[Federal Register Volume 72, Number 77 (Monday, April 23, 2007)]
[Notices]
[Pages 20154-20158]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E7-7649]


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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 P.L. 104-13, 
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 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)

[[Page 20155]]

should be submitted to the OMB Desk Officer and the SSA Reports 
Clearance Officer. The information can be mailed, faxed or e-mailed to 
the individuals at the addresses and fax numbers listed below:

(OMB), Office of Management and Budget, Attn: Desk Officer for SSA, 
Fax: 202-395-6974, E-mail address: <a href="/cdn-cgi/l/email-protection#d6999f84978985a3b4bbbfa5a5bfb9b896b9bbb4f8b3b9a6f8b1b9a0"><span class="__cf_email__" data-cfemail="91ded8c3d0cec2e4f3fcf8e2e2f8feffd1fefcf3bff4fee1bff6fee7">[email protected]</span></a>.
(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: <a href="/cdn-cgi/l/email-protection#622d322e2f4c30212d221111034c050d14"><span class="__cf_email__" data-cfemail="145b4458593a46575b546767753a737b62">[email protected]</span></a>.

    I. The information collections listed below are 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 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. Request for Program Consultation--20 CFR 404.1601--1661-0960-
New. The Disability Determination Services (DDS) offices are staffed by 
State employees who perform disability determinations for applicants 
for Social Security disability benefits under Title II and Title XVI of 
the Social Security Act.
    SSA's federal regional quality assurance office has the authority 
to review DDS determinations, to assess errors, and to return cases for 
corrective action by the DDS.
    The information collected on the Request for Program Consultation 
(RPC) will be used by the DDS's that request a review of the regional 
quality assurance evaluations. The DDS's use the RPC to present their 
rationale that supports their determinations. The information collected 
includes a short rationale and policy citations supporting their 
rebuttal. The RPC team will use the information to reassess their 
initial determination.
    The respondents are DDS's who request a review of the regional 
quality assurance determination.
    Type of Request: Request for a new information collection.
    Number of Respondents: 4500.
    Frequency of Response: 1.
    Average Burden Per Response: 50 minutes.
    Estimated Annual Burden: 3750 hours.
    2. Request to Decision Review Board To Vacate the Administrative 
Law Judge Dismissal of Hearing--20 CFR 405.427--0960-NEW. The 
information collected on Form SSA-525 will be used by Social Security 
Administration's Decision Review Board (Board) when a hearing on a 
claim for Title II or Title XVI disability payments is dismissed and 
the claimant requests that the dismissal be vacated. The Board will use 
this information to (1) establish the continued involvement of the 
requester in his or her claim;
    (2) consider the requester's arguments for vacating the dismissal; 
and (3) vacate or decline to vacate the administrative law judge's 
dismissal order. The respondents are Social Security disability or 
Supplemental Security Income (SSI) claimants who are requesting that 
the dismissal be vacated.
    Type of Request: Request for a new information collection.
    Number of Respondents: 30,000.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 5,000 hours.
    3. Medical History and Disability Report, Disabled Child--20 CFR 
416.912--0960-0577. The Social Security Act requires claimants to 
furnish medical and other evidence to prove they are disabled. The form 
SSA-3820 is used to obtain various types of information about a child's 
condition, his/her treating sources and/or other medical sources of 
evidence. The information collected on the SSA-3820 is needed for the 
determination of disability by the State DDSs. The respondents are 
applicants for Title XVI (SSI) child disability benefits.
    Type of Request: Revision to an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Frequency of     burden per       Estimated
                Collection format                   respondents      responses       responses     annual burden
                                                                                      (hours)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3820 (Paper Form)...........................             500               1               1             500
Electronic Disability Collection System (EDCS)..         422,000               1          \1\ 34         239,133
i3820 (Internet)................................          39,500               1               2          79,000
                                                 ---------------------------------------------------------------
    Totals......................................         462,000  ..............  ..............        318,633
----------------------------------------------------------------------------------------------------------------
1 Minutes.

    4. Social Security Disability Report--20 CFR 404.1512 & 416.912--
0960-0579. The Social Security Administration requires applicants for 
disability payments to furnish medical, work history, and other 
evidence or information indicating they have an impairment which is 
disabling. This information is collected by form SSA-3368, the Adult 
Disability Report, and is used by State DDS's to make disability 
determinations for SSA.
    The respondents are applicants for Title II and Title XVI 
disability benefits. These applicants may complete the form using any 
of the following modalities: (1) The traditional paper form; (2) an 
interview with an SSA field office representative, using the Electronic 
Disability Collection System (EDCS); (3) the Internet (i3368); and (4) 
a modality, the i3368-PRO, an Internet form designed to be completed by 
representatives of applicants for disability payments. The latter three 
versions of the form collect the same information as the paper form, 
but may be formatted differently and include certain enhancements (ex: 
self-help screens) to guide the claimant or interviewer through the 
application process.
    Type of Request: Revision to an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Frequency of     burden per       Estimated
                Collection format                   respondents      response        response      annual burden
                                                                                      (hours)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3368 (Paper version)........................           9,364               1               1           9,364

[[Page 20156]]

 
Field office/Electronic Disability Collection          3,138,920               1               1       3,138,920
 System (EDCS)..................................
i3368 (Internet version; Hour burden varies from         101,135               1          2\1/2\         252,837
 1\1/2\-3 hours, depending on information
 required)......................................
i3368-PRO.......................................         101,135               1          1\1/2\         151,702
                                                 ---------------------------------------------------------------
    Totals......................................       3,350,554  ..............  ..............       3,552,823
----------------------------------------------------------------------------------------------------------------

    5. Certification of Contents of Document(s) or Record(s)--20 CFR 
404.715 ff-0960-689. SSA must secure evidence necessary for individuals 
to establish rights to benefits. Some of the types of evidence needed 
are evidence of age relationship, citizenship, marriage, death, and 
military service. Form SSA-704 allows SSA employees, state record 
custodians, and other custodians of evidentiary documents to record 
information from documents and records to establish these types of 
evidence. SSA employees use this form but it is also used by state 
record custodians and other custodians of evidentiary documents.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 4,800.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 800.
    6. Waiver of Your Right to Personal Appearance before an 
Administrative Law Judge--20 CFR 404.948(b)(l)(i) and 416.1448(b)(l)(i) 
-0960-0284. Each claimant has a statutory right to appear in person (or 
through a representative) and present evidence about his/her claim at a 
hearing before an Administrative Law Judge (ALJ). If a claimant wishes 
to waive his/her statutory right to appear before an ALJ, he/she must 
complete a written request. The claimant may use Form HA-4608 for this 
request. The information collected is used to document an individual's 
claim to show that an oral hearing is not preferred in the appellate 
process. The respondents are applicants for Title II benefits and Title 
XVI payments who request a hearing.
    Number of Respondents: 12,000.
    Frequency of Response: 1.
    Average Burden per Response: 2 minutes.
    Estimated Annual Burden: 400 hours.
    7. Youth Transition Process Demonstration Evaluation Data 
Collection-0960-0687.

Background

    The Youth Transition Demonstration (YTD) projects are intended to 
help young people with disabilities make the transition from school to 
work. By waiving certain disability program rules and offering services 
to youth who are either receiving disability benefits or at risk of 
receiving them, these projects are expected to encourage youth to work 
and/or continue their education. YTD projects will be fully implemented 
in 10 sites across the country. The evaluation will produce empirical 
evidence on the impacts of the waivers and project services not only on 
educational attainment, employment, earnings, and receipt of benefits 
by youth with disabilities but also on the Social Security Trust Fund 
and federal income tax revenues. This type of project is authorized by 
sections 1110 and 234 of the Social Security Act.

Project Description

    Given the importance of estimating YTD impacts as accurately as 
possible, the evaluation will be conducted using rigorous analytic 
methods based on the random assignment of youth to a treatment or 
control group. Several data collection efforts are planned. These 
include (1) baseline interviews with youth and their parents or 
guardians prior to random assignment; (2) follow-up interviews at 12 
and 36 months after random assignment; (3) interviews and/or roundtable 
discussions with local program administrators, program supervisors, and 
service delivery staff; and (4) focus groups of youth, their parents, 
and service providers. The respondents will be youths with disabilities 
who have enrolled in the project, their parents or guardians, program 
staff, and service providers.
    Type of Request: Revision of an existing OMB Clearance.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Responses per    burden per    Total response
     Data collection year          Collection       respondents     respondent       response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
2007..........................  Baseline........             962               1              33             529
                                12 month follow-             437               1              50             364
                                 up.
                                Focus group.....             140               1              90             210
                                Program staff/                32               1              60              32
                                 service
                                 provider.
                                                 ---------------------------------------------------------------
    Total 2007................  ................  ..............  ..............  ..............           1,135
----------------------------------------------------------------------------------------------------------------

    8. Annual Registration Statement Identifying Separated Participants 
With Deferred Benefits, Schedule SSA--0960-0606. Schedule SSA is a form 
filed annually as part of a series of pension plan documents required 
by section 6057 of the IRS Code. Administrators of pension benefit 
plans are required to report specific information on future plan 
benefits for those participants who left plan coverage during the year. 
SSA maintains the information until a claim for Social Security 
benefits has been approved. At that time, SSA notifies the beneficiary 
of his/her potential eligibility for payments from the private pension 
plan. The respondents are administrators of pension benefit plans or 
their service providers employed to prepare the Schedule SSA on behalf 
of the pension benefit plan. Below are the estimates of the cost and 
hour burdens for completing and filing Schedule SSA(s). We have used an 
average to estimate the hour burden. However, the burden may be greater 
or smaller depending on whether the respondent is a large or small 
pension benefit plan and how

[[Page 20157]]

many Schedule SSA's are filed in a given year.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 88,000.
    Frequency of Response: 1.
    Average Burden per Response: 2.5 hours.
    Estimated Annual Burden: 220,000 hours.
    Estimated Annual Cost Burden for All Respondents: $12,194,400.
    II. The information collections listed below have been submitted to 
OMB for clearance. Your comments on the information collections would 
be most useful if received by OMB and SSA within 30 days from the date 
of this publication. You can obtain a copy of the OMB clearance 
packages by calling the SSA Reports Clearance Officer at 410-965-0454, 
or by writing to the address listed above.
    1. Application for Benefits under the Italy-U.S. International 
Social Security Agreement--20 CFR 404.19250--960-0445. The United 
States and Italy entered into an agreement on November 1, 1978. Article 
19.2 of that agreement provides that an applicant for benefits can file 
his application with either country. Article 4.3 of the Protocol to the 
Agreement provides that the country that receives the application will 
forward agreed upon forms and applications to the other country. Form 
SSA-2528 is the form agreed upon that is completed by individuals who 
file an application for U.S. benefits directly with one of the Italian 
Social Security Agencies. The information collected on Form SSA-2528 is 
required by SSA in order to determine entitlement to benefits. The 
respondents are applicants for old-age, survivors or disability 
benefits, who reside in Italy.
    Type of Request: Extension of an OMB-approved information 
collection
    Number of Respondents: 200.
    Frequency of Response: 1.
    Average Burden per Response: 20 minutes.
    Estimated Annual Burden: 67 hours.
    2. Physician's/Medical Officer's Statement of Patient's Capability 
to Manage Benefits--20 CFR 404.2015 & 416.615--0960-0024. The 
information collected on the SSA-787 is used to determine whether an 
individual is capable of handling his or her own benefits. This 
information is also used for leads in selecting a representative payee, 
if needed. The respondents are physicians of the beneficiaries or 
medical officers of the institution in which the beneficiaries reside.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 120,000.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 20,000 hours.
    3. Modified Benefit Formula Questionnaire--Foreign Pension--0960-
0561. The information collected on the SSA-308 is used to determine 
exactly how much (if any) of a foreign pension may be used to reduce 
the amount of Social Security retirement or disability benefits under 
the modified benefit formula. The respondents are applicants for Social 
Security retirement or disability benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 50,000.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 8,333 hours.
    4. Social Security Benefits Applications--20 CFR Subpart D, 
404.310-404.311 and 20 CFR Subpart F, 404.601-401.603--0960-0618. One 
of the requirements for obtaining Social Security benefits is the 
filing of an application so that a determination may be made on the 
applicant's eligibility for monthly benefits. In addition to the 
traditional paper application, SSA has developed various options, 
listed below, for the public to add convenience and operational 
efficiency to the application process. The total estimated number of 
respondents to all application collections formats is 3,843,369 with a 
cumulative total of 963,056 burden hours. The respondents are 
applicants for retirement insurance benefits (RIB), disability 
insurance benefits (DIB), and/or spouses' benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Internet Social Security Benefits Application (ISBA)
    ISBA, which is available through SSA's Internet site, is one method 
that an individual can choose to file an application for benefits. 
Individuals can use ISBA to apply for retirement insurance benefits 
(RIB), disability insurance benefits (DIB) and spouse's insurance 
benefits based on age. SSA gathers only information relevant to the 
individual applicant's circumstances and will use the information 
collected by ISBA to entitle individuals to RIB, DIB, and/or spouses' 
benefits. The respondents are applicants for RIB, DIB, and/or spouses 
benefits.
    Number of Respondents: 169,000.
    Frequency of Response: 1.
    Average Burden per Response: 20.4 minutes.
    Estimated Annual Burden: 57,460 hours.

Paper Application Forms

Application for Retirement Insurance Benefits (SSA-1)

    The SSA-1 is used by SSA to determine an individual's entitlement 
to RIB. In order to receive Social Security RIB, an individual must 
file an application with SSA. The SSA-1 is one application that the 
Commissioner of Social Security prescribes to meet this requirement. 
The information that SSA collects will be used to determine entitlement 
to benefits. The respondents are individuals who choose to apply for 
Social Security RIB using the paper application.
    Approximately 1,460,692 respondents complete the SSA-1 annually. Of 
this total 97% (1,416,871) are completed through SSA's Modernized 
Claims System (MCS) and 50% of the MCS respondents will use Signature 
Proxy (708,435.5). The breakdown is displayed on the following chart.

----------------------------------------------------------------------------------------------------------------
                                                                                     Estimated
                                                                     Number of      completion
                        Collection method                           respondents        time        Burden hours
                                                                                     (minutes)
----------------------------------------------------------------------------------------------------------------
MCS.............................................................         708,436            10.5         123,976
MCS/Signature Proxy.............................................         708,435             9.5         112,169
Paper...........................................................          43,821            10.5           7,669
                                                                 -----------------------------------------------
    Totals......................................................       1,460,692  ..............         243,814
----------------------------------------------------------------------------------------------------------------


[[Page 20158]]

Application for Wife's or Husband's Insurance Benefits (SSA-2)

    SSA uses the information collected on Form SSA-2 to determine if an 
applicant (including a divorced applicant) can be entitled to benefits 
as the spouse of the worker and the amount of the spouse's benefits. 
The respondents are applicants for wife's or husband's benefits, 
including those who are divorced.
    Approximately 700,000 respondents complete the SSA-2 annually. Of 
this total 95% (665,000) are completed through MCS and 50% of the MCS 
respondents will use Signature Proxy (332,500). The breakdown is 
displayed on the following chart:

----------------------------------------------------------------------------------------------------------------
                                                                                     Estimated
                                                                     Number of      completion
                        Collection method                           respondents        time        Burden hours
                                                                                     (minutes)
----------------------------------------------------------------------------------------------------------------
MCS.............................................................         332,500              15          83,125
MCS/Signature Proxy.............................................         332,500              14          77,583
Paper...........................................................          35,000              15           8,750
                                                                 -----------------------------------------------
    Totals......................................................         700,000  ..............         169,458
----------------------------------------------------------------------------------------------------------------

Application for Disability Insurance Benefits (SSA-16)

    Form SSA-16-F6 obtains the information necessary to determine 
whether the provisions of the Act have been satisfied with respect to 
an applicant for disability benefits, and detects whether the applicant 
has dependents who would qualify for benefits on his or her earnings 
record. The information collected on form SSA-16 helps to determine 
eligibility for Social Security disability benefits. The respondents 
are applicants for Social Security disability benefits.
    Approximately 1,513,677 respondents complete the SSA-16 annually. 
Of this total 97% (1,468,267) are completed through SSA's Modernized 
Claims System (MCS) and 50% of the MCS respondents will use Signature 
Proxy (734,133.5). The breakdown is displayed on the following chart:

----------------------------------------------------------------------------------------------------------------
                                                                                     Estimated
                                                                     Number of      completion
                        Collection method                           respondents        time        Burden hours
                                                                                     (minutes)
----------------------------------------------------------------------------------------------------------------
MCS.............................................................         734,134              20         244,711
MCS/Signature Proxy.............................................         734,133              19         232,476
Paper...........................................................          45,410              20          15,137
                                                                 -----------------------------------------------
    Totals......................................................       1,513,677  ..............         492,324
----------------------------------------------------------------------------------------------------------------


    Dated: April 17, 2007.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. E7-7649 Filed 4-20-07; 8:45 am]
BILLING CODE 4191-02-P


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