Federal Register: December 9, 2005 (Volume 70, Number 236)

DOCID: FR Doc E5-7111

SOCIAL SECURITY ADMINISTRATION

Social Security Administration

NOTICE: NOTICES

SUBJECT CATEGORY:

Agency Information Collection Activities: Proposed Request

DOCUMENT SUMMARY:

The Social Security Administration (SSA) publishes a list of information collection packages that requires clearance by the Office of Management and Budget (OMB) in compliance with Public Law 10413, the Paperwork Reduction Act of 1995, effective October 1, 1995. The information collection packages that may be included in this notice are for new information collections, approval of existing information collections, revisions to OMBapproved information collections, and extensions (no change) of OMBapproved 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. Written comments and recommendations regarding the information collection(s) should be submitted to the OMB Desk Officer and the SSA Reports Clearance Officer.
(OMB), Office of Management and Budget, Attn: Desk Officer for SSA. Fax: 2023956974.
(SSA), Social Security Administration, DCFAM, Attn: Reports Clearance Officer. Fax: 4109656400. Email: OPLM.RCO@ssa.gov.

The information collection listed below is pending at SSA and 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 a copy of the collection instrument by calling the SSA Reports Clearance Officer at 4109650454 or by emailing or faxing your request to the above email address and fax number.
Medicare Subsidy Quality Review Case Analysis Forms20 CFR 418(b)(5) 09600707

Under the aegis of the Medicare Modernization Act of 2003, SSA will make Medicare Part D subsidy determinations for the Medicare Prescription Drug program for Medicare beneficiaries with limited income and resources. The subsidy determination is based on applicants' answers to questions about household size, income, and resources. This information is selfreported by applicants using form OMB No. 09600696 (SSA1020), and thus, SSA needs a way to determine if this form is being completed accurately and completely and a way to validate its determination decisions. To this end, SSA will use the new Medicare Quality Review system to check the accuracy of the determination. In this system, SSA will conduct phone interviews with selected applicants and will confirm information such as household size, income, and resources. A questionnaire and several other forms will be used as part of the Medicare Quality Review System. The collection instruments, their descriptions, and burden information are listed in the table below.

Note: This Notice is for the permanent approval of this collection, which was cleared by OMB temporarily through February 2006 as an emergency information collection.

Type of Request: Extension of a currently approved information collection.
Average Description of Number of Frequency of burden per Estimated Form number and name form respondents response response annual burden (minutes) (hours) SSA9301 (Medicare Subsidy Telephone 10,000 1 35 5,833 Quality Review Case Analysis questionnaire
Questionnaire). which will be
administered by
SSA employees
to applicants
for Medicare
Part D Subsidy.
Includes
questions about
family size,
marriage,
income, assets,
etc.
[[Page 73320]]
SSA9302 (Notice of Quality After receiving 10,000 1 15 2,500 Review Acknowledgement Form notice of the
for those with Phones). scheduled date/
time of the
telephone
questionnaire,
Part D
applicants will
return this
form confirming
their
availability
for the
interview and
making note of
any special
needs for the
call.
SSA9303 (Notice of Quality Same as for SSA 1,000 1 15 250 Review Acknowledgement Form 9302, except
for those without Phones). used by
participants
without phones
or whose phone
numbers are not
known by SSA.
On form SSA
9303, however,
participants
confirm receipt
of the letter
and are asked
to call SSA on
a specified
date.
SSA9304 (Checklist of This checklist, .............. .............. .............. .............. Required Information). which
accompanies
forms SSA9302
and SSA9303,
is a list of
the
documentation
respondents are
supposed to
have prepared
when SSA calls
them to conduct
the Quality
Review phone
interview.
Their burden is
accounted for
in the burdens
for forms SSA
9302 and SSA
9303.
SSA9308 (Request for Form which SSA 20,000 1 15 5,000 Information). will send to
various third
parties to
obtain/confirm
information
reported by
beneficiaries.
SSA9310 (Request for Following the 10,000 1 5 833 Documents). phone
interview, SSA
sends this
notice to the
participants
advising them
of the
documents they
must return to
SSA.
SSA9309 (Life Insurance Form completed 8,000 1 15 2,000 Verification Form). by insurance
companies
confirming
type, face
value, cash
surrender value
and dividends
for insurance
policies of
applicants for
Medicare Part D
subsidy.
SSA8510 (Authorization to the Beneficiaries 10,000 1 5 833 Social Security give their
Administration to Obtain permission for
Personal Information). SSA to contact
third parties
to obtain/
confirm
information.

Total..................... ................ 69,000 .............. .............. 17,249

Total Estimated Annual Burden: 17,249 hours.

Dated: December 2, 2005.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. E57111 Filed 12805; 8:45 am]
BILLING CODE 419102P

SUMMARY:

Agency information collection activities; proposals, submissions, and approvals,

DOCUMENT BODY 2: