Federal Register: November 29, 2000 (Volume 65, Number 230)
DOCID: FR Doc 00-30403
SOCIAL SECURITY ADMINISTRATION
Social Security Administration
NOTICE: NOTICES
ACTION: Agency information collection activities:
SUBJECT CATEGORY:
Agency Information Collection Activities: Proposed Request and Comment Request
DOCUMENT SUMMARY:
In compliance with Public Law 10413, the Paperwork Reduction Act of 1995, SSA is providing notice of its information collections that require submission to the Office of Management and Budget (OMB). The Social Security Administration (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 on ways to minimize burden on respondents, including the use of automated collection techniques or other forms of information technology.
I. The information collections listed below will be submitted to OMB within 60 days from the date of this notice. Therefore, comments and recommendations regarding the information collections would be most useful if received by the Agency within 60 days from the date of this publication. Comments should be directed to the SSA Reports Clearance Officer at the address listed at the end of this publication. You can obtain a copy of the collection instruments by calling the SSA Reports Clearance Officer on (410) 9654145, or by writing to him at the address listed at the end of this publication.
1. Application for Benefits Under The Federal Mine And Safety And
Health Act Of 1977, as Amended (Widow's Claim, Child's Claim And
Dependent's Claim)09600118. Section 402(g) and Section 412(a) of the
Federal Mine Safety and Health Act provide that those widows, surviving
children and dependent parents, brothers and sisters who are not
currently receiving benefits on the deceased miner's account must [[Page 71196]]
file the appropriate application for Black Lung benefits within 6
months of the deceased miner's death. Forms SSA47F4, SSA48F4, and
SSA49F3 are used to collect the information needed by the SSA to
determine eligibility for benefits. The respondents are widows,
surviving children and dependents (parents, brothers or sisters) who
are not currently receiving Black Lung benefits on the deceased miner's account.
SSA47F4 SSA48F4 SSA49F3
Number of Respondents........................................... 600 600 600
Frequency of Response........................................... 1 1 1
Average Burden Per Response (minutes)........................... 11 11 11
Estimated Annual Burden (hours)................................. 110 110 110
2. Representative Payee Report of Benefits and Dedicated Account
09600576. Form SSA6233 is used to ensure that the representative
payee is using the benefits received for the beneficiary's current
maintenance and personal needs and that expenditures of funds from the
dedicated account are in compliance with the law. The respondents are
individuals and organizational representative payees who are required
by law to establish a separate (``dedicated'') account in a financial institution for certain pastdue SSI benefits.
Number of Respondents: 30,000.
Frequency of Response: 1.
Average Burden Per Response: 20 minutes.
Estimated Annual Burden: 10,000 hours.
3. Physician's/Medical Officer's Statement of Patient's Capability
to Manage Benefits09600024. SSA uses the information collected on
Form SSA787 to determine an individual's capability, or lack thereof,
to handle his or her own benefits. The information also provides SSA
with leads to follow in selecting a representative payee, if needed. The respondents are physicians of these beneficiaries.
Number of Respondents: 120,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 20,000 hours.
4. Request for Internet ServicePassword0960NEW. SSA will
collect and use information to establish a PIN/Password Data File. The
file will be used to allow customers to conduct electronic business
with the Agency. SSA will request the following information: Name,
Social Security Number, Password Request Code, Last Month Payment
Amount and Director Deposit Account Number (if applicable). The
respondents are individuals electing to conduct business with SSA in the electronic medium.
Number of Respondents: 250,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 41,667 hours.
5. Internet Social Security Benefits Applications (also known as
ISBA)09600618. The ISBA (formerly the Internet Retirement Insurance
Benefit or IRIB application) is one application that the Commissioner
of Social Security will prescribe to meet the requirement to file an
application for title II retirement and/or spouse's benefits. The ISBA
will be available on the Social Security Administration Internet site
and will enable individuals to complete the application electronically
on their own and submit the application over the Internet. Until SSA
develops an acceptable electronic signature process, applicants will
also print, sign and mail the IBSA statement with the required evidence
that supports their application. The information that SSA collects will
be used to determine entitlement to retirement insurance benefits. The
respondents are individuals and their spouses, if applicable, who choose to apply for title II benefits over the Internet.
Number of Respondents: 189,764.
Frequency of Response: 1.
Average Burden Per Response: 20 minutes.
Estimated Annual Burden: 63,255 hours.
6. Discrimination Complaint Form09600585. The information
collected on form SSA437 will be used by SSA to investigate and
informally resolve complaints of discrimination based on race, color,
national, origin, sex, age religion and retaliation in any program or
activity conducted by SSA. A person who believes that he or she has
been discriminated against on any of the above bases may file a written
complaint of discrimination. The information will be used to identify
the complainant; identify the alleged discriminatory act; ascertain the
date of such alleged act; obtain the identity of the individual(s)/
facility/component that allegedly discriminated; and ascertain other
relevant information that would assist in the investigation and
resolution of the complaints. The respondents are individuals who allege discrimination on the grounds described above.
Number of Respondents: 300.
Frequency of Response: 1.
Average Burden Per Response: 1 hour.
Estimated Annual Burden: 300 hours.
7. Claimant's Statement When Request for Hearing is Filed and the Issue is Disability09600316. SSA requests that a claimant complete an HA4486 when a claim for title II disability benefits or title XVI Supplemental Security Income benefits is denied and the claimant wishes a hearing before an Administrative Law Judge (ALJ). SSA uses this form to obtain updated information on the claimant's medical treatment to assist the ALJ in preparing for the hearing and in issuing a decision on entitlement to benefits. The respondents are individuals whose claims have been denied and who want a hearing before an ALJ.
Number of Respondents: 442,720.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 110,680.
II. The information collections listed below have been submitted to OMB for clearance. Written comments and recommendations on the information collections would be most useful if received within 30 days from the date of this publication. Comments should be directed to the SSA Reports Clearance Officer and the OMB Desk Officer at the addresses listed at the end of this publication. You can obtain a copy of the OMB clearance packages by calling the SSA Reports Clearance Officer on (410) 9654145, or by writing to him.
1. National Teacher Questionnaire (SSA5665BK), and Information
About the Working Age Child (SSA5665SUPP)0960New. The information
collected on forms SSA5665BK and SSA5665Sup is used by the Social
Security Administration (SSA) and the State Disability Determination
Services (DDS) to obtain descriptions of children claiming SSI benefits
based on disability and their ability to function on a daily basis. The
forms will be used for initial determinations of eligibility, in appeals
[[Page 71197]]
and in initial continuing disability reviews.
These forms are being developed because the forms currently used by
the DDSs vary in format and content. It was decided that for the sake
of a uniform national childhood program (and with this information in
hand and the sensitivity of this population), the time has come for a
National Teacher Questionnaire and Information About the Working Age
Child. The respondents are the educational community and small
businesses that educate and/or employ applicants for Supplemental Security Income for the aged, blind, and Disabled.
SSA5665BK SSA5665Sup
Number of Respondents................... 475,000 125,000
Frequency of Response................... 1 1
Average Burden Per Response (minutes)... 1520 510
Estimated Annual Burden (hours)......... 158,333 20,833
2. Beneficiary Recontact Report09600536. SSA collects the
information on Form SSA1587 to ensure that eligibility for benefits
continues after entitlement is established. SSA asks children ages 15,
16, and 17 information about marital status to detect overpayments and
avoid continuing payment to those no longer entitled. Studies show that
children who marry fail to report the marriage, which is a terminating
event. The respondents are applicants for Title II (OldAge, Survivors
and Disability Insurance) Children/Beneficiaries who are ages 15, 16, and 17.
Number of Respondents: 982,357.
Frequency of Response: 1.
Average Burden Per Response: 3 minutes.
Estimated Annual Burden: 49,118 hours.
3. Questionnaire About Employment or SelfEmployment Outside the
United States, 09600050. This information is used by SSA to determine
whether work performed by beneficiaries outside the United States
(U.S.) is cause for deductions from their monthly benefits; to
determine which of two work tests (foreign or regular) is applicable;
and to determine the months, if any, for which deductions should be
imposed. The respondents are beneficiaries living and working outside the U.S.
Number of Respondents: 20,000.
Frequency of Response: 1.
Average Burden Per Response: 12 minutes.
Estimated Annual Burden: 4,000 hours.
(SSA Address)
Social Security Administration, DCFAM, Attn: Frederick W. Brickenkamp,
1A21 Operations Bldg., 6401 Security Blvd., Baltimore, MD 21235. (OMB Address)
Office of Management and Budget, OIRA, Attn: Desk Officer for SSA, New
Executive Office Building, Room 10230, 725 17th St., NW., Washington, DC 20503.
Date: November 22, 2000.
Elizabeth A. Davidson,
Acting Reports Clearance Officer, Social Security Administration.
[FR Doc. 0030403 Filed 112800; 8:45 am]
BILLING CODE 419102P
SUMMARY:
Proposed collection; comment request,
DOCUMENT BODY 2:
In compliance with Public Law 10413, the Paperwork Reduction Act of 1995, SSA is providing notice of its information collections that require submission to the Office of Management and Budget (OMB). The Social Security Administration (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 on ways to minimize burden on respondents, including the use of automated collection techniques or other forms of information technology.
I. The information collections listed below will be submitted to OMB within 60 days from the date of this notice. Therefore, comments and recommendations regarding the information collections would be most useful if received by the Agency within 60 days from the date of this publication. Comments should be directed to the SSA Reports Clearance Officer at the address listed at the end of this publication. You can obtain a copy of the collection instruments by calling the SSA Reports Clearance Officer on (410) 9654145, or by writing to him at the address listed at the end of this publication.
1. Application for Benefits Under The Federal Mine And Safety And
Health Act Of 1977, as Amended (Widow's Claim, Child's Claim And
Dependent's Claim)09600118. Section 402(g) and Section 412(a) of the
Federal Mine Safety and Health Act provide that those widows, surviving
children and dependent parents, brothers and sisters who are not
currently receiving benefits on the deceased miner's account must [[Page 71196]]
file the appropriate application for Black Lung benefits within 6
months of the deceased miner's death. Forms SSA47F4, SSA48F4, and
SSA49F3 are used to collect the information needed by the SSA to
determine eligibility for benefits. The respondents are widows,
surviving children and dependents (parents, brothers or sisters) who
are not currently receiving Black Lung benefits on the deceased miner's account.
SSA47F4 SSA48F4 SSA49F3
Number of Respondents........................................... 600 600 600
Frequency of Response........................................... 1 1 1
Average Burden Per Response (minutes)........................... 11 11 11
Estimated Annual Burden (hours)................................. 110 110 110
2. Representative Payee Report of Benefits and Dedicated Account
09600576. Form SSA6233 is used to ensure that the representative
payee is using the benefits received for the beneficiary's current
maintenance and personal needs and that expenditures of funds from the
dedicated account are in compliance with the law. The respondents are
individuals and organizational representative payees who are required
by law to establish a separate (``dedicated'') account in a financial institution for certain pastdue SSI benefits.
Number of Respondents: 30,000.
Frequency of Response: 1.
Average Burden Per Response: 20 minutes.
Estimated Annual Burden: 10,000 hours.
3. Physician's/Medical Officer's Statement of Patient's Capability
to Manage Benefits09600024. SSA uses the information collected on
Form SSA787 to determine an individual's capability, or lack thereof,
to handle his or her own benefits. The information also provides SSA
with leads to follow in selecting a representative payee, if needed. The respondents are physicians of these beneficiaries.
Number of Respondents: 120,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 20,000 hours.
4. Request for Internet ServicePassword0960NEW. SSA will
collect and use information to establish a PIN/Password Data File. The
file will be used to allow customers to conduct electronic business
with the Agency. SSA will request the following information: Name,
Social Security Number, Password Request Code, Last Month Payment
Amount and Director Deposit Account Number (if applicable). The
respondents are individuals electing to conduct business with SSA in the electronic medium.
Number of Respondents: 250,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 41,667 hours.
5. Internet Social Security Benefits Applications (also known as
ISBA)09600618. The ISBA (formerly the Internet Retirement Insurance
Benefit or IRIB application) is one application that the Commissioner
of Social Security will prescribe to meet the requirement to file an
application for title II retirement and/or spouse's benefits. The ISBA
will be available on the Social Security Administration Internet site
and will enable individuals to complete the application electronically
on their own and submit the application over the Internet. Until SSA
develops an acceptable electronic signature process, applicants will
also print, sign and mail the IBSA statement with the required evidence
that supports their application. The information that SSA collects will
be used to determine entitlement to retirement insurance benefits. The
respondents are individuals and their spouses, if applicable, who choose to apply for title II benefits over the Internet.
Number of Respondents: 189,764.
Frequency of Response: 1.
Average Burden Per Response: 20 minutes.
Estimated Annual Burden: 63,255 hours.
6. Discrimination Complaint Form09600585. The information
collected on form SSA437 will be used by SSA to investigate and
informally resolve complaints of discrimination based on race, color,
national, origin, sex, age religion and retaliation in any program or
activity conducted by SSA. A person who believes that he or she has
been discriminated against on any of the above bases may file a written
complaint of discrimination. The information will be used to identify
the complainant; identify the alleged discriminatory act; ascertain the
date of such alleged act; obtain the identity of the individual(s)/
facility/component that allegedly discriminated; and ascertain other
relevant information that would assist in the investigation and
resolution of the complaints. The respondents are individuals who allege discrimination on the grounds described above.
Number of Respondents: 300.
Frequency of Response: 1.
Average Burden Per Response: 1 hour.
Estimated Annual Burden: 300 hours.
7. Claimant's Statement When Request for Hearing is Filed and the Issue is Disability09600316. SSA requests that a claimant complete an HA4486 when a claim for title II disability benefits or title XVI Supplemental Security Income benefits is denied and the claimant wishes a hearing before an Administrative Law Judge (ALJ). SSA uses this form to obtain updated information on the claimant's medical treatment to assist the ALJ in preparing for the hearing and in issuing a decision on entitlement to benefits. The respondents are individuals whose claims have been denied and who want a hearing before an ALJ.
Number of Respondents: 442,720.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 110,680.
II. The information collections listed below have been submitted to OMB for clearance. Written comments and recommendations on the information collections would be most useful if received within 30 days from the date of this publication. Comments should be directed to the SSA Reports Clearance Officer and the OMB Desk Officer at the addresses listed at the end of this publication. You can obtain a copy of the OMB clearance packages by calling the SSA Reports Clearance Officer on (410) 9654145, or by writing to him.
1. National Teacher Questionnaire (SSA5665BK), and Information
About the Working Age Child (SSA5665SUPP)0960New. The information
collected on forms SSA5665BK and SSA5665Sup is used by the Social
Security Administration (SSA) and the State Disability Determination
Services (DDS) to obtain descriptions of children claiming SSI benefits
based on disability and their ability to function on a daily basis. The
forms will be used for initial determinations of eligibility, in appeals
[[Page 71197]]
and in initial continuing disability reviews.
These forms are being developed because the forms currently used by
the DDSs vary in format and content. It was decided that for the sake
of a uniform national childhood program (and with this information in
hand and the sensitivity of this population), the time has come for a
National Teacher Questionnaire and Information About the Working Age
Child. The respondents are the educational community and small
businesses that educate and/or employ applicants for Supplemental Security Income for the aged, blind, and Disabled.
SSA5665BK SSA5665Sup
Number of Respondents................... 475,000 125,000
Frequency of Response................... 1 1
Average Burden Per Response (minutes)... 1520 510
Estimated Annual Burden (hours)......... 158,333 20,833
2. Beneficiary Recontact Report09600536. SSA collects the
information on Form SSA1587 to ensure that eligibility for benefits
continues after entitlement is established. SSA asks children ages 15,
16, and 17 information about marital status to detect overpayments and
avoid continuing payment to those no longer entitled. Studies show that
children who marry fail to report the marriage, which is a terminating
event. The respondents are applicants for Title II (OldAge, Survivors
and Disability Insurance) Children/Beneficiaries who are ages 15, 16, and 17.
Number of Respondents: 982,357.
Frequency of Response: 1.
Average Burden Per Response: 3 minutes.
Estimated Annual Burden: 49,118 hours.
3. Questionnaire About Employment or SelfEmployment Outside the
United States, 09600050. This information is used by SSA to determine
whether work performed by beneficiaries outside the United States
(U.S.) is cause for deductions from their monthly benefits; to
determine which of two work tests (foreign or regular) is applicable;
and to determine the months, if any, for which deductions should be
imposed. The respondents are beneficiaries living and working outside the U.S.
Number of Respondents: 20,000.
Frequency of Response: 1.
Average Burden Per Response: 12 minutes.
Estimated Annual Burden: 4,000 hours.
(SSA Address)
Social Security Administration, DCFAM, Attn: Frederick W. Brickenkamp,
1A21 Operations Bldg., 6401 Security Blvd., Baltimore, MD 21235. (OMB Address)
Office of Management and Budget, OIRA, Attn: Desk Officer for SSA, New
Executive Office Building, Room 10230, 725 17th St., NW., Washington, DC 20503.
Date: November 22, 2000.
Elizabeth A. Davidson,
Acting Reports Clearance Officer, Social Security Administration.
[FR Doc. 0030403 Filed 112800; 8:45 am]
BILLING CODE 419102P