[Federal Register Volume 69, Number 215 (Monday, November 8, 2004)]
[Notices]
[Pages 64801-64803]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-24810]


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SOCIAL SECURITY ADMINISTRATION


Agency Information Collection Activities: Proposed Request and 
Comment Request

    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. 104-13 
effective October 1, 1995, The Paperwork Reduction Act of 1995. The 
information collection packages that may be included in this notice are 
for new information collections, revisions to OMB-approved information 
collections, and extensions (no change) 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 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.

(OMB), Office of Management and Budget, Attn: Desk Officer for SSA, 
Fax: 202-395-6974.
(SSA), Social Security Administration, DCFAM, Attn: Reports Clearance 
Officer, 1338 Annex Bldg., 6401 Security Blvd., Baltimore, MD 21235; 
Fax: 410-965-6400.

    I. The information collections listed below are pending at SSA and 
will be submitted to OMB January 7, 2005. Therefore, your comments 
should be submitted to SSA by this date. You can obtain copies of the 
collection instruments by calling the SSA Reports Clearance Officer at 
410-965-0454, or by writing to the address listed above.
    1. Disability Determination and Transmittal--20 CFR 404.1615(e), 
416.1015(f)--0960-0437. The information collected on Form SSA-831-C3/U3 
is used by SSA to document the State agency determination as to whether 
an individual who applies for disability benefits is eligible for those 
benefits based on his/her alleged disability. SSA also uses the 
information for program management and evaluation. The respondents are 
State Disability Determination Services adjudicating Title II and Title 
XVI disability determinations for SSA.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 3,155,120.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Average Burden: 788,780 hours.
    2. Non-Attorney Representative Demonstration Project Application--
0960-NEW. Section 303 of the Social Security Protection Act of 2004 
(SSPA) provides for a 5-year demonstration project to be conducted by 
SSA under which the direct payment of SSA-approved fees is extended to 
certain non-attorney claimant representatives. Under the SSPA, to be 
eligible for direct payment of fees, a non-attorney representative must 
fulfill the following statutory requirements: (1) Possess a bachelors 
degree or have equivalent qualifications derived from training and work 
experience; (2) pass an examination that tests knowledge of the 
relevant provisions of the Social Security Act; (3) secure professional 
liability insurance or equivalent insurance; (4) pass a criminal 
background check; and (5) demonstrate completion of relevant continuing 
education courses. Through the services of a private contractor, SSA 
must collect the requested information to determine if a non-attorney 
representative has met the statutory requirements to be eligible for 
direct payment of fees for his or her claimant representation services. 
The information collection is needed to comply with the legislation. 
The respondents are non-attorney representatives who apply for direct 
payment of fees.
    Type of Request: New information collection.
    Number of Respondents: 500.
    Frequency of Response: 1.
    Average Burden Per Response: 1 hour.
    Estimated Annual Burden: 500 hours.
    3. Request For Review of Hearing Decision/Order--20 CFR 
404.967-.981, 20 CFR 416.1467-.1481--0960-0277. SSA collects the 
information on Form HA-520 from each claimant for Title II or Title XVI 
benefits who is dissatisfied with the hearing decision or the dismissal 
of a hearing request and wants to request review of the decision by the 
Appeals Council. An individual may request Appeals Council review by 
filing a written request. However, a completed HA-520 ensures that SSA 
receives the information necessary to establish that the claimant filed 
the request for review within the prescribed time, that the claimant is 
a proper party, and that the claimant has completed the requisite steps 
to permit review by the Appeals Council. The Appeals Council also uses 
the information provided by the claimant to document the claimant's 
reason(s) for disagreeing with the ALJ decision or dismissal, to 
determine whether the claimant has additional evidence to submit, and 
to determine whether the claimant has a representative or wants to 
appoint one.
    Type of Request: Extension of an approved OMB information 
collection.
    Number of Respondents: 107,485.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 17,914 hours.
    4. State Mental Institution Policy Review--20 CFR 416 subpart U, 20 
CFR 416 subpart F, 20 CFR 404.2035 and .2065, 20 CFR 416.635 and .665--
0960-0110. SSA sends Form SSA-9584-BK to State mental institutions that 
participate in SSA's representative payee onsite review program. As a 
representative payee, the State mental institution has the 
responsibility to receive and administer payments to beneficiaries who 
have been determined by SSA to be incapable of managing benefits. SSA 
is required by law and regulations to monitor representative payees' 
use of benefits. Under the onsite review program, SSA conducts a 
triennial review of State mental institutions in order to determine 
whether the institutions' policies and practices conform with SSA's 
regulations in the use of benefits, and the other duties and 
responsibilities required of representative payees.
    The form obtains information needed by the SSA review team 
(comprised of representatives from SSA's regional and field offices) 
and provides a basis for conducting the actual onsite review. In 
addition, the information is used in the preparation of the subsequent 
report of findings and recommendations, which is issued to the 
institutions.
    Type of Request: Extension of an approved OMB information 
collection.

[[Page 64802]]

    Number of Respondents: 100.
    Frequency of Response: 1.
    Average Burden Per Response: 60 minutes.
    Estimated Annual Burden: 100 hours.
    II. The information collections listed below have been submitted to 
OMB for clearance. Written comments and recommendations regarding the 
information collections should be submitted to the OMB Desk Officer and 
the SSA Reports Clearance Officer. In order for your comments to be 
considered, you must send them by December 8, 2004. You can obtain a 
copy of the OMB clearance package by calling the SSA Reports Clearance 
Officer at 410-965-0454, or by writing to the address listed above.
    1. Acknowledgement of Receipt (Notice of Hearing)--20 CFR 404.938 
and 416.1438--0960-0671. The information collected by form HA-504 is 
used by the Social Security Administration to process requests for 
hearings about unfavorable determinations of entitlement or eligibility 
to disability payments. Specifically, this form is used to acknowledge 
receipt of the notice of hearing issued by an Administrative Law Judge. 
The respondents are applicants for Title II disability payments who 
want to have a hearing to appeal an unfavorable entitlement or 
eligibility decision.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 670,000.
    Frequency of Response: 1.
    Average Burden Per Response: 1 minute.
    Estimated Annual Burden: 11,167 hours.
    2. Early Intervention Project/Employment Services Provider Survey/
0960-NEW.

Background

    The Employment Services Provider Survey is being conducted as part 
of a process demonstration authorized by the Ticket to Work and Work 
Incentives Improvement Act of 1999. The process demonstration, Early 
Intervention (EI), will provide employment services and supports to 
certain applicants for Social Security disability insurance.
    The purpose of the EI Project is to encourage applicants to begin 
the return to work process immediately after the onset of a disability. 
Many experts believe early intervention to be one of the most important 
factors in successful rehabilitation. Therefore, EI will immediately 
focus on a person's ability to work as opposed to proving they are 
unable to work as they do during the existing Title II disability 
determination process. The proposed process demonstration is necessary 
to test the instruments and procedures targeted towards these 
objectives.

The EI Survey

    Beginning in early 2005, EI will be piloted in three states. In New 
Mexico, EI will be piloted in the Albuquerque, Roswell/Carlsbad/Hobbs 
and Clovis areas. In Vermont, EI will be piloted throughout the entire 
state. In Wisconsin, EI will be piloted in the following counties: 
Green, Jefferson, Rock, Walworth, and Waukesha.
    Information collected through the EI survey will be used by SSA for 
the purposes of project design, implementation and evaluation. The 
information will assist in designing how linkages are formed between 
participants and providers for EI. SSA's EI project staff will use the 
information to identify appropriate employment service providers for 
project participants. Project evaluators will use the information 
collected from the survey as a baseline assessment of the provider 
market in each area. The respondents to the EI survey are employment 
service providers in the pilot states.
    Type of Request: New information collection.
    Number of Respondents: 150.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 75 hours.
    3. Request for Hearing by Administrative Law Judge--20 CFR 404.933 
and 416.1433, 42 CFR 405.722--0960-0269. The information collected by 
form HA-501 is used by SSA to process a request for a hearing on an 
unfavorable determination of entitlement or eligibility to benefits 
administered by SSA. The respondents are individuals whose claims for 
benefits are denied and who request a hearing to appeal the denial.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 667,236.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 111,206 hours.
    4. Contact with the Representative Payee and Contact with 
Beneficiary--0960-0639. SSA will use the SSA-L4945, Contact with the 
Representative Payee, and SSA-L4947, Contact with Beneficiary, to 
inform respondents and conduct quality reviews of payments made under 
the titles II and XVI programs. Cases for the review will be selected 
randomly and the information solicited will be used for verification of 
payment data on record in the claims folder and SSA's Master 
Beneficiary Record. Form SSA-L4945 will be used to notify 
Representative Payees who have the responsibility of managing payments 
for a beneficiary that the case has been selected for the review 
process and to request the required information. Form SSA-L4947 will be 
used to notify beneficiaries that their case has been selected for the 
review process and request the needed information. Both letters contain 
information that must be verified and returned to SSA under the review 
process. The respondents are beneficiaries and representative payees 
for beneficiaries receiving Title II and Title XVI benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 200.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 50 hours.
    5. Employer Report of Special Wage Payments--20 404.428-404.429--
0960-0565. SSA gathers the information on Form SSA-131 to prevent 
earnings-related overpayments to employees, and to avoid erroneous 
withholding of benefits. The respondents are employers who provide 
special wage payment verification.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 30,000.
    Frequency of Response: 1.
    Average Burden of Response: 20 minutes.
    Estimated Average Burden: 10,000 hours.
    6. Disability Hearing Officer's Report of Disability Hearing (DC)--
20 CFR 416.1407--0906-0507. The information collected on form SSA-1204-
BK is used by the Disability Hearing Officer (DHO) to conduct and 
document disability hearings, and to provide a structured format that 
covers all conceivable issues relating to Title XVI claims for disabled 
children. The completed SSA-1204-BK will aid the DHO in preparing the 
disability decision and will provide a record of what transpired in the 
hearing. The respondents are DHOs in the State Disability Determination 
Services.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 35,000.
    Frequency of Response: 1.
    Average Burden per Response: 60 minutes.
    Estimated Average Burden: 35,000 hours.
    7. Medical Report (Individual with Childhood Impairment)--20 CFR 
404.1512-404.1515, 20 CFR 416.912-

[[Page 64803]]

416.915--0960-0102. The information collected on Form SSA-3827 is 
needed to determine the claimant's physical and mental status prior to 
making a childhood disability determination. The respondents are 
medical sources.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 12,000.
    Frequency of Response: 1.
    Average Burden per Response: 30 minutes.
    Estimated Average Burden: 6,000 hours.
    8. RS/DI Quality Review Case Analysis: Sampled Number Holder, 
Auxiliaries/Survivors, Parents: Stewardship Annual Earnings Test 
Workbook--0960-0189. SSA uses the information collected by forms SSA-
2930, SSA-2931, and SSA-2932 to establish a national payment accuracy 
rate for all cases in payment status; to measure the accuracy rate for 
newly adjudicated claims for beneficiaries receiving old-age, 
survivors, or disability insurance; and to serve as a source of 
information regarding problem areas in the RSI/DI programs. Form SSA-
4569 is used to evaluate and determine the effectiveness of the annual 
earnings test and to use the results to develop ongoing improvements in 
the process. The respondents are beneficiaries and representative 
payees for beneficiaries receiving old age, survivors, or disability 
insurance.
    Type of Request: Extension of an OMB-approved information 
collection.

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                                                                                      Average
                                                     Number of     Frequency of     burden per       Estimated
                                                    respondents      response        response     annual  burden
                                                                                     (minutes)        (hours)
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SSA-2930........................................           3,000               1              30           1,500
SSA-2931........................................           1,500               1              30             750
SSA-2932........................................             650               1              20             217
SSA-4659........................................             325               1              10              54
                                                 -----------------
    Totals......................................           5,475  ..............  ..............           2,521
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    Total Estimated Annual Burden: 2,521 hours.

    Dated: November 2, 2004.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 04-24810 Filed 11-5-04; 8:45 am]
BILLING CODE 4191-02-P