Federal Register: December 28, 2000 (Volume 65, Number 250)
DOCID: FR Doc 00-33109
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:
The Social Security Administration (SSA) publishes a list of information collection packages that will require clearance by the Office of Management and Budget (OMB) in compliance with Pub. L. 10413 effective October 1, 1995, The Paperwork Reduction Act of 1995. 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.
Written comments and recommendations regarding the information
collection(s) should be submitted to the SSA Reports Clearance Officer and to the OMB Desk Officer at the following addresses:
(OMB), Attn: Desk Officer for SSA, New Executive Office Building,
Room 10230, 725 17th St., NW, Washington, DC 20503; (SSA), Social
Security Administration, DCFAM, Attn: Frederick W. Brickenkamp, 1A21
Operations Bldg., 6401 Security Blvd., Baltimore, MD 21235.
I. The information collections listed below will be submitted to OMB within 60 days from the date of this notice. Your comments should be submitted to SSA within 60 days from the date of this publication. You can obtain a copy of the collection instruments by calling the SSA Reports Clearance Officer at 4109654145, or by writing to him at the address listed above.
1. Pre1957 Military Service Federal Benefit Questionnaire0960 0120. Form SSA2512 collects data used in the claims adjudication process to grant gratuitous military wage credits, when applicable, and solicits sufficient information to make a determination of eligibility. The respondents are individuals who are applying for Social Security benefits on the record of a wage earner with pre1957 military service.
Number of Respondents: 12,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 2,000 hours.
2. Application for a Social Security Card09600066. The information collected on form SS5 is needed to assign a Social Security Number (SSN) and issue a card. SSA screens its records to make sure applicants for original SSN cards don't already have SSNs before assigning an original number. SSA also uses the information from the SS5 to insure that replacement SSN cards are issued to the correct number holder. Use of SSNs enables SSA to keep an accurate record of each individual's earnings for the payment of benefits and for administrative purposes as an identifier for healthmaintenance and incomemaintenance programs, such as the Retirement, Survivors and Disability Insurance programs, the SSI program and other programs administered by the Federal government including Black Lung, Medicare and veterans compensation and pension programs. The Internal Revenue Service uses the SSN as a taxpayer identification number for those individuals who are eligible to be assigned an SSN. The respondents are applicants for original, duplicate or corrected Social Security cards.
Number of Respondents: 17.6 million.
Frequency of Response: 1.
Average Burden Per Response: 8\1/2\9 minutes.
Estimated Annual Burden: 2,501,667 hours.
3. Certificate of Responsibility for Welfare and Care of Child Not in Applicant's Custody09600019. SSA uses the information collected on form SSA781 to decide if ``in care'' requirements are met by non custodial parent(s), who is filing for benefits based on having a child in care. The respondents are noncustodial wage earners whose entitlement to benefits depends upon having an entitled child in care.
Number of Respondents: 14,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 2,333 hours.
4. Questionnaire for Children Claiming SSI Benefits09600499. The
information collected on form SSA3881 is used by SSA to evaluate disability in children who apply for
[[Page 82443]]
Supplemental Security Income (SSI) payments. The respondents are
individuals who apply for SSI benefits for a disabled child.
Number of Respondents: 272,000.
Frequency of Response: 1.
Average Burden Per Response: 30 minutes.
Estimated Annual Burden: 136,000 hours.
II. The information collections listed below have been submitted to OMB for clearance. Your comments on the information collections would be most useful if received by OMB and SSA within 30 days from the date of this publication. You can obtain a copy of the OMB clearance packages by calling the SSA Reports Clearance Officer on (410) 965 4145, or by writing to him at the address listed above.
1. Child Relationship Statement09600116. SSA uses the
information collected on Form SSA2519 to help determine the
entitlement of children to Social Security benefits under section
216(h)(3) of the Social Security Act (deemed child provision). The
respondents are persons providing information about the relationship
between the worker and his/her alleged biological child, in connection with the child's application for benefits.
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 12,500 hours.
2. Request to Resolve Questionable Quarters of Coverage (QC); Request for QC History Based on Relationship09600575. Form SSA512 is used by the States to request clarification from SSA on questionable QCs information. The Personal Responsibility and Work Opportunity Reconciliation Act states that aliens admitted for lawful residence who have worked and earned 40 qualifying QCs for Social Security purposes can generally receive State benefits. Form SSA513 is used by States to request QC information for an alien's spouse or child in cases where the alien does not sign a consent form giving permission to access his/ her Social Security records. QCs can also be allocated to a spouse and/ or to a child under age 18, if needed, to obtain 40 qualifying QCs for the alien. The respondents are State agencies that require QC information in order to determine eligibility for benefits. SSA512 SSA513 Number of Respondents........................... 200,000 350,000 Frequency of Response........................... 1 1 Average Burden Per Response (minute)............ 2 2 Estimated Annual Burden (hours)................. 6,667 11,667
3. Affective Disorder Treatment Demonstration Project0960NEW Background
There is substantial research evidence that affective disorders (i.e., mental disorders that affect a person's mood, such as depression and bipolar disorder) usually respond to treatment; there is also evidence that many individuals with affective disorders do not receive effective treatment. The cost of care is one of the reasons for the low treatment rates of individuals with affective disorder. This may be true for many beneficiaries, particularly those in the Medicare waiting period. Therefore, SSA will test the hypothesis that providing access to treatment will result in improved health status of Disability Insurance (DI) beneficiaries with affective disorders, which might, in turn, lead to increased labor force participation and selfsufficiency. This outcome would benefit both participants and taxpayers. The Demonstration Project
SSA plans to implement a 5year demonstration project that will test the effectiveness of providing better access to quality affective disorders treatments for DI beneficiaries who have an affective disorder as their primary reason for disability. Several forms and survey instruments will be used during the demonstration to collect information for screening program participants, beneficiary protection, and program evaluation. Some of the data will be collected from beneficiaries, and other data will be collected from the medical service providers who treat beneficiaries during the study.
The respondents to this collection will be randomly selected DI
beneficiaries with an affective disorder and their health care providers.
Annual Average Estimated
number of Frequency burden per annual
respondents of response response burden Beneficiary:
Beneficiary telephone screening............................. 1,068 1 16 285
Authorization for release of medical information............ 855 1 5 71
Baseline survey............................................. 400 1 35 233
8Month followup survey.................................... 380 1 32 203
16Month followup survey................................... 361 1 32 193
24Month followup survey................................... 343 1 32 183
32Month followup survey................................... 326 1 35 190 Health Provider:
Copy medical records........................................ 667 1 20 222
Medical records questionnaire............................... 667 1 10 111
Treatment participation screen.............................. 200 1 15 50
Provider credentialing questionnaire........................ 150 1 15 38
Initial treatment plan...................................... 150 1 30 75
Quarterly progress report................................... 143 8 30 572
Total Respondents..................................... 5,708
Total Annual Burden Hrs............................... ........... ........... ........... 2,426 [[Page 82444]]
Dated: December 21, 2000.
Elizabeth A. Davidson,
Acting Reports Clearance Officer, Social Security Administration.
[FR Doc. 0033109 Filed 122700; 8:45 am]
BILLING CODE 419102U
SUMMARY:
Proposed collection and submission for OMB review; comment request,
DOCUMENT BODY 2:
The Social Security Administration (SSA) publishes a list of information collection packages that will require clearance by the Office of Management and Budget (OMB) in compliance with Pub. L. 10413 effective October 1, 1995, The Paperwork Reduction Act of 1995. 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.
Written comments and recommendations regarding the information
collection(s) should be submitted to the SSA Reports Clearance Officer and to the OMB Desk Officer at the following addresses:
(OMB), Attn: Desk Officer for SSA, New Executive Office Building,
Room 10230, 725 17th St., NW, Washington, DC 20503; (SSA), Social
Security Administration, DCFAM, Attn: Frederick W. Brickenkamp, 1A21
Operations Bldg., 6401 Security Blvd., Baltimore, MD 21235.
I. The information collections listed below will be submitted to OMB within 60 days from the date of this notice. Your comments should be submitted to SSA within 60 days from the date of this publication. You can obtain a copy of the collection instruments by calling the SSA Reports Clearance Officer at 4109654145, or by writing to him at the address listed above.
1. Pre1957 Military Service Federal Benefit Questionnaire0960 0120. Form SSA2512 collects data used in the claims adjudication process to grant gratuitous military wage credits, when applicable, and solicits sufficient information to make a determination of eligibility. The respondents are individuals who are applying for Social Security benefits on the record of a wage earner with pre1957 military service.
Number of Respondents: 12,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 2,000 hours.
2. Application for a Social Security Card09600066. The information collected on form SS5 is needed to assign a Social Security Number (SSN) and issue a card. SSA screens its records to make sure applicants for original SSN cards don't already have SSNs before assigning an original number. SSA also uses the information from the SS5 to insure that replacement SSN cards are issued to the correct number holder. Use of SSNs enables SSA to keep an accurate record of each individual's earnings for the payment of benefits and for administrative purposes as an identifier for healthmaintenance and incomemaintenance programs, such as the Retirement, Survivors and Disability Insurance programs, the SSI program and other programs administered by the Federal government including Black Lung, Medicare and veterans compensation and pension programs. The Internal Revenue Service uses the SSN as a taxpayer identification number for those individuals who are eligible to be assigned an SSN. The respondents are applicants for original, duplicate or corrected Social Security cards.
Number of Respondents: 17.6 million.
Frequency of Response: 1.
Average Burden Per Response: 8\1/2\9 minutes.
Estimated Annual Burden: 2,501,667 hours.
3. Certificate of Responsibility for Welfare and Care of Child Not in Applicant's Custody09600019. SSA uses the information collected on form SSA781 to decide if ``in care'' requirements are met by non custodial parent(s), who is filing for benefits based on having a child in care. The respondents are noncustodial wage earners whose entitlement to benefits depends upon having an entitled child in care.
Number of Respondents: 14,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 2,333 hours.
4. Questionnaire for Children Claiming SSI Benefits09600499. The
information collected on form SSA3881 is used by SSA to evaluate disability in children who apply for
[[Page 82443]]
Supplemental Security Income (SSI) payments. The respondents are
individuals who apply for SSI benefits for a disabled child.
Number of Respondents: 272,000.
Frequency of Response: 1.
Average Burden Per Response: 30 minutes.
Estimated Annual Burden: 136,000 hours.
II. The information collections listed below have been submitted to OMB for clearance. Your comments on the information collections would be most useful if received by OMB and SSA within 30 days from the date of this publication. You can obtain a copy of the OMB clearance packages by calling the SSA Reports Clearance Officer on (410) 965 4145, or by writing to him at the address listed above.
1. Child Relationship Statement09600116. SSA uses the
information collected on Form SSA2519 to help determine the
entitlement of children to Social Security benefits under section
216(h)(3) of the Social Security Act (deemed child provision). The
respondents are persons providing information about the relationship
between the worker and his/her alleged biological child, in connection with the child's application for benefits.
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 12,500 hours.
2. Request to Resolve Questionable Quarters of Coverage (QC); Request for QC History Based on Relationship09600575. Form SSA512 is used by the States to request clarification from SSA on questionable QCs information. The Personal Responsibility and Work Opportunity Reconciliation Act states that aliens admitted for lawful residence who have worked and earned 40 qualifying QCs for Social Security purposes can generally receive State benefits. Form SSA513 is used by States to request QC information for an alien's spouse or child in cases where the alien does not sign a consent form giving permission to access his/ her Social Security records. QCs can also be allocated to a spouse and/ or to a child under age 18, if needed, to obtain 40 qualifying QCs for the alien. The respondents are State agencies that require QC information in order to determine eligibility for benefits. SSA512 SSA513 Number of Respondents........................... 200,000 350,000 Frequency of Response........................... 1 1 Average Burden Per Response (minute)............ 2 2 Estimated Annual Burden (hours)................. 6,667 11,667
3. Affective Disorder Treatment Demonstration Project0960NEW Background
There is substantial research evidence that affective disorders (i.e., mental disorders that affect a person's mood, such as depression and bipolar disorder) usually respond to treatment; there is also evidence that many individuals with affective disorders do not receive effective treatment. The cost of care is one of the reasons for the low treatment rates of individuals with affective disorder. This may be true for many beneficiaries, particularly those in the Medicare waiting period. Therefore, SSA will test the hypothesis that providing access to treatment will result in improved health status of Disability Insurance (DI) beneficiaries with affective disorders, which might, in turn, lead to increased labor force participation and selfsufficiency. This outcome would benefit both participants and taxpayers. The Demonstration Project
SSA plans to implement a 5year demonstration project that will test the effectiveness of providing better access to quality affective disorders treatments for DI beneficiaries who have an affective disorder as their primary reason for disability. Several forms and survey instruments will be used during the demonstration to collect information for screening program participants, beneficiary protection, and program evaluation. Some of the data will be collected from beneficiaries, and other data will be collected from the medical service providers who treat beneficiaries during the study.
The respondents to this collection will be randomly selected DI
beneficiaries with an affective disorder and their health care providers.
Annual Average Estimated
number of Frequency burden per annual
respondents of response response burden Beneficiary:
Beneficiary telephone screening............................. 1,068 1 16 285
Authorization for release of medical information............ 855 1 5 71
Baseline survey............................................. 400 1 35 233
8Month followup survey.................................... 380 1 32 203
16Month followup survey................................... 361 1 32 193
24Month followup survey................................... 343 1 32 183
32Month followup survey................................... 326 1 35 190 Health Provider:
Copy medical records........................................ 667 1 20 222
Medical records questionnaire............................... 667 1 10 111
Treatment participation screen.............................. 200 1 15 50
Provider credentialing questionnaire........................ 150 1 15 38
Initial treatment plan...................................... 150 1 30 75
Quarterly progress report................................... 143 8 30 572
Total Respondents..................................... 5,708
Total Annual Burden Hrs............................... ........... ........... ........... 2,426 [[Page 82444]]
Dated: December 21, 2000.
Elizabeth A. Davidson,
Acting Reports Clearance Officer, Social Security Administration.
[FR Doc. 0033109 Filed 122700; 8:45 am]
BILLING CODE 419102U