26736 Federal Register / Vol. 83, No. 111 / Friday, June 8, 2018 / Notices 

Modality of completion Number of 

respondents 

Frequency of 

response 

Average 

burden of 

response 

(hours) 

Estimated total 

annual burden 

(hours) 

SSA–680 .......................................................................................................... 30 1 5 150 

II. SSA submitted the information 

collection below to OMB for clearance. 

Your comments regarding this 

information collection would be most 

useful if OMB and SSA receive them 30 

days from the date of this publication. 

To be sure we consider your comments, 

we must receive them no later than July 

9, 2018. Individuals can obtain copies of 

the OMB clearance packages by writing 

to OR.Reports.Clearance@ssa.gov. 

Statement of Reclamation Action—31 

CFR 210—0960–0734. Regulations 

governing the Federal Government 

Participation in the Automated Clearing 

House: (1) Allow SSA to send Social 

Security payments to Canada; and (2) 

mandate the reclamation of funds paid 

erroneously to a Canadian bank, or 

financial institution, after the death of a 

Social Security beneficiary. SSA uses 

Form SSA–1713, Notice of Reclamation 

Action, to determine if, how, and when 

the Canadian bank or financial 

institution is going to return erroneous 

payments after the death of a Social 

Security beneficiary who elected to have 

payments sent to Canada. Form SSA– 

1712 (or SSA–1712 CN), Notice of 

Reclamation-Canada Payment Made in 

the United States, is the cover sheet SSA 

prepares to request return of the 

payment. The respondents are Canadian 

banks and financial institutions who 

erroneously received Social Security 

payments. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of completion Number of 

respondents 

Frequency of 

response 

Average 

burden of 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–1712 ........................................................................................................ 8 1 5 1 

SSA–1713 ........................................................................................................ 7 1 5 1 

Totals ........................................................................................................ 15 ........................ ........................ 2 

Dated: June 4, 2018. 

Faye Lipsky, 

Reports Clearance Director, Social Security 

Administration. 

[FR Doc. 2018–12391 Filed 6–7–18; 8:45 am] 

BILLING CODE 4191–02–P 

SOCIAL SECURITY ADMINISTRATION 

[Docket No. SSA–2018–0024] 

Agency Information Collection 

Activities: Proposed Request and 

Comment Request 

The Social Security Administration 

(SSA) publishes a list of information 

collection packages requiring 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. This notice includes revisions, 

and one extension, 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 ways to 

minimize burden on respondents, 

including the use of automated 

collection techniques or other forms of 

information technology. Mail, email, or 

fax your comments and 

recommendations on the information 

collection(s) to the OMB Desk Officer 

and SSA Reports Clearance Officer at 

the following addresses or fax numbers. 

(OMB), Office of Management and 

Budget, Attn: Desk Officer for SSA, 

Fax: 202–395–6974, Email address: 

OIRA_Submission@omb.eop.gov. 

(SSA), Social Security Administration, 

OLCA, Attn: Reports Clearance 

Director, 3100 West High Rise, 6401 

Security Blvd., Baltimore, MD 21235, 

Fax: 410–966–2830, Email address: 

OR.Reports.Clearance@ssa.gov. 

Or you may submit your comments 

online through www.regulations.gov, 

referencing Docket ID Number [SSA– 

2018–0024]. 

I. The information collections below 

are pending at SSA. SSA will submit 

them to OMB within 60 days from the 

date of this notice. To be sure we 

consider your comments, we must 

receive them no later than August 7, 

2018. Individuals can obtain copies of 

the collection instruments by writing to 

the above email address. 

1. Employment Relationship 

Questionnaire—20 CFR 404.1007— 

0960–0040. When SSA needs 

information to determine a worker’s 

employment status for the purpose of 

maintaining a worker’s earning records, 

the agency uses Form SSA–7160–F4 to 

determine the existence of an employeremployee relationship. We use the 

information to develop the employment 

relationship; specifically, to determine 

whether a beneficiary is self-employed 

or an employee. The respondents are 

individuals seeking to establish their 

status as employees, and their alleged 

employers. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of completion Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–7160–F4—Individuals ............................................................................. 8,000 1 25 3,333 

SSA–7160–F4—Businesses ............................................................................ 7,200 1 25 3,000 

SSA–7160–F4—State/Local Governemnt ....................................................... 800 1 25 333 


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Federal Register / Vol. 83, No. 111 / Friday, June 8, 2018 / Notices 26737 

Modality of completion Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

Total .......................................................................................................... 16,000 ........................ ........................ 6,666 

2. Application for Circuit Court Law— 

20 CFR 404.985 & 416.1458—0960– 

0581. Persons claiming an acquiescence 

ruling (AR) would change SSA’s prior 

determination or decision must submit 

a written readjudication request with 

specific information. SSA reviews the 

information in the requests to determine 

if the issues stated in the AR pertain to 

the claimant’s case, and if the claimant 

is entitled to readjudication. If 

readjudication is appropriate, SSA 

considers the issues the AR covers. Any 

new determination or decision is subject 

to administrative or judicial review as 

specified in the regulations, and the 

claimants must provide information to 

request readjudication. Respondents are 

claimants for Social Security benefits 

and Supplemental Security Income 

(SSI) payments who request 

readjudication. 

Type of Request: Extension of an 

OMB-approved information collection. 

Modality of completion Number of 

rspondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated 

Total annual 

burden 

(hours) 

AR-based Readjudication Requests ................................................................ 10,000 1 17 2,833 

II. SSA submitted the information 

collections below to OMB for clearance. 

Your comments regarding these 

information collections would be most 

useful if OMB and SSA receive them 30 

days from the date of this publication. 

To be sure we consider your comments, 

we must receive them no later than July 

9, 2018. Individuals can obtain copies of 

the OMB clearance packages by writing 

to OR.Reports.Clearance@ssa.gov. 

1. Application for Parent’s Insurance 

Benefits—20 CFR 404.370–404.374 and 

20 CFR 404.601–404.603—0960–0012. 

Section 202(h) of the Social Security Act 

(Act) establishes the conditions of 

eligibility a claimant must meet to 

receive monthly benefits as a parent of 

a deceased worker. SSA uses 

information from Form SSA–7–F6 to 

determine if the claimant meets the 

eligibility and application criteria. The 

respondents are applicants for, and 

recipients of, Social Security Old Age, 

Survivors, and Disability Insurance 

(OASDI). 

Correction Notice: SSA is updating 

the burden information for this 

collection, so it differs from the 

information we published at 83 FR 

12455, on 3/21/18. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of completion Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–7–F6—Modernized Claims System and Paper Versions ....................... 168 1 15 42 

2. Request for Withdrawal of 

Application—20 CFR 404.640—0960– 

0015. Form SSA–521 documents the 

information SSA needs to process the 

withdrawal of an application for 

benefits. A paper SSA–521 is our 

preferred instrument for executing a 

withdrawal request; however, any 

written request for withdrawal signed 

by the claimant or a proper applicant on 

the claimant’s behalf will suffice. 

Individuals who wish to withdraw their 

applications for benefits complete Form 

SSA–521, or sign the completed form 

for each request to withdraw. SSA uses 

the information from the SSA–521 to 

process the request for withdrawal. The 

respondents are applicants for 

Retirement, Survivors, Disability, and 

Health Insurance benefits. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of completion Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–521 .......................................................................................................... 31,827 1 5 2,652 

3. Statement of Self-Employment 

Income—20 CFR 404.101, 404.110, 

404.1096(a)(d)—0960–0046. To qualify 

for insured status, and collect Social 

Security benefits, self-employed 

individuals must demonstrate they 

earned the minimum amount of selfemployment income (SEI) in a current 

year. SSA uses Form SSA–766, 

Statement of Self-Employment Income, 

to collect the information we need to 

determine if the individual earned at 

least the minimum amount of SEI 

needed for one or more quarters of 

coverage in the current year. Based on 

the information we obtain, we may 

credit additional quarters of coverage to 

give the individual insured status, 

expediting benefit payments. 

Respondents are self-employed 

individuals potentially eligible for 

Social Security benefits. 

Type of Request: Revision of an OMBapproved information collection. 


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26738 Federal Register / Vol. 83, No. 111 / Friday, June 8, 2018 / Notices 

Modality of completion Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–766 .......................................................................................................... 2,500 1 5 208 

4. Request for Workers’ 

Compensation/Public Disability Benefit 

Information—20 CFR 404.408(e)—0960– 

0098. Claimants for Social Security 

disability payments who are also 

receiving Worker’s Compensation/ 

Public Disability Benefits (WC/PDB) 

must notify SSA about their WC/PDB, 

so the agency can reduce claimants’ 

Social Security disability payments 

accordingly. If claimants provide 

necessary evidence, such as a copy of 

their award notice, benefit check, etc., 

that is sufficient verification. In cases 

where claimants cannot provide such 

evidence, SSA uses Form SSA–1709. 

The entity paying the WC/PDB benefits, 

its agent (such as an insurance carrier), 

or an administering public agency 

complete this form. The respondents are 

Federal, State, and local agencies, 

insurance carriers, and public or private 

self-insured companies administering 

WC/PDB benefits to disability 

claimants. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of completion Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–1709 ........................................................................................................ 120,000 1 15 30,000 

5. Third Party Liability Information 

Statement—42 CFR 433.136–433.139— 

0960–0323. To reduce Medicaid costs, 

Medicaid state agencies identify third 

party insurers liable for medical care or 

services for Medicaid beneficiaries. 

Regulations at 2 CFR 433.136–433.139 

require Medicaid state agencies to 

obtain this information on Medicaid 

applications and redeterminations as a 

condition of Medicaid eligibility. States 

may enter into agreements with the 

Commissioner of Social Security to 

make Medicaid eligibility 

determinations for aged, blind, and 

disabled beneficiaries in those states. 

Applications for and redeterminations 

of SSI eligibility in jurisdictions with 

such agreements are applications and 

redeterminations of Medicaid eligibility. 

Under these agreements, SSA obtains 

third party liability information using 

Form SSA–8019–U2, and provides that 

information to the Medicaid state 

agencies. The Medicaid state agencies 

use the information to bill third parties 

liable for medical care, support, or 

services for a beneficiary to guarantee 

that Medicaid remains the payer of last 

resort. The respondents are SSI 

claimants and recipients. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of completion Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–8019–U2—Paper Version ....................................................................... 200 1 5 17 

SSA–8019–U2—SSI Claims Sysetm Version ................................................. 49,621 1 5 4,135 

Totals ........................................................................................................ 49,821 ........................ ........................ 4,152 

6. Permanent Residence in the United 

States Under Color of Law (PRUCOL)— 

20 CFR 416.1615 and 416.1618—0960– 

0451. As per 20 CFR 416.1415 and 

416.1618 of the Code of Federal 

Regulations, SSA requires claimants or 

recipients to submit evidence of their 

alien status when they apply for SSI 

payments, and periodically thereafter as 

part of the eligibility determination 

process for SSI. When SSA cannot 

verify evidence of alien status through 

the regular claimant interview process, 

SSA verifies the validity of the evidence 

of PRUCOL for grandfathered 

nonqualified aliens with the Department 

of Homeland Security (DHS), and 

determines if the individual qualifies for 

PRUCOL status based on the DHS 

response. SSA does not maintain any 

forms or applications for respondents to 

use, rather, the regulations listed in 20 

CFR 416.1615 and 416.1618 specify the 

information respondents need to submit 

to SSA to show evidence of PRUCOL. 

Without this information, SSA is unable 

to determine whether the PRUCOL 

individual is eligible for SSI payments. 

Respondents are qualified and 

unqualified aliens who apply for SSI 

payments under PRUCOL. 

Type of Request: Extension of an 

OMB-approved information collection. 

Modality of completion Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

Personal or Telephone Interview ..................................................................... 1,049 1 5 87 


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Federal Register / Vol. 83, No. 111 / Friday, June 8, 2018 / Notices 26739 

7. Authorization for the Social 

Security Administration to Obtain 

Account Records from a Financial 

Institution and Request for Records 

(Medicare)—20 CFR 418.3420—0960– 

0729. The Medicare Prescription Drug, 

Improvement, and Modernization Act of 

2003 (MMA) established the Medicare 

Part D program for voluntary 

prescription drug coverage of premium, 

deductible, and copayment costs for 

individuals with limited income and 

resources. The MMA mandates that the 

Government provide subsidies for those 

individuals who qualify for the 

program, and who meet eligibility 

criteria for help with premium, 

deductible, or co-payment costs. SSA 

uses the SSA–4640, Authorization for 

the Social Security Administration to 

Obtain Account Records from a 

Financial Institution and Request for 

Records (Medicare), to determine if 

subsidy applicants or recipients qualify, 

or continue to qualify, for the subsidy. 

SSA uses Form SSA–4640 to: (1) Obtain 

the individual’s consent to verify 

balances of financial institution (FI) 

accounts; and (2) obtain verification of 

such balances from the FI. Respondents 

are Medicare Part D program subsidy 

applicants or claimants, and their 

financial institutions. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of completion Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–4640—Medicare Part D Subsidy Applicants .......................................... 5,000 1 1 83 

SSA–4640—Financial Institutions ................................................................... 5,000 1 4 333 

Total .......................................................................................................... 10,000 ........................ ........................ 416 

Dated: June 4, 2018. 

Faye Lipsky, 

Reports Clearance Director, Social Security 

Administration. 

[FR Doc. 2018–12395 Filed 6–7–18; 8:45 am] 

BILLING CODE 4191–02–P 

SOCIAL SECURITY ADMINISTRATION 

[Docket No. SSA 2017–0059] 

Privacy Act of 1974; Matching Program 

AGENCY: Social Security Administration 

(SSA). 

ACTION: Notice of a new matching 

program. 

SUMMARY: In accordance with the 

provisions of the Privacy Act, as 

amended, this notice announces a new 

matching program with the Railroad 

Retirement Board (RRB). This matching 

agreement sets forth the terms, 

safeguards, and procedures under which 

RRB, as the source agency, will disclose 

RRB annuity payment data to SSA, the 

recipient agency. SSA will use the 

information to verify Supplemental 

Security Income (SSI) and Special 

Veterans Benefits (SVB) eligibility and 

benefit payment amounts. SSA will also 

record the railroad annuity amounts 

RRB paid to SSI and SVB recipients in 

the Supplemental Security Income 

Record (SSR). 

DATES: The deadline to submit 

comments on the proposed matching 

program is 30 days from the date of 

publication in the Federal Register. The 

matching program will be applicable on 

September 2, 2018 and will expire on 

March 1, 2020, or once a minimum of 

30 days after publication of this notice 

has elapsed, whichever is later. The 

matching program will be in effect for 

a period of 18 months. 

ADDRESSES: Interested parties may 

comment on this notice by either 

telefaxing to (410) 966–0869, writing to 

Mary Ann Zimmerman, Acting 

Executive Director, Office of Privacy 

and Disclosure, Office of the General 

Counsel, Social Security 

Administration, G–401WHR Building, 

6401 Security Boulevard, Baltimore, MD 

21235–6401, or email at 

Mary.Ann.Zimmerman@ssa.gov. All 

comments received will be available for 

public inspection by contacting Ms. 

Zimmerman at this street address. 

FOR FURTHER INFORMATION CONTACT: 

Interested parties may submit general 

questions about the matching program 

to Mary Ann Zimmerman, Acting 

Executive Director, Office of Privacy 

and Disclosure, Office of the General 

Counsel, by any of the means shown 

above. 

Mary Ann Zimmerman, 

Acting Executive Director, Office of Privacy 

and Disclosure, Office of the General Counsel. 

Participating Agencies: SSA and RRB. 

Authority for Conducting the 

Matching Program: The legal authority 

for this agreement is executed in 

compliance with the Privacy Act of 

1974, as amended by the Computer 

Matching and Privacy Protection Act of 

1988, the regulations and guidance 

promulgated thereunder. Legal authority 

for the disclosure under this agreement 

for the SSI portion are 1631(e)(1)(A) and 

(B) and 1631(f) of the Social Security 

Act (Act) (42 U.S.C. 1383(e)(1)(A) and 

(B) and 1383(f)). The legal authority for 

the disclosure under this agreement for 

the SVB portion is 806(b) of the Act (42 

U.S.C. 1006(b)). 

Purpose(s): The purpose of this 

matching program is to set forth the 

terms, safeguards, and procedures under 

which RRB, as the source agency, will 

disclose RRB annuity payment data to 

SSA, the recipient agency. SSA will use 

the information to verify SSI and SVB 

eligibility and benefit payment amounts. 

SSA will also record the railroad 

annuity amounts RRB paid to SSI and 

SVB recipients in the SSR. 

Categories of Individuals: The 

individuals whose information is 

involved in this matching program are 

applicants for and recipients of SSI 

payments and SVB benefits. 

Categories of Records: SSA will match 

the Social Security number, name, date 

of birth, and RRB claim number on the 

RRB file and the SSR. 

System(s) of Records: RRB will 

provide SSA with an electronic data file 

containing annuity payment data from 

RRB’s system of records, RRB–22 

Railroad Retirement, Survivor, and 

Pensioner Benefits System, last 

published on May 15, 2015 (80 FR 

28018). SSA will match RRB’s data with 

data maintained in the SSR, 

Supplemental Security Income Record 

and Special Veterans Benefits, SSA/ 

OITPBS, 60–0103, published on January 

11, 2006 (71 FR 1830) and December 10, 

2007 (72 FR 69723). SVB data also 

resides on the SSR. 

[FR Doc. 2018–12314 Filed 6–7–18; 8:45 am] 

BILLING CODE 4191–02–P 


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