Federal Register: December 3, 2001 (Volume 66, Number 231)
DOCID: FR Doc 01-29848
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
[[Page 60235]]
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 OMB Desk Officer and the SSA Reports Clearance Officer and at the following addresses:
(OMB)
Office of Management and Budget, Attn: Desk Officer for SSA, New
Executive Office Building, Room 10230, 725 17th St., NW., Washington, DC 20503
(SSA)
Social Security Administration, DCFAM, Attn: Reports Clearance Officer
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. Therefore, your comments should be submitted to SSA within 60 days from the date of this publication. You can obtain copies of the collection instruments by calling the SSA Reports Clearance Officer at 4109654145, or by writing to him at the address listed above.
1. Information Collections Conducted by State Disability
Determination Services (DDS) on Behalf of SSA09600555. The State
DDSs collect certain information to administer SSA's disability
program. The information collected is as follows: (1) Medical evidence
of record (MER)DDSs use MER information to determine a person's
physical and/or mental status prior to making a disability
determination; (2) consultative exam (CE) medical evidenceDDSs use CE
medical evidence to make disability determinations when the claimant's
own medical sources cannot or will not provide the information; (3) CE claimant formsThe DDSs request that claimants complete an
authorization form for the release of consultative exam information to
a personal physician and to complete an appointment form to confirm
scheduled CE appointments; (4) CE provider informationDDSs use the CE
provider information to verify medical providers' credentials and
licenses before hiring them to conduct CEs; (5) activities of daily
living (ADL)this information and other medical evidence are part of
the evidentiary documentation used by the DDS's in evaluating a
person's disability; and (6) pain informationthis information is used
by the DDSs to assess the effects of symptoms on functionality for
determining disability. The respondents are medical providers, other sources of MER and disability claimants.
(1) MER (RespondentsMedical Providers and Other Sources)
Number of Responses: 6,052,494
Frequency of Response: Unknown
Average Burden Per Response: 15 minutes
Estimate Annual Burden: 1,513,124
(2) CE Medical Evidence (RespondentsMedical Providers)
Number of Responses: 1,640,269
Frequency of Response: Unknown
Average Burden Per Response: 30 minutes
Estimated Annual Burden: 820,135 hours
(3) CE Forms (RespondentsClaimants)
Appointment form Medical release
Number of Respondents:......... 820,134............ 1,640,269. Frequency of Response:......... 1.................. 1.
Average Burden Per Response:... 5 minutes.......... 5 minutes.
Estimated Annual Burden:....... 68,345 hours....... 136,689 hours. (4) CE Providers (RespondentsMedical Providers)
Number of Responses: 3,000
Frequency of Response: 1
Average Burden: 20 minutes
Estimated Annual Burden: 1,000 hours
(5) ADL (RespondentsClaimants)
Number of Responses: 2,000,000
Frequency of Response: 1
Average Burden Per Response: 15 minutes
Estimated Annual Burden: 500,000 hours
(6) Pain (RespondentsClaimants)
Number of Responses: 1,000,000
Frequency of Response: 1
Average Burden Per Response: 15 minutes
Estimated Average Burden: 250,000 hours
2. Application for U.S. Benefits Under the CanadaU.S.
International Agreement09600371. The information collected on Form
SSA1294 is used to determine entitlement to benefits. The respondents
are individuals who live in Canada and file for U.S. Social Security Benefits.
Number of Respondents: 1,000
Frequency of Response: 1
Average Burden Per Response: 15 minutes
Estimated Annual Burden: 250 hours
3. Disability Hearing Officer's Report of Disability Hearing (DC) 09600507. The information collected on form SSA1204BK is used by the Disability Hearing Officer (DHO) to conduct and document disability hearings, and to provide a structured format that concerns all conceivable issues relating supplemental security income claims for disabled children. The completed form SSA1204BK will aid the DHO in preparing the disability decision and will provide a record of what transpired at the hearing.
The respondents are DHO's in the State Disability Determination Services.
Number of Respondents: 100,000
Frequency of Response: 1
Average Burden Per Response: 60 minutes
Estimated Annual Burden: 100,000 hours
4. Statement of Death by Funeral Director09600142. The Social
Security Administration (SSA) uses the information on form SSA721 to
make timely and accurate decisions based on a report of death. The
respondents are funeral directors with knowledge of the fact of death. Number of Respondents: 1,059,400
Frequency of Response: 1
Average Burden Per Response: 4 minutes
Estimated Annual Burden: 70,627 hours
5. Statement Regarding Marriage09600017. Form SSA753 elicits
information from third parties to verify the applicant's statements
about intent, cohabitation, and holding out to the public as married,
which are the basic tenets of a commonlaw marriage. The responses are
used by SSA to determine if a valid marital relationship exists and to
make an accurate determination regarding entitlement to spouse/
widow(er) benefits. The respondents are individuals who are familiar
with and can provide confirmation of an applicant's commonlaw marriage.
Number of Respondents: 40,000
Frequency of Response: 1
Average Burden Per Response: 9 minutes
[[Page 60236]]
Estimated Annual Burden: 6,000
6. Quarterly Statistical Report on Recipients and Payments Under
StateAdministered Assistance Programs for Aged, Blind, and Disabled
(Individuals and Couples) Recipients09600130. The information
collected on Form SSA9741 is used by States to provide statistical
data on recipients and assistance payments under the SSI State
administered State Supplementation Programs. The data are needed to
complement information available for the programs administered by SSA
and to fully explain the impact of the public income support programs
on the needy, aged, blind, and disabled. The respondents are State
agencies who administer supplementary payment programs under SSI. Number of Respondents: 30
Frequency of Response: 4
Average Burden Per Response: 60 minutes
Estimated Annual Burden: 2 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. Modified Benefits Formula Questionnaire, Employer09600477.
Form SSA58 is used by SSA to verify or disprove a claimant's
allegation regarding a pension based on noncovered employment after
1956. It also shows whether that claimant was eligible for the pension
before 1986. The respondents are persons who are eligible (after 1985)
for both Social Security benefits and a pension from their employer, based on work not covered by SSA.
Number of Respondents: 30,000
Frequency of Response: 1
Average Burden Per Response: 20 minutes
Estimated Annual Burden: 10,000 hours
2. Application for Survivors Benefits09600062. The information
collected on Form SSA24 is needed to satisfy the ``Jointly Prescribed
Application'' of title 38 U.S.C. 5105. The provision requires that
survivors who file with SSA or the VA shall be deemed to have filed
with both agencies, and that each agency's forms must request
information to constitute an application for both SSA and VA benefits.
The respondents are survivors of military service veterans filing for Social Security benefits.
Number of Respondents: 3,200
Frequency of Response: 1
Average Burden Per Response: 15 minutes
Estimated Annual Burden: 800 hours
3. Medical Report (Individual With Childhood Impairment)0960
0102. The information on Form SSA3827BK is needed to determine the
claimant's physical and mental status prior to making a childhood
disability determination. The respondents are medical sources. Number of Respondents: 12,000
Frequency of Response: 1
Average Burden Per Response: 30 minutes
Estimated Annual Burden: 6,000 hours
4. Work Activity Report (SelfEmployed)09600598. Form SSA820F4
is used to determine whether work an individual performs in self
employment is at the substantial gainful activity (SGA) level. An
individual's entitlement to benefits ends if he/she demonstrates an
ability to perform SGA. The respondents are social security disability beneficiaries and Supplemental Security Income recipients.
Number of Respondents: 100,000
Frequency of Response: 1
Average Burden Per Response: 30 minutes
Estimated Annual Burden: 50,000 hours
5. Agreement to Sell Property09600127. Form SSA8060U3 is used
by SSA to document and ensure that individuals or couples who are
otherwise eligible for Supplemental Security Income (SSI) payments, but
who own in excess of the statutory limit, may receive conditional
benefit payments if they agree to dispose of the excess resources and
repay any overpayments with the proceeds of the disposition. The form
is also used to ensure that the individuals understand their
obligations under the agreement. The respondents are individuals (or
couples) who are receiving (or will receive) conditional SSI payments. Number of Respondents: 20,000
Frequency of Response: 1
Average Burden Per Response: 10 minutes
Estimated Annual Burden: 3,333 hours
6. Reconsideration Disability Report09600144. SSA uses the
information collected on Form SSA3441 to determine if the claimant's
medical or vocational situation changed after the initial disability
determination, when the claimant requests a reconsideration of a denied
disability claim. The form also elicits additional sources of medical
and vocational evidence that were not considered in the initial
determination. The respondents are disability beneficiaries who request a reconsideration of their claim.
Number of Respondents: 400,000
Frequency of Response: 1
Average Burden Per Response: 30 minutes
Estimated Average Burden: 200,000 hours
7. Electronic Benefit Verification Information09600595. SSA
provides verification of benefits, when requested, to individuals
receiving title II and/or title XVI benefits. In order to provide to
the public an easy and convenient means of requesting benefit
information, SSA has developed an electronic request form that will
allow persons to request the information through the Internet. The
information collected on the electronic screens will be used by SSA to
process the request for a benefit verification statement. To ensure
appropriate confidentiality, the statement will be mailed to the
recipient/beneficiary address shown in SSA's records. The respondents
are title II and XVI recipients/beneficiaries who request benefit verification information using the Internet.
Number of Respondents: 133,920
Frequency of Response: 1
Average Burden Per Response: \1/2\ minute
Estimated Average Burden: 1,116 hours
8. Statement by School Official About Student's Attendance;
Statement to U.S. Social Security Administration By School Outside the
United States About Student's Attendance09600090. The information
collected on Forms SSA1371 and SSA1371FC is used by SSA to verify a
student's alleged fulltime attendance at an educational institution,
in order to determine the student's eligibility for Social Security
student benefits. The respondents are school officials who provide the information on these forms.
Number of Respondents: 5,000
Frequency of Response: 1
Average Burden Per Response: 10 minutes
Estimated Average Burden: 833 hours
9. Report of Continuing Disability Interview09600072. SSA
periodically reviews the cases of individuals who receive Social
Security benefits and Supplemental Security Income (SSI) to determine
if disability continues. During a review, SSA uses Form SSA454BK to
collect information on disability. The information on the form is used
to update the record of the disabled individual on recent medical treatment, vocational and educational experiences,
[[Page 60237]]
work activity, and evaluations of potential for return to work. Based
on this information and other evidence, SSA makes a determination on
whether disability continues or has ended, and if so, when disability
ended. The respondents are individuals who receive Social Security or SSI disability benefits, or their representatives.
Number of Respondents: 852,000
Frequency of Response: 1
Average Burden Per Response: 30 minutes
Estimated Annual Burden: 426,000 hours
Dated: November 26, 2001.
Nicholas E. Tagliareni,
Director, Center for Publications Management, Social Security Administration.
[FR Doc. 0129848 Filed 113001; 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
[[Page 60235]]
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 OMB Desk Officer and the SSA Reports Clearance Officer and at the following addresses:
(OMB)
Office of Management and Budget, Attn: Desk Officer for SSA, New
Executive Office Building, Room 10230, 725 17th St., NW., Washington, DC 20503
(SSA)
Social Security Administration, DCFAM, Attn: Reports Clearance Officer
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. Therefore, your comments should be submitted to SSA within 60 days from the date of this publication. You can obtain copies of the collection instruments by calling the SSA Reports Clearance Officer at 4109654145, or by writing to him at the address listed above.
1. Information Collections Conducted by State Disability
Determination Services (DDS) on Behalf of SSA09600555. The State
DDSs collect certain information to administer SSA's disability
program. The information collected is as follows: (1) Medical evidence
of record (MER)DDSs use MER information to determine a person's
physical and/or mental status prior to making a disability
determination; (2) consultative exam (CE) medical evidenceDDSs use CE
medical evidence to make disability determinations when the claimant's
own medical sources cannot or will not provide the information; (3) CE claimant formsThe DDSs request that claimants complete an
authorization form for the release of consultative exam information to
a personal physician and to complete an appointment form to confirm
scheduled CE appointments; (4) CE provider informationDDSs use the CE
provider information to verify medical providers' credentials and
licenses before hiring them to conduct CEs; (5) activities of daily
living (ADL)this information and other medical evidence are part of
the evidentiary documentation used by the DDS's in evaluating a
person's disability; and (6) pain informationthis information is used
by the DDSs to assess the effects of symptoms on functionality for
determining disability. The respondents are medical providers, other sources of MER and disability claimants.
(1) MER (RespondentsMedical Providers and Other Sources)
Number of Responses: 6,052,494
Frequency of Response: Unknown
Average Burden Per Response: 15 minutes
Estimate Annual Burden: 1,513,124
(2) CE Medical Evidence (RespondentsMedical Providers)
Number of Responses: 1,640,269
Frequency of Response: Unknown
Average Burden Per Response: 30 minutes
Estimated Annual Burden: 820,135 hours
(3) CE Forms (RespondentsClaimants)
Appointment form Medical release
Number of Respondents:......... 820,134............ 1,640,269. Frequency of Response:......... 1.................. 1.
Average Burden Per Response:... 5 minutes.......... 5 minutes.
Estimated Annual Burden:....... 68,345 hours....... 136,689 hours. (4) CE Providers (RespondentsMedical Providers)
Number of Responses: 3,000
Frequency of Response: 1
Average Burden: 20 minutes
Estimated Annual Burden: 1,000 hours
(5) ADL (RespondentsClaimants)
Number of Responses: 2,000,000
Frequency of Response: 1
Average Burden Per Response: 15 minutes
Estimated Annual Burden: 500,000 hours
(6) Pain (RespondentsClaimants)
Number of Responses: 1,000,000
Frequency of Response: 1
Average Burden Per Response: 15 minutes
Estimated Average Burden: 250,000 hours
2. Application for U.S. Benefits Under the CanadaU.S.
International Agreement09600371. The information collected on Form
SSA1294 is used to determine entitlement to benefits. The respondents
are individuals who live in Canada and file for U.S. Social Security Benefits.
Number of Respondents: 1,000
Frequency of Response: 1
Average Burden Per Response: 15 minutes
Estimated Annual Burden: 250 hours
3. Disability Hearing Officer's Report of Disability Hearing (DC) 09600507. The information collected on form SSA1204BK is used by the Disability Hearing Officer (DHO) to conduct and document disability hearings, and to provide a structured format that concerns all conceivable issues relating supplemental security income claims for disabled children. The completed form SSA1204BK will aid the DHO in preparing the disability decision and will provide a record of what transpired at the hearing.
The respondents are DHO's in the State Disability Determination Services.
Number of Respondents: 100,000
Frequency of Response: 1
Average Burden Per Response: 60 minutes
Estimated Annual Burden: 100,000 hours
4. Statement of Death by Funeral Director09600142. The Social
Security Administration (SSA) uses the information on form SSA721 to
make timely and accurate decisions based on a report of death. The
respondents are funeral directors with knowledge of the fact of death. Number of Respondents: 1,059,400
Frequency of Response: 1
Average Burden Per Response: 4 minutes
Estimated Annual Burden: 70,627 hours
5. Statement Regarding Marriage09600017. Form SSA753 elicits
information from third parties to verify the applicant's statements
about intent, cohabitation, and holding out to the public as married,
which are the basic tenets of a commonlaw marriage. The responses are
used by SSA to determine if a valid marital relationship exists and to
make an accurate determination regarding entitlement to spouse/
widow(er) benefits. The respondents are individuals who are familiar
with and can provide confirmation of an applicant's commonlaw marriage.
Number of Respondents: 40,000
Frequency of Response: 1
Average Burden Per Response: 9 minutes
[[Page 60236]]
Estimated Annual Burden: 6,000
6. Quarterly Statistical Report on Recipients and Payments Under
StateAdministered Assistance Programs for Aged, Blind, and Disabled
(Individuals and Couples) Recipients09600130. The information
collected on Form SSA9741 is used by States to provide statistical
data on recipients and assistance payments under the SSI State
administered State Supplementation Programs. The data are needed to
complement information available for the programs administered by SSA
and to fully explain the impact of the public income support programs
on the needy, aged, blind, and disabled. The respondents are State
agencies who administer supplementary payment programs under SSI. Number of Respondents: 30
Frequency of Response: 4
Average Burden Per Response: 60 minutes
Estimated Annual Burden: 2 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. Modified Benefits Formula Questionnaire, Employer09600477.
Form SSA58 is used by SSA to verify or disprove a claimant's
allegation regarding a pension based on noncovered employment after
1956. It also shows whether that claimant was eligible for the pension
before 1986. The respondents are persons who are eligible (after 1985)
for both Social Security benefits and a pension from their employer, based on work not covered by SSA.
Number of Respondents: 30,000
Frequency of Response: 1
Average Burden Per Response: 20 minutes
Estimated Annual Burden: 10,000 hours
2. Application for Survivors Benefits09600062. The information
collected on Form SSA24 is needed to satisfy the ``Jointly Prescribed
Application'' of title 38 U.S.C. 5105. The provision requires that
survivors who file with SSA or the VA shall be deemed to have filed
with both agencies, and that each agency's forms must request
information to constitute an application for both SSA and VA benefits.
The respondents are survivors of military service veterans filing for Social Security benefits.
Number of Respondents: 3,200
Frequency of Response: 1
Average Burden Per Response: 15 minutes
Estimated Annual Burden: 800 hours
3. Medical Report (Individual With Childhood Impairment)0960
0102. The information on Form SSA3827BK is needed to determine the
claimant's physical and mental status prior to making a childhood
disability determination. The respondents are medical sources. Number of Respondents: 12,000
Frequency of Response: 1
Average Burden Per Response: 30 minutes
Estimated Annual Burden: 6,000 hours
4. Work Activity Report (SelfEmployed)09600598. Form SSA820F4
is used to determine whether work an individual performs in self
employment is at the substantial gainful activity (SGA) level. An
individual's entitlement to benefits ends if he/she demonstrates an
ability to perform SGA. The respondents are social security disability beneficiaries and Supplemental Security Income recipients.
Number of Respondents: 100,000
Frequency of Response: 1
Average Burden Per Response: 30 minutes
Estimated Annual Burden: 50,000 hours
5. Agreement to Sell Property09600127. Form SSA8060U3 is used
by SSA to document and ensure that individuals or couples who are
otherwise eligible for Supplemental Security Income (SSI) payments, but
who own in excess of the statutory limit, may receive conditional
benefit payments if they agree to dispose of the excess resources and
repay any overpayments with the proceeds of the disposition. The form
is also used to ensure that the individuals understand their
obligations under the agreement. The respondents are individuals (or
couples) who are receiving (or will receive) conditional SSI payments. Number of Respondents: 20,000
Frequency of Response: 1
Average Burden Per Response: 10 minutes
Estimated Annual Burden: 3,333 hours
6. Reconsideration Disability Report09600144. SSA uses the
information collected on Form SSA3441 to determine if the claimant's
medical or vocational situation changed after the initial disability
determination, when the claimant requests a reconsideration of a denied
disability claim. The form also elicits additional sources of medical
and vocational evidence that were not considered in the initial
determination. The respondents are disability beneficiaries who request a reconsideration of their claim.
Number of Respondents: 400,000
Frequency of Response: 1
Average Burden Per Response: 30 minutes
Estimated Average Burden: 200,000 hours
7. Electronic Benefit Verification Information09600595. SSA
provides verification of benefits, when requested, to individuals
receiving title II and/or title XVI benefits. In order to provide to
the public an easy and convenient means of requesting benefit
information, SSA has developed an electronic request form that will
allow persons to request the information through the Internet. The
information collected on the electronic screens will be used by SSA to
process the request for a benefit verification statement. To ensure
appropriate confidentiality, the statement will be mailed to the
recipient/beneficiary address shown in SSA's records. The respondents
are title II and XVI recipients/beneficiaries who request benefit verification information using the Internet.
Number of Respondents: 133,920
Frequency of Response: 1
Average Burden Per Response: \1/2\ minute
Estimated Average Burden: 1,116 hours
8. Statement by School Official About Student's Attendance;
Statement to U.S. Social Security Administration By School Outside the
United States About Student's Attendance09600090. The information
collected on Forms SSA1371 and SSA1371FC is used by SSA to verify a
student's alleged fulltime attendance at an educational institution,
in order to determine the student's eligibility for Social Security
student benefits. The respondents are school officials who provide the information on these forms.
Number of Respondents: 5,000
Frequency of Response: 1
Average Burden Per Response: 10 minutes
Estimated Average Burden: 833 hours
9. Report of Continuing Disability Interview09600072. SSA
periodically reviews the cases of individuals who receive Social
Security benefits and Supplemental Security Income (SSI) to determine
if disability continues. During a review, SSA uses Form SSA454BK to
collect information on disability. The information on the form is used
to update the record of the disabled individual on recent medical treatment, vocational and educational experiences,
[[Page 60237]]
work activity, and evaluations of potential for return to work. Based
on this information and other evidence, SSA makes a determination on
whether disability continues or has ended, and if so, when disability
ended. The respondents are individuals who receive Social Security or SSI disability benefits, or their representatives.
Number of Respondents: 852,000
Frequency of Response: 1
Average Burden Per Response: 30 minutes
Estimated Annual Burden: 426,000 hours
Dated: November 26, 2001.
Nicholas E. Tagliareni,
Director, Center for Publications Management, Social Security Administration.
[FR Doc. 0129848 Filed 113001; 8:45 am]
BILLING CODE 419102U