[Federal Register Volume 72, Number 89 (Wednesday, May 9, 2007)]
[Notices]
[Pages 26443-26446]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E7-8804]


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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, 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

[[Page 26444]]

regarding the information collection(s) 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#531c1a01120c0026313e3a20203a3c3d133c3e317d363c237d343c25"><span class="__cf_email__" data-cfemail="b1fef8e3f0eee2c4d3dcd8c2c2d8dedff1dedcd39fd4dec19fd6dec7">[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#b3fce3fffe9de1f0fcf3c0c0d29dd4dcc5"><span class="__cf_email__" data-cfemail="2768776b6a097564686754544609404851">[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. Representative Payee Evaluation Report--20 CFR 404.2065 & 
416.665--0960-0069. Sections 205(j) and 1631(a)(2) of the Social 
Security Act provide that a representative payee may be appointed to 
receive benefits on behalf of an individual entitled to Title II and/or 
Title XVI benefits when that individual is unable to manage or direct 
the management of those funds by themselves. The representative payee 
is required to report to SSA at least once per year on how those funds 
received have been used or conserved. When a representative payee fails 
to adequately report to SSA as required, SSA will conduct a face-to-
face interview with the payee to complete an SSA-624, Representative 
Payee Evaluation Report, in order to determine the continued 
suitability of the representative payee to serve as a payee. The 
respondents are individuals and organizations who act as representative 
payees for Title II and Title XVI benefits who fail to comply with 
SSA's statutory annual reporting requirement.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 252,000.
    Frequency of Response: 1.
    Average Burden per Response: 30 minutes.
    Estimated Annual Burden: 126,000 hours.
    2. Request for Change in Time/Place of Disability Hearing--20 CFR 
404.914(c)(2) and 416.1414(c)(2)--0960-0348. The information on Form 
SSA-769 is used by SSA and the State Disability Determination Services 
(DDS) to provide claimants with a structured format to exercise their 
right to request a change in time or place of a scheduled disability 
hearing. The information will be used as a basis for granting or 
denying requests for changes and for rescheduling disability hearings. 
Respondents are claimants who wish to request a change in the time and/
or place of their hearing.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 7,483.
    Frequency of Response: 1.
    Average Burden Per Response: 8 minutes.
    Estimated Annual Burden: 998 hours.
    3. Agency/Employer Government Pension Offset Questionnaire--20 CFR 
404.408(a)--0960-0470. The information collected by form SSA-4163 will 
provide SSA with accurate information from the agency paying the 
pension, for purposes of applying the pension-offset provision. The 
form will be used only when (1) the claimant does not have the 
information and (2) the pension-paying agency has not cooperated with 
the claimant. Respondents are Federal and State Government agencies 
which have information needed by SSA to determine if the GPO applies 
and the amount of offset.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 1000.
    Frequency of Response: 1.
    Average Burden Per Response: 3 minutes.
    Estimated Annual Burden: 50 hours.
    4. Child Care Dropout Questionnaire--20 CFR 404.211(e)(4)--0960-
0474. Information collected on this form is ed by SSA to determine if 
an individual qualifies for a child care exclusion in computing the 
individual's disability benefit amount. Respondents are applicants for 
disability benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 2000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 167 hours.
    5. Statement for Determining Continuing Eligibility for 
Supplemental Security Income Payments--Adult, Form SSA-3988; Statement 
for Determining Continuing Eligibility for Supplemental Security Income 
Payments--Child, Form SSA-3989--20 CFR Subpart B--416.204--0960-0643.
    Forms SSA-3988 and SSA-3989 will be used to determine whether SSI 
recipients have met and continue to meet all statutory and regulatory 
non-medical requirements for Supplemental Security Income eligibility, 
and whether they have been and are still receiving the correct payment 
amount. The SSA-3988 and SSA-3989 are designed as self-help forms that 
will be mailed to recipients or to their representative payees for 
completion and return to SSA. The respondents are recipients of SSI 
payments or their representatives.
    Type of Request: Revisions to an existing OMB information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                                     Estimated
              Collection instrument                 Respondents    Frequency of   Average burden   annual burden
                                                                     response      per response       (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3988........................................          30,000               1         26 min.          13,000
SSA-3989........................................          30,000               1         26 min.          13,000
    Totals......................................          60,000  ..............  ..............          26,000
----------------------------------------------------------------------------------------------------------------

    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. Treating Physician Consultative Examination Interest Form--20 
CFR 404.1519g-i--0960-NEW. The individual's treating physician (TP) is 
the preferred source to perform a consultative examination (CE). SSA 
uses the SSA-84 to ascertain whether the TP is interested in performing 
the CE. This form is sent to the claimant's treating physician along 
with the medical evidence of record request letter. If the treating 
physician is interested in performing the CE, he or she indicates

[[Page 26445]]

interest by completing the SSA-84 and returning it to SSA. If the form 
is not returned, SSA assumes that the TP is not interested in 
performing the CE. Respondents are the claimants' treating physicians.
    Type of Request: Collection in Use Without an OMB Number.
    Number of Respondents: 168.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 14 hours.
    2. Application for Child's Insurance Benefits--20 CFR 404.350-
404.368, 404.603, & 416.350--0960-0010. SSA uses the information 
collected by the SSA-4-BK to entitle children of living and deceased 
workers to monthly Social Security payments. Respondents are guardians 
completing the form on behalf of the children of living or deceased 
workers, or the children of living or deceased workers.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 1,740,000.
    Estimated Annual Burden: 344,141 hours.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Frequency per    burden per       Estimated
                 Type of request                    respondents      response        response      annual burden
                                                                                     (minutes)
----------------------------------------------------------------------------------------------------------------
Life Claims.....................................          46,250               1              10           7,708
Life Claims--MCS................................         439,375               1              10          73,229
Life Claims--Signature Proxy....................         439,375               1               9          65,906
Death Claims....................................          40,750               1              15          10,188
Death Claims--MCS...............................         387,125               1              15          96,781
Death Claims--Signature Proxy...................         387,125               1              14          90,329
                                                 ---------------------------------------------------------------
    Totals......................................       1,740,000  ..............  ..............         344,141
----------------------------------------------------------------------------------------------------------------

    3. Work History Report--20 CFR 404.1512 and 416.912-- 0960-0578. 
The information collected by form SSA-3369 is needed to determine 
disability by the State DDS. The information will be used to document 
an individual's past work history. The respondents are applicants for 
SSI disability payments and Social Security disability benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 1,000,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 500,000 hours.
    4. Beneficiary Interview and Auditor's Observations Form--0960-
0630. The information collected through the Beneficiary Interview and 
Auditor's Observation Form, SSA-322, will be used by SSA's Office of 
the Inspector General to interview beneficiaries and/or their payees to 
determine whether representative payees are complying with their duties 
and responsibilities under SSA's regulations at 20 CFR 404.2035 and 
416.635. Respondents to this collection will be randomly selected SSI 
recipients and Social Security beneficiaries who have representative 
payees.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 2,550.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 638 hours.
    5. Report to U.S. SSA by Person Receiving Benefits for a Child or 
Adult Unable to Handle Funds; Report to U.S. SSA--0960-0049. SSA needs 
the information on Form SSA-7161-OCR-SM to monitor the performance of 
representative payees outside the U.S and the information on Form SSA-
7162-OCR-SM to determine continuing entitlement to Social Security 
benefits and correct benefit amounts for beneficiaries outside the U.S. 
The respondents are individuals outside the U.S. who are receiving 
benefits either for someone else, or on their own behalf, under title 
II of the Social Security Act.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Frequency of     burden per       Estimated
                    Form No.                        respondents      response        response      annual burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-7161-OCR-SM.................................          30,000               1              15           7,500
SSA-7162-OCR-SM.................................         236,500               1               5          19,708
                                                 ---------------------------------------------------------------
    Totals......................................         257,000  ..............  ..............          27,208
----------------------------------------------------------------------------------------------------------------

    6. Real Property Current Market Value Estimate--0960-0471. The SSA-
L2794 is used to obtain current market value estimates of real property 
owned by applicants for, or recipients of, SSI payments (or a person 
whose resources are deemed to such an individual). The value of an 
individual's resources, including non-home real property is one of the 
eligibility requirements for SSI payments. The respondents are 
individuals with knowledge of local real property values.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 5,438.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 1,813 hours.
    7. Requests for Self-Employment Information, Employee Information, 
Employer Information--20 CFR 422.120--0960-0508. SSA uses forms SSA-
L2765, SSA-L3365 and SSA-L4002 to request correct information when an 
employer, employee or self-employed person reports an individual's 
earnings without a Social Security Number (SSN) or with an incorrect 
name or SSN. The respondents are employers, employees or self-employed 
individuals who are requested to furnish additional identifying 
information.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 26446]]



----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Frequency of     burden per       Estimated
                    Form No.                        respondents      response        response      annual burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L2765.......................................          15,400               1              10           2,567
SSA-L3365.......................................         173,100               1              10          28,850
SSA-L4002.......................................         656,000               1              10         109,333
    Total.......................................         844,500  ..............  ..............         140,750
----------------------------------------------------------------------------------------------------------------

    8. Questionnaire for Children Claiming SSI Benefits--0960-0499. The 
information collected on form SSA-3881-BK is used by SSA to evaluate 
disability in children who are appealing an unfavorable disability 
decision or whose continuing disability is being reviewed. The form 
requests the names and addresses of non-medical sources such as 
schools, counselors, agencies, organizations or therapists who would 
have information about a child's functioning. The respondents are 
children or their representatives who are appealing an unfavorable 
decision on their claim or whose continuing disability is being 
reviewed.
    Type of Request: Extension of OMB-approved collection.
    Number of Respondents: 253,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 126,500 hours.

    Dated: May 2, 2007.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
 [FR Doc. E7-8804 Filed 5-8-07; 8:45 am]
BILLING CODE 4191-02-P


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