[Federal Register Volume 62, Number 211 (Friday, October 31, 1997)]
[Notices]
[Pages 59010-59011]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-28782]


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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 PL. 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. Request to be Selected as Payee--0960-0014. The information 
collected on Form SSA-11-BK is used to determine the proper payee for a 
Social Security beneficiary, and it is designed to aid in the 
investigation of a payee applicant. The form will establish the 
applicant's relationship to the beneficiary, the justification, the 
concern for the beneficiary and the manner in which the benefits will 
be used. The respondents are applicants for

[[Page 59011]]

selection as representative payee for Old-Age, Survivors and Disability 
Insurance (OASDI), Supplemental Security Income (SSI) and Black Lung 
benefits.
    Number of Respondents: 1,709,657.
    Frequency of Response: 1.
    Average Burden Per Response: 10.5 Minutes.
    Estimated Annual Burden: 299,190 Hours.
    2. Application for Benefits Under the Federal Mine Safety and 
Health Act of 1977, as Amended; (Widow's Claim, Child's Claim and 
Dependent's Claim)--0960-0118. Sections 402(g) and 412(a) of the 
Federal Mine Safety and Health Act provide that those widows, surviving 
children, and dependent parents, brothers or sisters who are not 
currently receiving benefits on the deceased miner's account must file 
the appropriate application within 6 months of the deceased miner's 
death, using Forms SSA-47, 48 and 49. This information is used to 
determine eligibility for benefits.
    Number of Respondents: 1,800.
    Frequency of Response: 1.
    Average Burden Per Response: 11 Minutes.
    Estimated Annual Burden: 330 Hours.
    3. Work History Report--0960-0552. Form SSA-3369-BK is used by the 
State Disability Determination Services (DDSs) to determine disability 
and to record information about the claimant's work history during the 
past 15 years. The respondents are claimants who live in Virginia and 
are applying for OASDI and SSI benefits.
    Number of Respondents: 32,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 Minutes.
    Estimated Annual Burden: 16,000 Hours.
    4. Disability Report-Child--0960-0504. Form SSA-3820-BK is used by 
the State DDSs to record claimants' allegations and sources of evidence 
in determining eligibility for children filing for SSI disability 
benefits. The respondents are SSI claimants who live in Virginia and 
are applying for disabled child's benefits.
    Number of Respondents: 10,900.
    Frequency of Response: 1.
    Average Burden Per Response: 40 Minutes.
    Estimated Annual Burden: 7,267 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 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. Disability Report--0960-0573. The information collected on Form 
SSA-3368-F6 is needed for the determination of disability by the State 
DDSs. 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.
    2. Work History Report--0960-0572. The information collected on 
Form SSA-3369-F6 is needed for the determination of disability by the 
State DDSs. The information will be used to document an individual's 
past work history. The respondents are applicants for OASDI and SSI 
benefits.
    Number of Respondents: 1,000,000.
    Frequency of Response: 1.
    Average Burden Per Response: 30 minutes.
    Estimated Annual Burden: 500,000 hours.
    3. Medical History and Disability Report, Disabled Child--0960-
0574. The information collected on Form SSA-3820-F4 is needed for the 
determination of disability by the State DDSs 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 SSI claimants 
who are applying for disabled child's 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 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: October 24, 1997.
Nicholas E. Tagliareni,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 97-28782 Filed 10-30-97; 8:45 am]
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