[Federal Register Volume 86, Number 125 (Friday, July 2, 2021)]
[Notices]
[Pages 35371-35374]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-14167]


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SOCIAL SECURITY ADMINISTRATION

[Docket No: SSA-2021-0016]


Agency Information Collection Activities: Proposed Request

    The Social Security Administration (SSA) publishes a list of 
information collection packages requiring clearance by the Office of 
Management and Budget (OMB) in compliance with Public Law 104-13, the 
Paperwork Reduction Act of 1995, effective October 1, 1995. This notice 
includes revisions, and an extension 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. 
Comments: https://www.reginfo.gov/public/do/PRAMain. Submit your 
comments online referencing Docket ID Number [SSA-2021-0016].
(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 https://www.reginfo.gov/public/do/PRAMain, referencing Docket ID Number [SSA-
2021-0016].
    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 
August 31, 2021. Individuals can obtain copies of the collection 
instruments by writing to the above email address.
    1. Request for Withdrawal of Application--20 CFR 404.640--0960-
0015. Form SSA-521, Request for Withdrawal of Application, allows 
claimants to specify which application they want to withdraw and the 
reason for the withdrawal. Form SSA-521 is our preferred instrument for 
a withdrawal request; however, any written request for withdrawal 
signed by the claimant or a proper applicant 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 Form SSA-521 to 
process the request for withdrawal. The respondents are applicants for 
Retirement, Survivors, Disability, and Health Insurance benefits.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 35372]]



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                                                                                                                              Average
                                                                                          Average burden     Estimated      theoretical    Total annual
                 Modality of completion                      Number of     Frequency of    per response    total annual     hourly cost     opportunity
                                                            respondents      response        (minutes)    burden (hours)      amount      cost (dollars)
                                                                                                                            (dollars) *         **
--------------------------------------------------------------------------------------------------------------------------------------------------------
Respondents applying for or receiving Retirement,                 60,753               1               5           5,063        * $10.95      ** $55,440
 Survivors, or Health Insurance benefits................
Respondents applying for or receiving Disability                  14,374               1               5           1,198         * 10.95       ** 13,118
 benefits...............................................
                                                         -----------------------------------------------------------------------------------------------
    Totals..............................................          75,127  ..............  ..............           6,261  ..............       ** 68,558
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* We based this figure on the average DI payments based on SSA's current FY 2021 data (https://www.ssa.gov/legislation/2021FactSheet.pdf).
** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; rather,
  these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual charge to
  respondents to complete the application.

    2. Statement of Employer--20 CFR 404.801-404.803--0960-0030. When 
workers report they were paid wages but cannot provide proof of those 
earnings, and the wages do not appear in SSA's records of earnings, SSA 
uses Form SSA-7011-F4, Statement of Employer, to document the alleged 
wages. Specifically, the agency uses the form to resolve discrepancies 
in the individual's Social Security earnings record and to process 
claims for Social Security benefits. We only send Form SSA-7011-F4 to 
employers if we are unable able to locate the earnings information 
within our own records. The respondents are employers who can verify 
wage allegations made by wage earners.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                                                            Average
                                                                                       Average burden  Estimated total    theoretical      Total annual
              Modality of completion                   Number of       Frequency of     per response    annual burden     hourly cost      opportunity
                                                      respondents        response        (minutes)         (hours)           amount       cost (dollars)
                                                                                                                          (dollars) *           **
--------------------------------------------------------------------------------------------------------------------------------------------------------
SSA-7011-F4.......................................             500                1               30              250         * $27.07        ** $6,768
--------------------------------------------------------------------------------------------------------------------------------------------------------
* We based this figure on average U.S. worker's hourly wages, as reported by Bureau of Labor Statistics data (https://www.bls.gov/oes/current/oes_nat.htm#00-0000).
** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; rather,
  these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual charge to
  respondents to complete the application.

    3. Statement of Care and Responsibility for Beneficiary--20 CFR 
404.2020, 404.2025, 408.620, 408.625, 416.620, and 416.625--0960-0109. 
SSA uses the information from Form SSA-788, Statement of Care and 
Responsibility for Beneficiary, to verify payee applicants' statements 
of concern, and to identify other potential payees. SSA is concerned 
with selecting the most qualified representative payee who will use 
Social Security benefits in the beneficiary's best interest. SSA 
considers factors such as the payee applicant's capacity to perform 
payee duties; awareness of the beneficiary's situation and needs; 
demonstration of past, and current concern for the beneficiary's well-
being If the payee applicant does not have custody of the beneficiary, 
SSA obtains information from the custodian for evaluation against 
information the applicant provides. Respondents are individuals who 
have custody of the beneficiary in cases where someone else has filed 
to be the beneficiary's representative payee.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                                                            Average
                                                                                       Average burden  Estimated total    theoretical      Total annual
              Modality of completion                   Number of       Frequency of     per response    annual burden     hourly cost      opportunity
                                                      respondents        response        (minutes)         (hours)           amount       cost (dollars)
                                                                                                                          (dollars) *           **
--------------------------------------------------------------------------------------------------------------------------------------------------------
SSA-788...........................................         134,000                1               10           22,333         * $27.07      ** $604,554
--------------------------------------------------------------------------------------------------------------------------------------------------------
* We based this figures on average U.S. citizen's hourly salary, as reported by Bureau of Labor Statistics data (https://www.bls.gov/oes/current/oes_nat.htm#00-00000).
** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; rather,
  these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual charge to
  respondents to complete the application.

    4. 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 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.

[[Page 35373]]

    Under these agreements, SSA obtains third party liability 
information using Form SSA-8019-U2, Third Party Liability Information 
Statement, 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.

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                                                                                                                           Average wait
                                                                                                              Average      time in field   Total annual
                                             Number of     Frequency of   Average burden     Estimated      theoretical    office or for    opportunity
         Modality of completion             respondents      response      per response    total annual     hourly cost     teleservice   cost (dollars)
                                                                             (minutes)    burden (hours)      amount          centers           ***
                                                                                                            (dollars) *    (minutes) **
--------------------------------------------------------------------------------------------------------------------------------------------------------
SSA-8019-U2 (Paper).....................             200               1               6              20        * $19.01  ..............        *** $380
SSI Claims System (Intranet)............          35,257               1               6           3,526         * 19.01           ** 21     *** 301,613
                                         ---------------------------------------------------------------------------------------------------------------
    Totals..............................          35,457  ..............  ..............           3,546  ..............  ..............     *** 301,993
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* We based this figure on averaging both the average DI payments based on SSA's current FY 2021 data (https://www.ssa.gov/legislation/2021FactSheet.pdf), and the average U.S. worker's hourly wages, as reported by Bureau of Labor Statistics data (https://www.bls.gov/oes/current/oes_nat.htm).
** We based this figure on averaging both the average FY 2021 wait times for field offices and teleservice centers, based on SSA's current management
  information data.
*** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; rather,
  these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual charge to
  respondents to complete the application.

    5. Certificate of Election for Reduced Spouse's Benefits--20 CFR 
404.421--0960-0398. SSA cannot pay reduced Social Security benefits to 
an already entitled spouse unless the spouse elects to receive reduced 
benefits and is (1) at least age 62, but under full retirement age; and 
(2) no longer caring for a child. In this situation, spouses who decide 
to elect reduced benefits must file Form SSA-25, Certificate of 
Election for Reduced Spouse's Benefits. SSA uses the information to pay 
qualified spouses who elect to receive reduced benefits. Respondents 
are entitled spouses seeking reduced Social Security benefits.
    Type of Request: Revision of an OMB approved information 
collection.

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                                                                                                                            Average
                                                                                       Average burden  Estimated total    theoretical      Total annual
              Modality of completion                   Number of       Frequency of     per response    annual burden     hourly cost      opportunity
                                                      respondents        response        (minutes)         (hours)           amount       cost (dollars)
                                                                                                                          (dollars) *           **
--------------------------------------------------------------------------------------------------------------------------------------------------------
SSA-25............................................          30,000                1               13            6,500         * $27.07      ** $175,955
--------------------------------------------------------------------------------------------------------------------------------------------------------
* We based this figures on average U.S. citizen's hourly salary, as reported by Bureau of Labor Statistics data (https://www.bls.gov/oes/current/oes_nat.htm#00-00000).
** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; rather,
  these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual charge to
  respondents to complete the application.

    6. Permanent Residence in the United States Under Color of Law 
(PRUCOL)--20 CFR 416.1615 and 416.1618--0960-0451. Under 20 CFR 
416.1415 and 416.1618, 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) using the DHS 
Systemic Alien Verification for Entitlements (SAVE) program. SSA 
determines if the individual qualifies for PRUCOL status based on the 
SAVE program 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
                                                                                       Average burden  Estimated total    theoretical      Total annual
              Modality of completion                   Number of       Frequency of     per response    annual burden     hourly cost      opportunity
                                                       responses         response        (minutes)         (hours)           amount       cost (dollars)
                                                                                                                          (dollars) *           **
--------------------------------------------------------------------------------------------------------------------------------------------------------
Personal Interview................................           1,049                1                5               87         * $27.07        ** $2,355
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* We based this figure on average U.S. worker's hourly wages, as reported by Bureau of Labor Statistics data (https://www.bls.gov/oes/current/oes_nat.htm#00-0000).

[[Page 35374]]

 
** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; rather,
  these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual charge to
  respondents to complete the application.

    7. Request for Deceased Individual's Social Security Record--20 CFR 
402.130--0960-0665. The Freedom of Information Act (FOIA), at 5 U.S.C. 
552(a)(3) of the U.S. Code, provides instructions for members of the 
public to request records from Federal agencies. When a member of the 
public requests an individual's Social Security record under FOIA, SSA 
needs the name and address of the requestor as well as a description of 
the requested record to process the request. SSA uses the information 
the respondent provides on Form SSA-711, Request for Deceased 
Individual's Social Security Record, or via an internet request through 
SSA's electronic Freedom of Information Act (eFOIA) website, to:
    (1) Verify the wage earner is deceased; and (2) access the correct 
Social Security record. Respondents are members of the public 
requesting deceased individuals' Social Security records.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                                              Average
                                                                          Average burden     Estimated      theoretical    Average wait    Total annual
         Modality of completion              Number of     Frequency of    per response    total annual     hourly cost    time in field    opportunity
                                            respondents      response        (minutes)    burden (hours)      amount          office      cost (dollars)
                                                                                                            (dollars) *    (minutes) **         ***
--------------------------------------------------------------------------------------------------------------------------------------------------------
Internet Request through eFOIA..........          49,800               1               7           5,810        * $27.07  ..............    *** $157,277
SSA-711 (paper).........................             200               1               7              23         * 27.07           ** 24       *** 2,788
                                         ---------------------------------------------------------------------------------------------------------------
    Total...............................          50,000  ..............  ..............           5,833  ..............  ..............     *** 160,065
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* We based this figure on average U.S. worker's hourly wages, as reported by Bureau of Labor Statistics data (https://www.bls.gov/oes/current/oes_nat.htm#00-0000).
** We based this figure on the average FY 2021 wait times for field offices, based on SSA's current management information data.
*** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; rather,
  these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual charge to
  respondents to complete the application.

    8. Request for Business Entity Taxpayer Information--0960-0731. SSA 
requires law firms or other business entities to complete Form SSA-
1694, Request for Business Entity Taxpayer Information, if they wish to 
serve as appointed representatives and receive direct payment of fees 
from SSA. SSA uses the information to issue a Form 1099-MISC. SSA also 
uses the information to allow business entities to designate 
individuals to serve as entity administrators authorized to perform 
certain administrative duties on their behalf, such as providing bank 
account information, maintaining entity information, and updating 
individual affiliations. Respondents are law firms or other business 
entities with attorneys or other qualified individuals as partners or 
employees who represent claimants before SSA.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                                                              Average
                                                                                          Average burden     Estimated      theoretical    Total annual
                 Modality of completion                      Number of     Frequency of    per response    total annual     hourly cost     opportunity
                                                            respondents      response        (minutes)    burden (hours)      amount      cost (dollars)
                                                                                                                            (dollars) *         **
--------------------------------------------------------------------------------------------------------------------------------------------------------
SSA-1694 (Paper)........................................             366               1              20             122        * $61.03       ** $7,446
BSO online submission...................................             103               1              20              34         * 61.03        ** 2,075
                                                         -----------------------------------------------------------------------------------------------
    Totals..............................................             469  ..............  ..............             156  ..............        ** 9,521
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* We based this figure on the average legal occupation's hourly salary, as reported by Bureau of Labor Statistics data (https://www.bls.gov/oes/current/oes_nat.htm#00-00000).
** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; rather,
  these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual charge to
  respondents to complete the application.


    Dated: June 29, 2021.
Eric Lowman,
Acting Reports Clearance Officer, Office of Legislative Development and 
Operations, Social Security Administration.
[FR Doc. 2021-14167 Filed 7-1-21; 8:45 am]
BILLING CODE 4191-02-P