[Federal Register Volume 62, Number 160 (Tuesday, August 19, 1997)]
[Notices]
[Pages 44163-44164]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-21783]


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SOCIAL SECURITY ADMINISTRATION


Information Collection Activities: Proposed Collection Requests 
and Comment Requests

    This notice lists information collection packages that will require 
submission to the Office of Management and Budget (OMB), as well as 
information collection packages submitted to OMB for clearance, in 
compliance with Public Law 104-13 effective October 1, 1995, The 
Paperwork Reduction Act of 1995.
    I. The information collection(s) listed below require(s) 
extension(s) of the current OMB approval(s) or are proposed new 
collection(s):
    1. Railroad Employment Questionnaire--0960-0078. Form SSA-671 is 
used to secure sufficient information for required coordination with 
the Railroad Retirement Board for Social Security claims processing. 
The form is completed whenever claimants indicate that they have been 
employed in the railroad industry. The respondents are retired 
employees of the railroad industry or their dependents.
    Number of Respondents: 125,000.
    Frequency of Response: 1.
    Average Burden Per Response: 5 minutes.
    Estimated Annual Burden: 10,417 hours.
    2. Employment Relationship Questionnaire--0960-0040. Form SSA-7160 
covers all possible employment situations, and is used by the Social 
Security Administration to determine an individual's work status. The 
respondents are applicants for Social Security benefits.
    Number of Respondents: 47,500.
    Frequency of Response: 1.
    Average Burden Per Response: 25 minutes.
    Estimated Annual Burden: 19,792 hours.
    3. Questionnaire About Employment or Self-Employment Outside the 
United States--0960-0050. The information on Form SSA-7163 is needed to 
determine whether work performed outside the United States by 
beneficiaries is cause for deductions from their monthly benefits; to 
determine whether the foreign work test or the regular work test is 
applicable; and to determine the months, if any, for which deductions 
should be imposed. The respondents are beneficiaries who live and work 
outside the United States.
    Number of Respondents: 20,000.
    Frequency of Response: 1.
    Average Burden Per Response: 12 minutes.
    Estimated Annual Burden: 4,000 hours.
    4. Disability Report--0960-0573. The information collected on Form 
SSA-3368 is needed for the determination of disability by the State 
Disability Determination Services. The information will be used to 
develop medical evidence and to assess the alleged disability. The 
respondents are applicants for disability benefits.
    Number of Respondents: 2,438,496.
    Frequency of Response: 1.
    Average Burden Per Response: 45 minutes.
    Estimated Annual Burden: 1,828,872 hours.
    5. Work History Report--0960-0572. The information collected on 
Form SSA-3369 is needed for the determination of disability by the 
State Disability Determination Services. The respondents are applicants 
for disability benefits. The information will be used to document an 
individual's past work history.
    Number of Respondents: 1,000,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 500,000 hours.
    6. Medical History and Disability Report, Disabled Child--0960-
0574. The information collected on Form SSA-3820 is needed for the 
determination of disability by the State Disability Determination 
Services. The SSA-3820 will be used to obtain various types of 
information about a child's condition, his/her treating sources and/or 
other medical sources of evidence. The respondents are applicants for 
disability benefits.
    Number of Respondents: 523,000.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 174,333 hours.
    Written comments and recommendations regarding the information 
collection(s) should be sent within 60 days from the date of this 
publication, directly to the SSA Reports Clearance Officer at the 
following address: Social Security Administration, DCFAM, Attn: 
Nicholas E. Tagliareni, 6401 Security Blvd., 1-A-21 Operations Bldg., 
Baltimore, MD 21235.
    In addition to your comments on the accuracy of the agency's burden 
estimate, we are soliciting comments on

[[Page 44164]]

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.
    II. The information collection(s) listed below have been submitted 
to OMB:
    1. Subpart T--State Supplementation Provisions; Agreement; 
Payments, 20 CFR 416.2099--0960-0240. Section 1618 of the Social 
Security Act contains pass-along provisions of the Social Security 
amendments. These provisions require that States which supplement the 
Federal SSI benefit pass along Federal cost-of-living increases to 
individuals who are eligible for State supplementary 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. Regulations in 20 CFR 416.2099 require States to report 
mandatory minimum and optional supplementary payment data to SSA. The 
information is used to determine compliance with laws and regulations. 
The respondents are States which supplement Federal SSI payments.
    Number of Respondents: 26.
    Frequency of Response: 15 States report quarterly; 11 States report 
annually.
    Average Burden Per Response: 1 hour.
    Estimated Annual Burden: 71 hours.
    2. Application for Lump-Sum Death Payment--0960-0013. The 
information collected on Form SSA-8-F4 is required to authorize payment 
of the 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 receive lump-sum death benefits.
    Number of Respondents: 735,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 122,500 hours.
    3. Statement Regarding Contributions--0960-0020. Form SSA-783 
collects the information necessary to make a determination of one-half 
support, or contributions to support, in order to entitle certain child 
applicants to Social Security benefits. The respondents are children 
who apply for Social Security benefits.
    Number of Respondents: 30,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 7,500 hours.
    4. Application for Search of Census Record for Proof of Age--0960-
0097. The information collected on Form SSA-1535-U3 is required to 
provide the Census Bureau with sufficient identifying information, 
which will allow an accurate search of census records to establish 
proof of age for an individual applying for Social Security benefits. 
It is used for individuals who must establish age as a factor of 
entitlement. The respondents are individuals applying for Social 
Security benefits.
    Number of Respondents: 18,000.
    Frequency of Response: 1.
    Average Burden Per Response: 12 minutes.
    Estimated Annual Burden: 3,600 hours.
    5. Claimant's Statement About Loan of Food or Shelter, and 
Statement About Food or Shelter Provided to Another-- 0960-0529. Form 
SSA-5062 will be used to obtain an SSI applicant's statement about 
whether the food and/or shelter provided to him/her is a loan. Form 
SSA-5063 will be used to obtain an individual's statement about whether 
the food and/or shelter he/she provides to an SSI applicant is a loan. 
SSA needs to know if a bona fide loan exists in order to determine 
whether the food and/or shelter should (or should not) be counted as 
income, which can affect eligibility for SSI and the amount of SSI 
benefits payable. The respondents are SSI applicants who receive food 
and/or shelter (SSA-5062) and individuals who provide food and/or 
shelter to SSI applicants (SSA-5063).
    Number of Respondents: 131,080.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 21,847 hours.
    Written comments and recommendations regarding the information 
collection(s) should be directed within 30 days to the OMB Desk Officer 
and SSA Reports Clearance Officer at the following addresses:

(OMB)

Office of Management and Budget, OIRA, Attn: Laura Oliven, New 
Executive Office Building, Room 10230, 725 17th St., NW., Washington, 
D.C. 20503

(SSA)

Social Security Administration, DCFAM, Attn: Nicholas E. Tagliareni, 1-
A-21 Operations Bldg., 6401 Security Blvd., Baltimore, MD 21235

    To receive a copy of any of the forms or clearance packages, call 
the SSA Reports Clearance Officer on (410) 965-4125 or write to him at 
the address listed above.

    Dated: August 12, 1997.
Nicholas E. Tagliareni,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 97-21783 Filed 8-18-97; 8:45 am]
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