Federal Register / Vol. 74, No. 159 / Wednesday, August 19, 2009 / Notices 41959 

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 (Pub. L.) 104–13, the 

Paperwork Reduction Act of 1995, 

effective October 1, 1995. This notice 

includes revisions and extensions of 

OMB-approved information collections 

and a new collection. 

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 the burden on respondents, 

including the use of automated 

collection techniques or other forms of 

information technology. Mail, email, or 

fax your comments and 

recommendations on the information 

collection(s) to the OMB Desk Officer 

and the SSA Director for Reports 

Clearance to the addresses or fax 

numbers shown below. 

(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: Director, Center for 

Reports Clearance, 1333 Annex 

Building, 6401 Security Blvd., 

Baltimore, MD 21235, Fax: 410–965– 

0454, E-mail address: 

OPLM.RCO@ssa.gov. 

The information collection below is 

pending at SSA. SSA will submit it 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 October 19, 2009. Individuals 

can obtain copies of the collection 

instrument by calling the SSA Director 

for Reports Clearance at 410–965–0454 

or by writing to the email address we 

list above. 

1. State Supplementation Provisions: 

Agreement; Payments—20 CFR 

416.2095–416.2098, 416.2099—0960– 

0240. Section 1618 of the Social 

Security Act contains pass-along 

provisions of the Social Security 

amendments. These provisions require 

states that supplement the Federal 

Supplemental Security Income (SSI) 

payments to pass along Federal cost-ofliving increases to individuals who are 

eligible for State supplemental 

payments. If a state fails to keep 

payments at the required level, it 

becomes ineligible for Medicaid 

reimbursement under Title XIX of the 

Social Security Act. SSA uses the 

information to determine a state’s 

eligibility for Medicaid reimbursement. 

Respondents are state agencies 

administering supplemental programs. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 23. 

Frequency of Response: 1. 

Average Burden per Response: 60 

minutes 

Estimated Annual Burden: 23 hours. 

2. Vocational Rehabilitation Provider 

Claim—20 CFR 404.2108(b), 

404.2117(c)(1)&(2), 404.2101(b)&(c), 

404.2121(a), 416.2208(b), 

416.2217(c)(1)&(2), 416.2201(b)&(c), 

416.2221(a)—0960–0310. SSA refers 

certain disability beneficiaries to state 

Vocational Rehabilitation (VR) agencies. 

The state VR agencies use the SSA–199 

to make claims for reimbursement of the 

costs they incur when providing VR 

services for the beneficiaries. SSA uses 

the information on the SSA–199 to 

determine whether or not, and how 

much, to pay the state VR agencies 

under SSA’s VR program. Respondents 

are state VR agencies who offer 

vocational and employment services for 

Social Security and SSI recipients. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 80. 

Type of response 

(as explained below) 

Number of 

respondents Frequency of response Total responses 

Average 

burden per 

response 

(minutes) 

Estimated 

annual 

burden 

hours 

a. SSA–199 (404.2108 & 416.2208) 80 160 each/year .................................. 12,800 23 4,907 

b. (404.2117 & 416.2217) ................. 80 1 per year ......................................... 80 60 80 

c. (404.2121 & 416.2221) ................. 80 2–3 per year ..................................... 200 100 333 

Total ........................................... ........................ ........................................................... 13,080 ........................ 5,320 

Estimated Annual Burden: 5,320 

hours. 

3. Uniform Administrative 

Requirements for Grants and 

Agreements with Institutions of Higher 

Learning, Hospitals and Other NonProfit Organizations—20 CFR 435— 

0960–0616. SSA’s regulations at 20 CFR 

435 of the Code of Federal Regulations 

provide SSA’s standards for 

administering grants and agreements it 

awards to institutions of higher 

learning, hospitals, and other non-profit 

and/or commercial organizations. The 

regulations discuss administrative 

guidelines and reporting, recordkeeping, 

and disclosure requirements for 

recipients of grants and agreements. 

SSA uses the information to monitor the 

progress and successful completion of 

funded projects. Respondents are 

recipients of grants and agreements with 

SSA. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 127. 

Section No. Number of 

respondents Frequency of response 

Average 

burden per 

response 

(hours) 

Estimated 

annual burden 

(hours) 

435.23 Rec-kp ................................................. 107 Monthly (12) ................................................... 1 1,284 

435.25 Rpt ...................................................... 127 Biannually (2) ................................................. 4 1,016 

435.51 Rpt ...................................................... 127 Quarterly (4) ................................................... 12 6,096 

435.53 Rec-kp ................................................. 127 Annually (1) .................................................... 8 1,016 

Total ......................................................... ........................ ......................................................................... ........................ 9,412 


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41960 Federal Register / Vol. 74, No. 159 / Wednesday, August 19, 2009 / Notices 

4. Ticket to Work Program Evaluation 

Survey (National Beneficiary Survey)— 

0960–0666. The 1999 Ticket to Work 

and Work (TTW) Incentives 

Improvement Act, Public Law 106–170, 

established the TTW program to create 

additional access to services for SSA 

beneficiaries through a new system of 

public and private Employment 

Network (EN) providers. The legislation 

also mandated an evaluation of the 

program. In February 2003, SSA began 

a multi-phase evaluation of this 

program. Although we originally 

planned to complete the final data 

collection wave by 2009, we decided to 

postpone the final evaluation until 2010 

because of significant changes in the 

TTW program in 2008 (such as changes 

to the way state VR agencies can 

provide services). In this request, we are 

seeking clearance for round four of the 

National Beneficiary Survey and two 

associated experiments (all three 

activities will use the same data). The 

respondents are Social Security 

beneficiaries and TTW enrollees. As 

with the previous three phases of this 

project, a contractor will conduct this 

study for SSA. 

Type of Collection: New information 

collection (reinstatement with 

revisions). 

Instrument 

Annual 

number of 

respondents 

Number of 

responses per 

respondent 

Average 

burden hours 

per response 

Estimated 

annual burden 

hours 

National Beneficiary Sample ........................................................................... 2,400 1 .750 1,800 

Ticket Participant Sample ................................................................................ 3,000 1 .917 2,751 

Grand Total—Burden for NBS 

Grand Total for All .................................................................................... 5,400 1 ........................ 4,551 

5. Special Benefits for Certain World 

War II Veterans—20 CFR 408, Subparts 

G, H, I, J & L—0960–0683. Title VIII of 

the Social Security Act, Special Benefits 

for Certain World War II Veterans (SVB), 

allows, under certain circumstances, the 

payment of SVB to qualified veterans 

who reside outside the United States. 

The accompanying regulations set out 

the requirements an individual must 

meet to establish continuing eligibility 

to, and insure correct payment amount 

of, SVB and/or state recognition 

payments. Additionally, they provide 

requirements that a state must meet to 

elect, modify, or terminate a Federal 

agreement. For those information 

collection requests (ICR) cleared 

through SSA forms, the public reporting 

burden is accounted for in the ICRs for 

the various forms. A 1-hour placeholder 

* burden is assigned to those specific 

reporting requirements contained in the 

rule. The respondents are individuals 

who receive Title VIII SVB, and/or 

states that elect Federal administration 

of their recognition payments. 

Type of Request: Extension of an 

OMB-approved information collection. 

Section No. Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated 

annual burden 

(hours) 

§ 408.704–.714 ................................................................................................ 1 ........................ ........................ *1 

§ 408.802(b) ..................................................................................................... 5 1 15 1 

§ 408.814 ......................................................................................................... 5 1 15 1 

§ 408.820(c) ..................................................................................................... 5 1 15 1 

§ 408.923(b) ..................................................................................................... 1 ........................ ........................ *1 

§ 408.931(b) & § 408.932(d) ............................................................................ 1 ........................ ........................ *1 

§ 408.932(c) ..................................................................................................... 2 1 15 1 

§ 408.932(e) ..................................................................................................... 2 1 15 1 

§ 408.941(b) & § 408.942 ................................................................................. 2 1 15 1 

§ 408.944(a) ..................................................................................................... 2 1 30 1 

§ 408.1000(a) ................................................................................................... 1 ........................ ........................ *1 

Total .......................................................................................................... 27 ........................ ........................ 11 

6. Certificate of Incapacity—5 CFR 

890.302(d)—0960–0739. Rules 

governing the Federal Employee Health 

Benefits (FEHB) plan require that the 

physician verify disability of Federal 

employees’ children ages 22 and over to 

retain health benefits under the 

employees’ plans. The physician must 

verify that the adult child has a 

disability that meets the following 

criteria: (1) Pre-dates the child’s 22nd 

birthday; (2) is very serious; and (3) can 

be expected to last at least one year. 

Physicians use Form SSA–604, the 

Certificate of Incapacity, to document 

and certify the disability of children 

ages 22 and over whose parents are SSA 

employees. SSA uses the information to 

determine adult children’s (age 22 and 

above) eligibility for coverage under a 

parent’s FEHB plan. The respondents 

are physicians of SSA employees’ 

children ages 22 or over who are seeking 

to retain health benefits under their 

parent’s FEHB coverage. 

Type of Request: New information 

collection. 

Number of Respondents: 50. 

Frequency of Response: 1. 

Average Burden per Response: 45 

minutes. 

Estimated Annual Burden: 38 hours. 

7. Representative Payment Policies 

and Administrative Procedures for 

Imposing Penalties for False or 

Misleading Statements or Withholding 

of Information—0960–0740. This 

information collection request 

comprises several regulation sections 

that provide additional safeguards for 

Social Security beneficiaries whose 

representative payees receive their 

payments. Representative payees are 

required to notify SSA of any event or 

change in circumstances that would 

affect receipt of benefits or performance 

of payee duties. SSA uses the 

information to determine continued 

eligibility for benefits, the amount of 

benefits due and if the payee is suitable 

to continue serving as payee. The 


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Federal Register / Vol. 74, No. 159 / Wednesday, August 19, 2009 / Notices 41961 

respondents are representative payees 

who receive and use benefits on behalf 

of Social Security beneficiaries. 

Type of Collection: Extension of an 

OMB-approved information collection. 

Regulation section Number of 

respondents 

Completion time 

(hours) 

Burden 

(hours) 

404.2035(d) ................................................................................................................ 550,000 .083 45,650 

404.2035(f) ................................................................................................................. 5,500 .083 457 

416.635(d) .................................................................................................................. 300,000 .083 24,900 

416.635(f) ................................................................................................................... 3,000 .083 249 

Total .................................................................................................................... 858,500 .............................. 71,256 

II. SSA has submitted the information 

collections we list 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 September 18, 2009. You 

can obtain a copy of the OMB clearance 

packages by calling the SSA Director for 

Reports Clearance at 410–965–0454 or 

by writing to the above email address. 

1. Medicare Part B Income-Related 

Premium—Life-Changing Event Form 

0960–0735. Per the Medicare 

Modernization Act of 2003, selected 

recipients of Medicare Part B insurance 

pay an income-related monthly 

adjustment amount (IRMAA). The 

Internal Revenue Service uses income 

tax return data to determine the amount 

of the IRMAA. SSA uses Form SSA–44 

to determine if a recipient qualifies for 

a reduction in IRMMA. If affected 

Medicare Part B recipients believe more 

recent tax data should be used because 

a life-changing event has occurred that 

significantly reduces his/her income, 

they can report these changes to SSA 

and ask for a new initial determination 

of his/her IRMAA. The respondents are 

Medicare Part B recipients who have a 

modified adjusted gross income over a 

high-income ‘‘threshold.’’ 

Note: This is a correction notice. SSA 

published this information collection as an 

extension on June 25, 2009, at 74 FR 30353. 

Since we are revising the Privacy Act 

Statement, this is now a revision of an OMBapproved information collection. 

Type of Request: Revision of an OMBapproved information collection. 

Method of information collection Number of 

respondents 

Frequency of 

response 

Average burden 

per response 

(minutes) 

Estimated annual 

burden 

(hours) 

Personal Interview ................................................................... 128,000 1 30 64,000 

Form ......................................................................................... 32,000 1 45 24,000 

Totals ................................................................................ 160,000 .............................. .............................. 88,000 

Dated: August 14, 2009. 

Elizabeth A. Davidson, 

Director, Center for Reports Clearance, Social 

Security Administration. 

[FR Doc. E9–19905 Filed 8–18–09; 8:45 am] 

BILLING CODE 4191–02–P 

SOCIAL SECURITY ADMINISTRATION 

[Docket No. SSA–2009–0018] 

Privacy Act of 1974, as Amended; 

Computer Matching Program (Social 

Security Administration/Department of 

the Treasury, Internal Revenue Service 

(SSA/IRS))—Match Number 1310 

AGENCY: Social Security Administration 

(SSA). 

ACTION: Notice of renewal of an existing 

computer matching program scheduled 

to expire on October 3, 2009. 

SUMMARY: In accordance with the 

Privacy Act, as amended, this notice 

announces renewal of an existing 

computer matching program that we are 

currently conducting with IRS. 

DATES: We will file a report of the 

subject matching program with the 

Committee on Homeland Security and 

Governmental Affairs of the Senate; the 

Committee on Oversight and 

Government Reform of the House of 

Representatives, and the Office of 

Information and Regulatory Affairs, 

Office of Management and Budget 

(OMB). Renewal of the matching 

program will be effective as indicated 

below. 

ADDRESSES: Interested parties may 

comment on this notice by either 

telefaxing to (410) 965–0201 or writing 

to the Deputy Commissioner for Budget, 

Finance and Management, 800 Altmeyer 

Building, 6401 Security Boulevard, 

Baltimore, MD 21235–6401. All 

comments received will be available for 

public inspection at this address. 

FOR FURTHER INFORMATION CONTACT: The 

Deputy Commissioner for Budget, 

Finance and Management as shown 

above. 

SUPPLEMENTARY INFORMATION: 

A. General 

The Computer Matching and Privacy 

Protection Act of 1988 (Pub. L. 100– 

503), amended the Privacy Act (5 U.S.C. 

552a) by describing the conditions 

under which computer matching 

involving federal agencies could be 

performed and adding certain 

protections for persons applying for, 

and receiving, federal benefits. Section 

7201 of the Omnibus Budget 

Reconciliation Act of 1990 (Pub. L. 101– 

508) further amended the Privacy Act 

regarding protections for such persons. 

The Privacy Act, as amended, 

regulates the use of computer matching 

by federal agencies when records in a 

system of records are matched with 

other federal, state, or local government 

records. It requires federal agencies 

involved in computer matching 

programs to: 

(1) Negotiate written agreements with 

other agencies participating in the 

matching programs; 

(2) Obtain approval of the matching 

agreement by the Data Integrity Boards 

of the participating federal agencies; 


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