[Federal Register Volume 73, Number 4 (Monday, January 7, 2008)]
[Notices]
[Pages 1253-1257]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-10]


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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 Public Law 
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 the 
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. The information can be mailed, faxed or emailed 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#551a1c07140a062037383c26263c3a3b153a38377b303a257b323a23"><span class="__cf_email__" data-cfemail="501f1902110f0325323d392323393f3e103f3d327e353f207e373f26">[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#bef1eef2f390ecfdf1fecdcddf90d9d1c8"><span class="__cf_email__" data-cfemail="4609160a0b681405090635352768212930">[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. Function Report--Adult--Third Party--20 CFR 404.1512, 416.912--
0960-0635. The information collected on the SSA-3380-BK is needed to 
make determinations on Supplemental Security Income (SSI) and Social 
Security disability (SSDI) claims. This information is necessary for 
case development and adjudication, and is used by State Disability 
Determination Services (DDS) evaluators as an evidentiary source used 
in the disability evaluation process. The respondents are third parties 
familiar with the functional limitations (or lack thereof) of claimants 
who apply for SSDI benefits and SSI payments.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 1254]]

    Number of Respondents: 1,000,000.
    Frequency of Response: 1.
    Average Burden per Response: 60 minutes.
    Estimated Annual Burden: 1,000,000 hours.
    2. Function Report--Adult--20 CFR 404.1512 and 419.912--0960-0681. 
Form SSA-3373 is used to collect information about a disability 
applicant's impairment-related limitations and ability to function. It 
documents the types of information specified in SSA regulations and 
provides disability interviewers with a convenient means to record 
information about how the claimant's condition affects his or her 
ability to function. This information, together with medical evidence, 
forms the evidentiary basis upon which the initial disability process 
is founded. The respondents are SSDI and SSI applicants.
    Type of Request: Revision to an OMB-approved information 
collection.
    Number of Respondents: 4,005,367.
    Frequency of Response: 1.
    Average Burden per Response: 60 minutes.
    Estimated Annual Burden: 4,005,367 hours.
    3. Information Collections conducted by State DDS's on Behalf of 
SSA--20 CFR, subpart P, 404.1503a, 404.1512, 404.1513, 404.1514 
404.1517, 404.1519; 20 CFR subpart Q, 404.1613, 404.1614, 404.1624; 20 
CFR subpart I, 416.903a, 416.912, 416.913, 416.914, 416.917, 416.919 
and 20 CFR subpart J, 416.1013, 416.1024, 416.1014--0960-0555. The 
State DDS's collect certain information to administer the SSDI and SSI 
programs. They collect information from medical sources on consultative 
examination (CE) medical evidence, CE credentials and Medical Evidence 
of Record (MER). The DDS's collect information from claimants regarding 
medical appointments and pain/symptoms. The respondents are medical 
providers, other sources of MER and disability claimants.
    Type of Request: Revision of an OMB-approved information 
collection.
    The total combined burden is 1,803,810 hours.

CE Collections

    There are two collections from CE providers: (a) Medical evidence 
about claimants, which DDS's use to make disability determinations when 
the claimant's own medical sources cannot or will not provide the 
required information; and (b) when CE providers offer proof of their 
credentials.
    (a) Medical Evidence from CE Providers

----------------------------------------------------------------------------------------------------------------
                                                                              Average burden
                                               Number of     Frequency of      per response     Estimated annual
                                              respondents      response         (minutes)        burden (hours)
----------------------------------------------------------------------------------------------------------------
Paper Submissions.........................       1,215,000               1                 30            607,500
Electronic Records Express (ERE)                   285,000               1                 15             71,250
 Submissions..............................
                                           ---------------------------------------------------------------------
    Totals................................       1,500,000              --                 --            678,750
----------------------------------------------------------------------------------------------------------------

CE Credentials

----------------------------------------------------------------------------------------------------------------
                                                                              Average burden
                                               Number of     Frequency of      per response     Estimated annual
                                              respondents      response         (minutes)        burden (hours)
----------------------------------------------------------------------------------------------------------------
Paper Submission..........................           3,000               1                 20              1,000
----------------------------------------------------------------------------------------------------------------

    There are two CE claimant collections: (a) CE claimant completion 
of a response form in which claimants indicate if they intend to keep 
their CE appointment; and (b) CE claimant completion of a form 
indicating whether they want a copy of the CE report to be sent to 
their doctor.
    (a) Claimants re Appointment Letter

----------------------------------------------------------------------------------------------------------------
                                                                              Average burden
                                               Number of     Frequency of      per response     Estimated annual
                                              respondents      response         (minutes)        burden (hours)
----------------------------------------------------------------------------------------------------------------
Paper Submission..........................         750,000               1                  5             62,500
----------------------------------------------------------------------------------------------------------------

    (b) Claimants re Report to Medical Provider

----------------------------------------------------------------------------------------------------------------
                                                                              Average burden
                                               Number of     Frequency of      per response     Estimated annual
                                              respondents      response         (minutes)        burden (hours)
----------------------------------------------------------------------------------------------------------------
Paper Submission..........................       1,500,000               1                  5            125,000
----------------------------------------------------------------------------------------------------------------

MER Collections

    The DDS's collect MER information from the claimant's own medical 
sources to determine a claimant's physical and/or mental status, prior 
to making a disability determination.

[[Page 1255]]



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                                                                              Average burden
                                               Number of     Frequency of      per response     Estimated annual
                                              respondents      response         (minutes)        burden (hours)
----------------------------------------------------------------------------------------------------------------
Paper Submissions.........................       2,480,800               1                 15            620,200
Connect Direct (CD), (electronic transfer)         218,400               1                 15             54,600
ERE Submission............................         100,800               1                  7             11,760
                                           ---------------------------------------------------------------------
    Total.................................       2,800,000  ..............  .................            686,560
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Pain/Other Symptoms Information From Claimants

    The DDSs use information about pain/symptoms to determine how pain/
symptoms affect the claimant's ability to do work-related activities, 
prior to making a disability determination.

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                                                                              Average burden
                                               Number of     Frequency of      per response     Estimated annual
                                              respondents      response         (minutes)        burden (hours)
----------------------------------------------------------------------------------------------------------------
Paper Submission..........................       1,000,000               1                 15            250,000
----------------------------------------------------------------------------------------------------------------

    4. Social Security Number (SSN) Verification Services--20 CFR 
401.45--0960-0660. Under Internal Revenue Service regulations employers 
are obligated to provide wage and tax data to the SSA using Form W-2 or 
its electronic equivalent. As part of this process the employer must 
furnish the employee's name and their SSN. The employee's name and SSN 
must match SSA's records in order for the employee's earnings to be 
properly posted to their Earnings Record, which is maintained by SSA.
    In order to better assure that employers provide accurate employee 
name and SSN data that match SSA's records, SSA offers serveral cost-
free methods for employers to verify the information, as follows: (1) 
Internet-based service, known as the Social Secuirty Number 
Verification Service (SSNVS), where the employer can verify if the 
reported names and SSNs of their employees matches SSA's records; (2) 
the Employee Verification Service (EVS), where employers can verify, 
via cartridge, diskette, paper and telephone if the reported name and 
SSN of their employees matches SSA's records; (3) through our National 
800 Number SSA, which is introducing an automated telephone employee 
verification service (TNEV) that will allow callers, who have been 
authenicated and have a pin and password to use for this process, to 
verify employee's names and SSNs through the telephone system.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                                                      Average burden
                        Verification system                            Number of     Frequency of      Number of       per response       Total annual
                                                                      respondents      response        responses        (minutes)        burden (hours)
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EVS...............................................................          50,000              16         800,000                 10            133,333
SSNVS.............................................................         200,000              60      12,000,000                  5          1,000,000
TNEV..............................................................           5,798              60         347,880                  9             52,182
                                                                   -------------------------------------------------------------------------------------
    Total.........................................................         255,798  ..............       2,347,880  .................          1,185,515
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    5. Agreement to Sell Property--20 CFR 416.1240-1245--0960-0127. 
Individuals or couples who are otherwise eligible for SSI benefits but 
whose resources exceed the allowable limit may receive conditional 
payments if they agree to dispose of the excess non-liquid resources 
and make repayment. Form SSA-8060 is used to document this agreement 
and to ensure that the individuals understand their obligations. 
Respondents are applicants and recipients of SSI benefits who will be 
disposing of excess non-liquid resources.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 20,000.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 3,333 hours.
    6. Listing of Impairments--Part 404, Subpart P, Appendix I and II--
0960-0642.

Background

    The Listing of Impairments (the listings), part 404, subpart P, 
appendix I and II, describes for each of the major body systems, 
impairments which are severe enough to prevent a person from doing any 
gainful activity. As part of the listings, we provide a preface which 
identifies specific requirements that affect the body system, such as 
documentation requirements and other factors which must be considered 
when evaluating impairments within that body system. These can include 
requirements which include medical and other evidence. This clearance 
request covers sections in parts A and B.

The Information Collection

    The medical evidence documentation described in the listings is 
used by State DDS's to assess the alleged disability. The information, 
together with other evidence, is used to determine if an individual 
claiming disability benefits has an impairment that meets severity and 
duration requirements. The respondents are disability applicants and 
other sources of evidence. The public reporting burden is accounted for 
in the Information Collection Requests (ICR) for the various forms that 
the public uses to submit the information to SSA. Consequently, we are 
reporting no

[[Page 1256]]

burden for this regulation aside from a 1-hour placeholder burden.
    Type of Request: Extension of an OMB-approved information 
collection.
    7. Reporting Events--SSI--20 CFR 416.701-.732--0960-0128. The 
Social Security Act and regulations requires SSA to collection 
information to determine eligibility for SSI payments and to determine 
the correct payment amount. SSA periodically requests information from 
recipients to reevaluate their continuing SSI eligibility and payment 
amount using form SSA-8150-EV. Form SSA-8150-EV informs recipients of 
the information that needs to be reported to SSA in order to retain 
their benefits. Form SSA-8150-EV provides recipients with a means of 
reporting changes in their circumstances in writing. SSA uses the 
reported changes to determine SSI eligibility and correct payment 
amounts.
    Type of Request: Extension of an approved OMB information 
collection.
    Number of Respondents: 27,320.
    Frequency of Response: 1.
    Average Burden per Response: 5 minutes.
    Estimated Annual Burden: 2,277 hours.
    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. Advanced Notice of Termination of Child's Benefits & Student's 
Statement Regarding School Attendance--20 CFR 404.350-404.352, 404.367-
404.368--0960-0105. The information collected on Forms SSA-1372-BK and 
SSA-1372-BK-FC is needed to determine whether children of an insured 
worker are eligible for student benefits. The respondents are student 
claimants for Social Security benefits, their respective schools and, 
in some cases, their representative payees.
    Type of Request: Revision of an OMB-approved information 
collection.
    SSA-1372-BK:

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                                                                              Average burden
            Type of respondent                 Number of     Frequency of      per response       Total annual
                                              respondents      response         (minutes)       burden  (hours)
----------------------------------------------------------------------------------------------------------------
Individuals/Households....................          99,850               1                 11             18,306
State/Local/Tribal Government.............          99,850               1                 11             18,306
                                           ---------------------------------------------------------------------
    Totals................................         199,700  ..............  .................             36,612
----------------------------------------------------------------------------------------------------------------

    SSA-1372-BK-FC:

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                                                                              Average burden
            Type of respondent                 Number of     Frequency of      per response       Total annual
                                              respondents      response         (minutes)       burden  (hours)
----------------------------------------------------------------------------------------------------------------
Individuals/Households....................             150               1                 11                 27
State/Local/Tribal Government.............             150               1                 11                 27
                                           ---------------------------------------------------------------------
    Totals................................             300  ..............  .................                 54
----------------------------------------------------------------------------------------------------------------

    Correction Notice: In the First Federal Register Notice, we 
inadvertently labeled this ICR as an extension instead of a revision.
    2. Authorization to Disclose Information to SSA--20 CFR 404.1512 & 
20 CFR 416.912--0960-0623. SSA must obtain sufficient medical evidence 
to make eligibility determinations for SSDI benefits and SSI payments. 
For SSA to obtain medical evidence, an applicant must authorize his or 
her medical source(s) to release the information to SSA. The applicant 
may use one of the forms SSA-827, SSA-827-OP1 or SSA-827-OP2 to provide 
consent for the release of information. Generally, the State DDS 
completes the form(s) based on information provided by the applicant, 
and sends the form(s) to the designated medical source(s).
    Type of Request: Revision of a currently approved information 
collection.
    Number of Respondents: 3,853,928.
    Frequency of Response (Average per case): 4.
    Total Annual Responses: 15,415,712.
    Average Burden per Response: 13 minutes to complete all 4 forms.
    Estimated Annual Burden: 835,018 hours.
    3. Acknowledgement of Receipt (Notice of Hearing)--20 CFR 404.938 & 
416.1438--0960-0671. The HA-504 and HA-504-OP1 are used to acknowledge 
receipt of the notice of hearing issued by an Administrative Law Judge 
(ALJ). The ALJ uses the information collected on the HA-504 and HA-504-
OP1 to: (1) Prepare for the hearing as scheduled; or (2) reschedule the 
hearing to a different date and/or location. The respondents are 
applicants for Social Security benefits or SSI payments who request a 
hearing to appeal an unfavorable entitlement or eligibility 
determination.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                             Frequency  of    Average burden
                   Form                        Number of    response  (per     per response       Total annual
                                              respondents        year)          (minutes)       burden  (hours)
----------------------------------------------------------------------------------------------------------------
HA-504....................................          60,000               1                  1               1000
HA-504-OP1................................         540,000               1                  1               9000
                                           ---------------------------------------------------------------------
    Totals................................         600,000  ..............  .................             10,000
----------------------------------------------------------------------------------------------------------------


[[Page 1257]]

    Correction Notice: In the notice published on October 18, 2007 at 
75 FR 59132 we inadvertently labeled this ICR as an extension. It is, 
in fact, a revision in order to reflect both versions of the form HA-
504. Also, we are correcting the burden data from 660,000 respondents 
and 11,000 burden hours to 600,000 respondents and 10,000 burden hours.
    4. Request for Waiver of Special Veterans Benefits (SVB) 
Overpayment Recovery or Change in Repayment Rate--20 CFR 408.900-
408.950, 408.923(b), 408.931(b), 408.932(c), (d) and (e), 408.941(b) 
and 408.942--0960-0698. Title VIII allows the payment of a monthly 
benefit by the Commissioner of Social Security to a qualified World War 
II veteran who resides outside the United States. When an overpayment 
in SVB occurs, the beneficiary can use this form to request waiver of 
recovery of the overpayment or a change in the repayment rate. The SSA-
2032-BK will be used to obtain the information necessary to determine 
whether the provisions of the Act regarding waiver of recovery of the 
overpayment are met. The information on the form is needed to determine 
a repayment rate if repayment cannot be waived. Respondents are 
beneficiaries who have overpayments on their Title VIII record and wish 
to file a claim for waiver of recovery or change in repayment rate.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 450.
    Frequency of Response: 1.
    Average Burden per Response: 120 minutes.
    Total Annual Burden: 900 hours.
    Correction Notice: We are correcting information published on 
September 20, 2007 at 72 FR 53803 and on November 5, 2007 at 72 FR 
62510 to show updated burden information. We changed the number of 
respondents from 39 to 450 and the burden hours from 78 to 900 hours.
    5. Request for Medical Treatment in an SSA Employee Health 
Facility: Patient Self-Administered or Staff Administered Care--0960-
NEW. SSA operates Employee Health Clinics onsite in eight different 
states. These clinics provide health care for all SSA employees 
including treatment of personal medical conditions when authorized by a 
physician. The SSA-5072 is the employee's personal physician's order 
form. The information collected on the SSA-5072 gives the nurses the 
guidance they need by law to perform certain medical procedures and to 
administer prescription medications such as allergy immunotherapy. 
Also, the information collected by the SSA-5072 allows the SSA Medical 
Officer to determine whether the treatment can be administered safely 
and appropriately in the SSA Employee Health Units. Each State has a 
Nurse Practice Act governing the practice of registered nurses in the 
State. All Nurse Practice Acts require that registered nurses 
administer prescription medications and certain medical treatments by 
following a licensed physician's orders. Form SSA-5072 provides the 
vehicle for the physician to provide these orders to the SSA nursing 
staff. Respondents are physicians of SSA employees who need to have 
medical treatment in the SSA Employee Health Unit.
    Type of Request: Information Collection in Use without an OMB 
Number.

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                                                                                                                      Average burden
                         Reporting method                              Number of     Frequency of      Number of       per response     Estimated annual
                                                                      respondents      response        responses        (minutes)       burden  (hours)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Annual............................................................              25               1              25                  5                  2
Bi-Annual.........................................................              75               2             150                  5                 13
                                                                   -------------------------------------------------------------------------------------
    Totals........................................................             100  ..............             175  .................                 15
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    6. Sheltered Workshop Wage Reporting--0960-NEW.

Collection Background

    Section 1612(1)(C) of the Social Security Act (the Act) and 42 
U.S.C. 1382a define remuneration received for services performed in a 
sheltered workshop as earned income for the SSI program. The amount of 
monthly wages determines an individual's SSI benefit amount.

Collection Description

    SSA has maintained a working relationship with sheltered workshops 
since the inception of the SSI program. Most workshops report monthly 
wage totals to the local SSA office so that the client's SSI check is 
adjusted timely and overpayments are prevented. While participation of 
the workshop is strictly voluntary, they are highly motivated to report 
the wages because it provides a service to their clients. Sheltered 
Workshop reporting reduces the number of overpayments to SSI 
recipients. Processing these wage reports electronically reduces the 
cost of administering the program. SSA uses the information collected 
to verify and post monthly wages to the SSI recipient's record. 
Respondents are sheltered workshops that report monthly wages for 
services performed in the workshop.
    Type of Request: New information collection.
    Number of Respondents: 1,000.
    Frequency of Response: 12.
    Average Burden per Response: 15 minutes.
    Estimated Annual Burden: 3,000 hours.
    Correction Notice: We are updating information that was contained 
in the notices that were published at 72 FR 46529 on August 20, 2007 
and 725 FR 62510 on November 5, 2007. We are changing the burden 
estimate from 5 to 15 minutes.
    7. Request for Social Security Earnings Information--20 CFR 404.810 
& 401.100--0960-0525. The Social Security Act provides that a wage 
earner, or someone authorized by a wage earner, may request Social 
Security earnings information from SSA using form SSA-7050. SSA uses 
the information collected on the form to verify that the requestor is 
authorized to access the earnings record and to produce the earnings 
statement. The respondents are wage earners and organizations and legal 
representatives authorized by the wage earner.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 60,000.
    Frequency of Response: 1.
    Average Burden per Response: 11 minutes.
    Estimated Annual Burden: 11,000 hours.

    Dated: December 31, 2007.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
 [FR Doc. E8-10 Filed 1-4-08; 8:45 am]
BILLING CODE 4191-02-P


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