Federal Register / Vol. 76, No. 58 / Friday, March 25, 2011 / Notices 16847 

Percent 

Non-Profit Organizations Without Credit Available Elsewhere ..................................... 3.000 

For Economic Injury: 

Non-Profit Organizations Without Credit Available Elsewhere ..................................... 3.000 

The number assigned to this disaster 

for physical damage is 12495B and for 

economic injury is 12496B. 

(Catalog of Federal Domestic Assistance 

Numbers 59002 and 59008) 

James E. Rivera, 

Associate Administrator for Disaster 

Assistance. 

[FR Doc. 2011–7064 Filed 3–24–11; 8:45 am] 

BILLING CODE 8025–01–P 

SOCIAL SECURITY ADMINISTRATION 

Agency Information Collection 

Activities: Proposed Request and 

Comment 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 

to OMB-approved information 

collections and a collection in use 

without an OMB number. 

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, e-mail, 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, Fax: 202– 

395–6974, E-mail address: 

OIRA_Submission@omb.eop.gov. 

(SSA) 

Social Security Administration, 

DCBFM, Attn: Reports Clearance 

Officer, 1333 Annex Building, 6401 

Security Blvd., Baltimore, MD 21235, 

Fax: 410–965–6400, E-mail address: 

OPLM.RCO@ssa.gov. 

I. 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 May 24, 

2011. Individuals can obtain copies of 

the collection instruments by calling the 

SSA Reports Clearance Officer at 410– 

965–8783 or by writing to the above email address. 

1. Supplemental Security Income 

(SSI)—Quality Review Case Analysis— 

0960–0133. To assess the SSI program 

and ensure the accuracy of its payments, 

SSA conducts legally mandated 

periodic SSI case analysis quality 

reviews. SSA uses Form SSA–8508 to 

conduct these reviews, collecting 

information on operating efficiency, the 

quality of underlying policies, and the 

effect of incorrect payments. SSA also 

uses the data to determine SSI program 

payment accuracy rates, which is a 

performance measure for the agency’s 

service delivery goals. The respondents 

are recipients of SSI payments selected 

for the quality reviews. 

Type of Request: Revision of an OMBapproved information collection. 

Form Number of 

respondents 

Frequency of 

response 

Response time 

(minutes) 

Estimated 

annual burden 

(hours) 

SSA–8508–BK (paper interview) ..................................................................... 225 1 60 225 

SSA–8508–BK (electronic) .............................................................................. 4,275 1 60 4,275 

Totals ........................................................................................................ 4,500 ........................ ........................ 4,500 

2. Information Collections Conducted 

by State Disability Determination 

Services (DDS) on Behalf of SSA—20 

CFR, subpart P, 404.1503a, 404.1512, 

404.1513, 404.1514 404.1517, 404.1519; 

20 CFR subpart Q, 404.1613, 404.1614, 

404.1624; 20 CFR subpart I, 416.903a, 

416.912, 416.913, 416.914, 416.917, 

416.919 and 20 CFR subpart J, 416.1013, 

416.1024, 416.1014—0960–0555. State 

DDSs collect the information necessary 

to administer the Social Security 

Disability Insurance (SSDI) and SSI 

programs. They collect medical 

evidence from consultative exam (CE) 

sources, credential information from CE 

source applicants, and Medical 

Evidence of Record (MER) from 

claimants’ medical sources. The DDSs 

collect information from claimants 

regarding medical treatment and pain/ 

symptoms. The respondents are medical 

providers, other sources of MER, and 

disability claimants. 

Type of Request: Revision of an OMBapproved information collection. 

CE Collections 

There are two collections from CE 

providers: (a) Medical evidence about 

claimants’ medical condition(s) that 

DDSs use to make disability 

determinations when the claimant’s 

own medical sources cannot or will not 

provide the required information; and 

(b) proof of credentials from CE 

providers. 

Collection instrument Number of 

respondents 

Frequency of 

response 

Average 

burden per response 

(minutes) 

Estimated 

annual burden 

(hours) 

(a) Medical Evidence from CE Providers: 

Paper Submissions ................................................................................... 100,000 1 30 50,000 

Electronic Records Express (ERE) Submissions ..................................... 3,500,000 1 10 583,333 

Totals ................................................................................................. 4,600,000 ........................ ........................ 633,333 

(b) CE Credentials: 

Paper Submission .................................................................................... 3,000 1 15 750 


erowe on DSK5CLS3C1PROD with NOTICES
16848 Federal Register / Vol. 76, No. 58 / Friday, March 25, 2011 / Notices 

There are two CE claimant 

collections: (a) Claimant completion of 

a response form indicating whether they 

intend to keep their CE appointment:, 

and (b) claimant completion of a form 

indicating whether they want a copy of 

the CE report sent to their doctor. 

Type of CE claimant collection Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated annual burden 

(hours) 

Appointment Letter .......................................................................................... 2,500,000 1 5 208,333 

Claimants re: Report to Medical Provider ....................................................... 1,500,000 1 5 125,000 

Totals ........................................................................................................ 4,000,000 ........................ ........................ 333,333 

MER Collections 

The DDSs collect MER from the 

claimant’s medical sources to determine 

the claimant’s physical or mental status 

prior to making a disability 

determination. 

Collection instrument Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated annual burden 

(hours) 

Paper Submissions .......................................................................................... 500,000 1 15 125,000

Electronic and ERE Submissions .................................................................... 5,500,000 1 7 641,666 

Total .......................................................................................................... 6,000,000 ........................ ........................ 766,666 

Pain/Other Symptoms Information from 

Claimants 

The DDSs use information about pain/ 

symptoms to determine how pain/ 

symptoms affect the claimant’s ability to 

do work–related activities prior to 

making a disability determination. 

Number of 

respondents 

Frequency of 

response 

Average burden per 

response 

(minutes) 

Estimated annual burden 

(hours) 

Paper Submission ............................................................................................ 2,500,000 1 15 625,000 

The total combined burden is 

2,359,082 hours. 

II. SSA submitted the information 

collections listed below to OMB for 

clearance. Your comments on the 

information collections would be most 

useful if OMB and SSA receive them 

within 30 days from the date of this 

publication. To be sure we consider 

your comments, we must receive them 

no later than April 25, 2011. You can 

obtain a copy of the OMB clearance 

packages by calling the SSA Reports 

Clearance Officer at 410–965–8783 or by 

writing to the above e-mail address. 

1. Request for Waiver of Overpayment 

Recovery or Change in Repayment 

Notice—20 CFR 404.502–404.513, 

404.515 and 20 CFR 416.550–416.570, 

416.572—0960–0037. When Social 

Security beneficiaries and SSI recipients 

receive an overpayment, they must 

return the amount of the overpayment. 

These beneficiaries and recipients can 

use Form SSA–632–BK to take one of 

three actions: (1) Request an exemption 

from repaying, as recovery of the 

overpayment would cause financial 

hardship; (2) inform SSA they want to 

repay the overpayment at a monthly rate 

over a period longer than 36 months; or 

(3) request a different rate of recovery. 

In the latter two cases, the respondents 

must also provide financial information 

to help the agency determine how much 

the overpaid person can afford to repay 

each month. Respondents are overpaid 

Social Security beneficiaries or SSI 

recipients who are requesting a waiver 

of recovery of an overpayment or a 

lesser rate of withholding. 

Type of Request: Revision of an OMBapproved information collection. 

Type of request Number of 

respondents 

Frequency of 

response 

Response time 

(minutes) 

Total burden 

(hours) 

Waiver of Overpayment (Completes Whole Paper Form) .............................. 400,000 1 120 800,000 

Change in Repayment (Completes Partial Paper Form) ................................ 100,000 1 45 75,000 

Regional Application (NY Debt Management-NYDM) ..................................... 44,000 1 120 88,000 

Internet Instructions ......................................................................................... 500,000 1 5 41,667 

Totals ........................................................................................................ 1,044,000 ........................ ........................ 1,004,667 


erowe on DSK5CLS3C1PROD with NOTICES
Federal Register / Vol. 76, No. 58 / Friday, March 25, 2011 / Notices 16849 

2. Sheltered Workshop Wage 

Reporting—0960–0771. Sheltered 

workshops are nonprofit organizations 

or institutions that implement a 

recognized program of rehabilitation for 

workers who have handicaps, or 

provide such workers with 

remunerative employment or other 

occupational rehabilitating activity of an 

educational or therapeutic nature. 

Sheltered workshops perform a service 

for their clients by reporting monthly 

wages directly to SSA. SSA uses the 

information these workshops provide to 

verify and post monthly wages to the 

SSI recipient’s record. Most workshops 

report monthly wage totals to their local 

SSA office so we can adjust the client’s 

SSI payment amount in a timely manner 

and prevent overpayments. Sheltered 

workshops are motivated to report 

wages voluntarily as a service to their 

clients. Respondents are sheltered 

workshops that report monthly wages 

for services performed in the workshop. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 900. 

Frequency of Response: 12. 

Average Burden Per Response: 15 

minutes. 

Estimated Annual Burden: 3,000 

hours. 

3. Request for Medical Treatment in 

an SSA Employee Health Facility: 

Patient Self-Administered or StaffAdministered Care—0960–0772. SSA’s 

Employee Health Clinic (EHC) provides 

emergency care, treatment of on-the-job 

illnesses and injuries, and health care 

for employees with chronic medical 

conditions and allergies who require 

allergy antigens. SSA also permits 

employees to use the EHC for selfadministration of medical treatments for 

a chronic health condition. SSA collects 

information on Form SSA–5072 to 

approve or deny requests for medical 

treatment in an SSA EHC. The 

respondents are the private physicians 

of the SSA employees seeking medical 

treatment in an SSA EHC. 

Type of Request: Information 

Collection in Use without an OMB 

Number. 

Medication dosage changes Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Total annual 

burden (hours) 

Annually ........................................................................................................... 25 1 5 2 

Bi-Annually ....................................................................................................... 75 2 5 13 

Totals ........................................................................................................ 100 ........................ ........................ 15 

Dated: March 22, 2011. 

Faye Lipsky, 

Reports Clearance Officer, Center for Reports 

Clearance, Social Security Administration. 

[FR Doc. 2011–7123 Filed 3–24–11; 8:45 am] 

BILLING CODE 4191–02–P 

SOCIAL SECURITY ADMINISTRATION 

Agency Information Collection 

Activities: Proposed Request and 

Comment 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, e-mail, 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, Fax: 202– 

395–6974, E-mail address: 

OIRA_Submission@omb.eop.gov. 

(SSA) 

Social Security Administration, 

DCBFM, Attn: Reports Clearance 

Officer, 1333 Annex Building, 6401 

Security Blvd., Baltimore, MD 21235, 

Fax: 410–965–6400, E-mail address: 

OPLM.RCO@ssa.gov. 

I. 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 May 24, 

2011. Individuals can obtain copies of 

the collection instruments by calling the 

SSA Reports Clearance Officer at 410– 

965–8783 or by writing to the above email address. 

1. Questionnaire about Employment 

or Self-Employment outside the United 

States—20 CFR 404.401(b)(1), 404.415 & 

404.417—0960–0050. SSA collects 

information on the SSA–7163 to 

determine: (1) Whether work 

beneficiaries performed outside the 

United States is cause for deductions 

from their monthly benefits; (2) which 

of two work tests (foreign or regular test) 

is applicable; and (3) the number of 

months, if any, SSA should impose 

deductions. Respondents are 

beneficiaries living and working outside 

the United States. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 20,000. 

Frequency of Response: 1. 

Average Burden per Response: 12 

minutes. 

Estimated Annual Burden: 4,000 

hours. 

2. Statement of Income and 

Resources—20 CFR 416.207, 146.301– 

416.310, 416.704, and 416.708–0960– 

0124. SSA collects information about 

income and resources on the SSA– 

8010–BK for Supplemental Security 

Income (SSI) claims and 

redeterminations. SSA uses the 

information to make initial or 

continuing eligibility determinations for 

SSI claimants or recipients who are 

subject to deeming. The respondents are 

persons whose income and resources 

SSA may deem (consider to be 

available) to SSI applicants or 

recipients. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 341,000. 

Frequency of Response: 1. 

Average Burden per Response: 26 

minutes. 

Estimated Annual Burden: 147,767 

hours. 

3. Review of the Disability Hearing 

Officer’s Reconsidered Determinations 

before It Is Issued—20 CFR 404.913– 

404.918, 404.1512–404.1515, 404.1589, 

416.912–416.915, 416.989, 416.1413– 

416.1418, 404.918(d) and 416.1418(d)— 

0960–0709. After SSA approves 


erowe on DSK5CLS3C1PROD with NOTICES