------------------------------------------------------------------


    Dated: January 22, 2019.
Faye I. Lipsky,
Director, Office of Regulations and Reports Clearance, Social Security 
Administration.
[FR Doc. 2019-00194 Filed 1-24-19; 8:45 am]
 BILLING CODE 4191-02-P