[Federal Register Volume 84, Number 128 (Wednesday, July 3, 2019)]
[Notices]
[Pages 31972-31976]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-14173]


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SOCIAL SECURITY ADMINISTRATION

[Docket No: SSA-2019-0026]


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 extensions 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-2019-0026].
    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 
September 3, 2019. Individuals can obtain copies of the collection 
instruments by writing to the above email address.
    1. Application for Child's Insurance Benefits--20 CFR 404.350-
404.368, 404.603, & 416.350--0960-0010. Title II of the Social Security 
Act (Act) provides for the payment of monthly benefits to children of 
an insured retired, disabled, or deceased worker. Section 202(d) of the 
Act discloses the conditions and requirements the applicant must meet 
when filing an application. SSA uses the information on Form SSA-4-BK 
to determine entitlement for children of living and deceased workers to 
monthly Social Security payments. Respondents are guardians completing 
the form on behalf of the children of living or deceased workers, or 
the children of living or deceased workers.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 31973]]



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                                                                                      Average        Estimated
                                                     Number of     Frequency  of    burden per     total annual
             Modality of completion                 respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
Application for Child's Insurance Benefits/Death           1,204               1              12             241
 Claim/Paper SSA-4-BK...........................
Application for Child's Insurance Benefits/Death         204,777               1              11          37,542
 Claim/Modernized Claims System (MCS) and
 Preliminary Claims System (PCS)................
Application for Child's Insurance Benefits/Life            3,484               1              12             697
 Claim/Paper SSA-4-BK...........................
Application for Child's Insurance Benefits/Life          422,267               1              11          77,416
 Claim/MCS and PCS..............................
                                                 ---------------------------------------------------------------
    Totals......................................         631,732  ..............  ..............         115,896
----------------------------------------------------------------------------------------------------------------

    2. Request for Hearing by Administrative Law Judge--20 CFR 404.929, 
404.933, 416.1429, 404.1433, 418.1350, and 42 CFR 405.722--0960-0269. 
When SSA denies applicants', claimants', or beneficiaries' requests for 
new or continuing disability benefits or payments, the Act entitles 
those applicants, claimants, or beneficiaries to request a hearing to 
appeal the decision. To request a hearing, individuals complete Form 
HA-501; the associated Modernized Claims System (MCS) or Supplemental 
Security Income (SSI) Claims System interview; or the internet 
application (i501). SSA uses the information to determine if the 
individual: (1) Filed the request within the prescribed time; (2) is 
the proper party; and (3) took the steps necessary to obtain the right 
to a hearing. SSA also uses the information to determine: (1) The 
individual's reason(s) for disagreeing with SSA's prior determinations 
in the case; (2) if the individual has additional evidence to submit; 
(3) if the individual wants an oral hearing or a decision on the 
record; and (4) whether the individual has (or wants to appoint) a 
representative. The respondents are Social Security disability 
applicants and recipients who want to appeal SSA's denial of their 
request for new or continued benefits for disability and non-medical 
hearing requests; and Medicare Part B recipients who must pay the 
Medicare Part B Income-Related Monthly Adjustment Amount.
    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)
----------------------------------------------------------------------------------------------------------------
HA-501; MCS; SSI Claims System..................          10,325               1              10           1,721
i501 (Internet iAppeals)........................         653,318               1               5          54,443
                                                 ---------------------------------------------------------------
    Totals......................................         663,643  ..............  ..............          56,164
----------------------------------------------------------------------------------------------------------------

    3. Travel Expense Reimbursement--20 CFR 404.999(d) and 416.1499--
0960-0434. The Act provides for travel expense reimbursement from 
Federal and State agencies for claimant travel incidental to medical 
examinations, and to parties, their representatives, and all reasonably 
necessary witnesses for travel exceeding 75 miles to attend medical 
examinations; reconsideration interviews; and proceedings before an 
administrative law judge. Reimbursement procedures require the claimant 
to provide: (1) A list of expenses incurred, and (2) receipts of such 
expenses. Federal and state personnel review the listings and receipts 
to verify the reimbursable amount to the requestor. The respondents are 
claimants for Title II benefits and Title XVI payments, their 
representatives, and witnesses.
    Type of Request: Extension 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)
----------------------------------------------------------------------------------------------------------------
404.99(d) & 416.1499........................          60,000                1               10           10,000
----------------------------------------------------------------------------------------------------------------

    4. Certificate of Coverage Request--20 CFR 404.1913--0960-0554. The 
United States (U.S.) has agreements with 30 foreign countries to 
eliminate double Social Security coverage and taxation where, except 
for the provisions of the agreement, a worker would be subject to 
coverage and taxes in both countries. These agreements contain rules 
for determining the country under whose laws the worker's period of 
employment is covered, and to which country the worker will pay taxes. 
The agreements further dictate that, upon the request of the worker or 
employer, the country under whose system the period of work is covered 
will issue a certificate of coverage. The certificate serves as proof 
of exemption from coverage and taxation under the system of the other 
country. The information we collect assists us in determining a 
worker's coverage and in issuing a U.S. certificate of coverage as 
appropriate. Per our agreements, we ask a set number of questions to 
the workers and employers prior to issuing a certificate of coverage; 
however, our agreements with Denmark, Netherlands, Norway, and Sweden 
require us to ask more questions in those countries. Respondents are 
workers and employers wishing to establish exemption from foreign 
Social Security taxes.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 31974]]



----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency  of    burden per     total annual
             Modality of completion                 respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
Requests via Letter--Individuals (minus Denmark,           5,833               1              40           3,889
 Netherlands, Norway, Poland & Sweden)..........
Requests via Internet--Individuals (minus                  9,761               1              40           6,507
 Denmark, Netherlands, Norway, Poland & Sweden).
Requests via Letter--Individuals in Denmark,                 284               1              44             208
 Netherlands, Norway, & Sweden..................
Requests via Letter--Individuals in Poland......              16               1              41              11
Requests via Internet--Individuals in Denmark,               427               1              44             313
 Netherlands, Norway, & Sweden..................
Requests via Internet--Individuals in Poland....              25               1              41              17
Requests via Letter--Employers (minus Denmark,            26,047               1              40          17,365
 Netherlands, Norway, Poland & Sweden)..........
Requests via Internet--Employers (minus Denmark,          39,096               1              40          26,064
 Netherlands, Norway, Poland, & Sweden).........
Requests via Letter--Employers in Denmark,                 1,137               1              44             834
 Netherlands, Norway, & Sweden..................
Requests via Letter--Employers in Poland........              57               1              41              39
Requests via Internet--Employers in Denmark,               1,704               1              44           1,250
 Netherlands, Norway, & Sweden..................
Requests via Internet--Employers in Poland......              86               1              41              59
                                                 ---------------------------------------------------------------
    Totals......................................          84,473  ..............  ..............          56,556
----------------------------------------------------------------------------------------------------------------

    5. Privacy and Disclosure of Official Records and Information; 
Availability of Information and Records to the Public--20 CFR 
401.40(b)&(c), 401.55(b), 401.100(a), 402.130, 402.185--0960-0566. SSA 
established methods for the public to: (1) Access their SSA records; 
(2) allow SSA to disclose records; (3) correct or amend their SSA 
records; (4) consent for release of their records; (5) request records 
under the Freedom of Information Act (FOIA); and (6) request access to 
an extract of their SSN record. SSA often collects the necessary 
information for these requests through a written letter, with the 
exception of the consent for release of records, for which we use Form 
SSA-3288. The respondents are individuals requesting access to, 
correction of, or disclosure of SSA records.
    Type of Request: Extension 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)
----------------------------------------------------------------------------------------------------------------
Access to Records...............................          10,000               1              11           1,833
Designating a Representative for Disclosure of             3,000               1             120           6,000
 Records........................................
Amendment of Records............................             100               1              10              17
Consent of Release of Records...................       3,000,760               1               3         150,038
FOIA Requests for Records.......................          15,000               1               5           1,250
Respondents who request access to an extract of               10               1             8.5               1
 their SSN record...............................
                                                 ---------------------------------------------------------------
    Totals......................................       3,028,870  ..............  ..............         159,139
----------------------------------------------------------------------------------------------------------------

    6. Disability Report--Child--20 CFR 416.912--0960-0577--Sections 
223(d)(5)(A) and 1631(e)(1) of the Act require SSI claimants to furnish 
medical and other evidence to prove they are disabled. SSA uses Form 
SSA-3820 to collect various types of information about a child's 
condition from treating sources or other medical sources of evidence. 
The State Disability Determination Services evaluators use the 
information from Form SSA-3820 to develop medical and school evidence, 
and to assess the alleged disability. The information, together with 
medical evidence, forms the evidentiary basis upon which SSA makes its 
initial disability evaluation. The respondents are claimants seeking 
SSI childhood disability payments.
    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-3820........................................         177,572               1              90         266,358
EDCS............................................           1,000               1             120           2,000
i3820...........................................         176,572               1             120         353,144
                                                 ---------------------------------------------------------------
    Totals......................................         355,144  ..............  ..............         621,502
----------------------------------------------------------------------------------------------------------------


[[Page 31975]]

    7. Request for Reconsideration--20 CFR 404.907-404.921, 416.1407-
416.1421, 408.1009, and 418.1325--0960-0622. The Act states those 
individuals who are dissatisfied with the results of an initial 
determination regarding their Title II disability; Tile XVI disability 
(SSI); Title VIII (Special Veterans benefits); or Title XVIII (Medicare 
benefits), can request a reconsideration hearing. Individuals use Form 
SSA-561-U2; the associated MCS or SSI Claims System interview; or the 
internet application (i561) to initiate a request for reconsideration 
of a denied claim. SSA uses the information to document the request and 
to determine an individual's eligibility or entitlement to Social 
Security benefits (Title II); SSI payments (Title XVI); Special 
Veterans Benefits (Title VIII); Medicare (Title XVIII); and for initial 
determinations regarding Medicare Part B income-related premium subsidy 
reductions. The respondents are applicants, claimants, beneficiaries, 
or recipients filing for reconsideration of an initial determination.
    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-561 and Modernized Claims System (MCS)......         330,370               1               8          40,049
I561 (Internet iAppeals)........................       1,161,300               1               5          96,775
                                                 ---------------------------------------------------------------
    Totals......................................       1,491,670  ..............  ..............         136,824
----------------------------------------------------------------------------------------------------------------

    8. Request to Withdraw a Hearing Request; Request to Withdraw an 
Appeals Council Request for Review; and Administrative Review Process 
for Adjudicating Initial Disability Claims--20 CFR parts 404, 405, and 
416--0960-0710. Claimants have a statutory right under the Act and 
current regulations to apply for Social Security Disability Insurance 
(SSDI) benefits or SSI payments. SSA collects information at each step 
of the administrative process to adjudicate claims fairly and 
efficiently. SSA collects this information to establish a claimant's 
right to administrative review, and determine the severity of the 
claimant's alleged impairments. SSA uses the information we collect to 
determine entitlement or continuing eligibility to SSDI benefits or SSI 
payments, and to enable appeals of these determinations. In addition, 
SSA collects information on Forms HA-85 and HA-86 to allow claimants to 
withdraw a hearing request or an Appeals Council review request. The 
respondents are applicants for Title II SSDI or Title XVI SSI benefits; 
their appointed representatives; legal advocates; medical sources; and 
schools.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Frequency  of    burden per       Estimated
               20 CFR section No.                   respondents      response        response     annual  burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
404.961, 416.1461, 405.330, and 405.366.........          12,220               1              20           4,073
404.950, 416.1450, and 405.332..................           1,040               1              20             347
404.949 and 416.1449............................           2,868               1              60           2,868
405.334.........................................              20               1              60              20
404.957, 416.1457, and 405.380..................          21,041               1              10           3,507
405.381.........................................              37               1              30              19
405.401.........................................           5,310               1              10             885
404.971 and 416.1471............................           1,606               1              10             268
(HA-85; HA-86)..................................
404.982 and 416.1482............................           1,687               1              30             844
404.987 & 404.988 and 416.1487 & 416.1488 and             12,425               1              30           6,213
 405.601........................................
404.1740(b)(1)..................................             150               1               2               5
416.1540(b)(1)..................................             150               1               2               5
404.1512, 404.1740(c)(4), 416.912, and                       150               1               2               5
 416.1540(c)(4).................................
405.372(c)......................................           5,310               1              10             885
405.1(b)(5).....................................             833               1              30             417
405.372(b)......................................
405.505.........................................             833               1              30             417
405.1(c)(2).....................................           5,310               1              10             885
405.20..........................................           5,310               1              10             885
                                                 ---------------------------------------------------------------
    Totals......................................          76,300  ..............  ..............          22,548
----------------------------------------------------------------------------------------------------------------

    9. Request for Accommodation in Communication Method--0960-0777. 
SSA allows disabled or impaired Social Security applicants, 
beneficiaries, recipients, and representative payees to choose one of 
seven alternative methods of communication they want SSA to use when we 
send them benefit notices and other related communications. The seven 
alternative methods we offer are: (1) Standard print notice by first-
class mail; (2) standard print mail with a follow-up telephone call; 
(3) certified mail; (4) Braille; (5) Microsoft Word file on data CD; 
(6) large print (18-point font); or (7) audio CD. However, respondents 
who want to receive notices from SSA through a communication method 
other than the seven methods listed above must explain their request to 
us. Those respondents use Form SSA-9000 to: (1) Describe the type of 
accommodation they want; (2) disclose their condition necessitating the 
need for a different type of accommodation; and (3) explain why none of 
the seven methods

[[Page 31976]]

described above are sufficient for their needs. SSA uses Form SSA-9000 
to determine, based on applicable law and regulation, whether to grant 
the respondents' requests for an accommodation based on their 
impairment or disability. SSA collects this information electronically 
through either an in-person interview or a telephone interview during 
which the SSA employee keys in the information on our iAccommodate 
Intranet screens. The respondents are disabled or impaired Social 
Security applicants, beneficiaries, recipients, and representative 
payees who ask SSA to send notices and other communications in an 
alternative method besides the seven modalities we currently offer.
    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-9000/iAccommodate.......................           5,000                1               20            1,667
----------------------------------------------------------------------------------------------------------------

    10. Report of Adult Functioning-Employer--20 CFR 404.1512 and 
416.912--0960-0805. Section 205(a), 223(d)(5)(A), 1631(d)(1), and 
1631(e)(1) of the Act require claimants' applying for SSDI benefits or 
SSI payments to provide SSA with medical and other evidence of their 
disability. 20 CFR 404.1512 and 20 CFR 416.912 of the Code of Federal 
Regulations provides detailed requirements of the types of evidence 
SSDI beneficiaries and SSI claimants must provide showing how their 
impairment(s) affect their ability to work (e.g., evidence of age; 
education and training, work experience; daily activities; efforts to 
work; and any other evidence). Past employers familiar with the 
claimant's ability to perform work activities complete Form SSA-385-BK, 
Report of Adult Functioning-Employer to provide SSA with information 
about the employees day-to-day functioning in the work setting. SSA and 
Disability Determination Services use the information Form SSA-3385-BK 
collects as the basis to determine eligibility or continued eligibility 
for disability benefits. The respondents are claimants' past employers.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden     Estimated
           Modality of completion                Number of      Frequency  of    per  response     total annual
                                                 responses         response        (minutes)     burden  (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3385-BK.................................           3,601                1               20            1,200
----------------------------------------------------------------------------------------------------------------


    Dated: June 27, 2019.
Naomi Sipple,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2019-14173 Filed 7-2-19; 8:45 am]
 BILLING CODE 4191-02-P