[Federal Register Volume 65, Number 126 (Thursday, June 29, 2000)]
[Notices]
[Pages 40151-40152]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-16407]


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SOCIAL SECURITY ADMINISTRATION


Agency Information Collection Activities: Proposed Request and 
Comment Request

    In compliance with Public Law 104-13, the Paperwork Reduction Act 
of 1995, SSA is providing notice of its information collections that 
require submission to the Office of Management and Budget (OMB). 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.
    I. The information collections listed below will be submitted to 
OMB within 60 days from the date of this notice. Therefore, comments 
and recommendations regarding the information collections would be most 
useful if received by the Agency within 60 days from the date of this 
publication. Comments should be directed to the SSA Reports Clearance 
Officer at the address listed at the end of this publication. You can 
obtain a copy of the collection instruments by calling the SSA Reports 
Clearance Officer on (410) 965-4145, or by writing to him at the 
address listed at the end of this publication.
    1. Application for Lump Sum Death Payment--0960-0013. The 
information collected on form SSA-8 by the Social Security 
Administration is required to authorize payment of a lump-sum death 
benefit to a widow, widower, or children as defined in Section 202(i) 
of the Social Security Act. The respondents are widows, widowers or 
children who apply for a lump-sum death payment.

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Number of respondents.......................................     43,850
Frequency of response.......................................          1
Average burden per response.................................   10 mins.
Estimated annual burden.....................................  7308 hrs.
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    2. Application for Special Age 72-or-Over Monthly Payments--0960-
0096. Form SSA-19-F6 is needed by the Social Security Administration 
(SSA) to determine whether an individual is entitled to Special Age-72 
payments. Eligibility requirements will be evaluated by the data 
collected on this form. The respondents are individuals who attained 
age 72 before 1972.

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Number of respondents.......................................         10
Frequency of response.......................................          1
Average burden per response.................................   20 mins.
Estimated annual burden.....................................     3 hrs.
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    3. Request for Self-Employment Information, Request for Employee 
Information, Request for Employer Information--0960-0508. SSA needs the 
information collected on Forms SSA-L2765, SSA-L3365 and SSA-L4002 in 
order to credit the reported earnings to the proper earnings record. 
When W-2 wage data for an individual cannot be identified, the data are 
placed in the earnings suspense file, and SSA sends decentralized 
correspondence (DECOR) to the employee (in certain instances to the 
employer) in an attempt to obtain his/her correct name and SSN. The 
respondents are employees, employers or self-employed individuals being 
requested to furnish additional information for individuals for whom 
earnings were reported.

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Number of respondents.....................................    3,000,000
Frequency of response.....................................            1
Average burden per response...............................     10 mins.
Estimated annual burden...................................  500,000 hrs.
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    4. State Agency Report of Obligations for SSA Disability Programs--
0960-0421. The data collected on Form SSA-4513 are necessary for 
detailed analysis and evolution of costs incurred by Disability 
Determination Services (DDS) in making disability determinations for 
SSA. The data collected also help to

[[Page 40152]]

determine funding levels for each DDS. The respondents are DDSs, which 
are the State agencies that have the responsibility for making 
disability determinations for SSA.

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Number of respondents.......................................         54
Frequency of response.......................................          4
Average burden per response.................................    60 mins
Estimated annual burden.....................................    216 hrs
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    5. Statement For Determining Continuing Eligibility or Supplemental 
Security Income Payments--0960-0416. Form SSA-8203-BK (printed in both 
English and Spanish) is used by SSA for high-error-profile (HEP) 
redeterminations. It is completed in field offices by personal contact 
(face-to-face or telephone interview) and is not supposed to be mailed 
to recipients to be completed and returned. The form is used only when 
a systems limitation prevents the interview from being conducted using 
the automated Modernized SSI Claim System. A tear-off sheet (Pages 7 
and 8 of the form) is given to recipients at the conclusion of a face-
to-face interview or is mailed to recipients at the completion of the 
telephone interview. The tear-off includes information about how, what, 
when, where, and why Supplemental Security Income (SSI) recipients 
report when there is a change in income, resources, or living 
arrangements. The respondents are recipients of title XVI SSI benefits.

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Number of respondents.....................................      920,000
Frequency of response.....................................            1
Average burden per response...............................      17 mins
Estimated annual burden...................................  260,667 hrs
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    II. The information collections listed below have been submitted to 
OMB for clearance. Written comments and recommendations on the 
information collections would be most useful if received within 30 days 
from the date of this publication. Comments should be directed to the 
SSA Reports Clearance Officer and the OMB Desk Officer at the addresses 
listed at the end 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.
    1. Supplement to Claim of Person Outside the United States--0960-
0051. The information collected on Form SSA-21 is used by the Social 
Security Administration (SSA) to determine continuing entitlement to 
Social Security benefits and the proper benefit amounts of alien 
beneficiaries living outside the United States (U.S.). It is also used 
to determine whether benefits are subject to withholding tax. The 
respondents are comprised of individuals entitled to Social Security 
benefits, who are, will be, or have been residing outside the U.S.

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Number of respondents.......................................     35,000
Frequency of response.......................................          1
Average burden per response.................................     5 mins
Estimated annual burden.....................................  2,917 hrs
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    2. Statement of Care and Responsibility for Beneficiary--0960-0109. 
SSA uses Form SSA-788 to select the most qualified representative payee 
who will apply the benefits in the beneficiary's best interests. The 
respondents are individuals who have custody of a beneficiary where 
someone else has filed to be the beneficiary's payee.

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Number of respondents.....................................      130,000
Frequency of response.....................................            1
Average burden per response...............................      10 mins
Estimated annual burden...................................   21,667 hrs
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    (SSA Address)--Social Security Administration, DCFAM, Attn: 
Frederick W. Brickenkamp, 6401 Security Blvd., 1-A-21 Operations Bldg., 
Baltimore, MD 21235.
    (OMB Address)--Office of Management and Budget, OIRA, Attn: Desk 
Officer for SSA, New Executive Office Building, Room 10230, 725 17th 
St., NW, Washington, DC 20503.

    Dated: June 23, 2000.
Frederick W. Brickenkamp,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 00-16407 Filed 6-28-00; 8:45 am]
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