[Federal Register Volume 83, Number 111 (Friday, June 8, 2018)]
[Notices]
[Pages 26736-26739]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-12395]


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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: <a href="/cdn-cgi/l/email-protection#6c23253e2d333f190e01051f1f0503022c03010e4209031c420b031a"><span class="__cf_email__" data-cfemail="125d5b40534d4167707f7b61617b7d7c527d7f703c777d623c757d64">[email protected]</span></a>.
(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: <a href="/cdn-cgi/l/email-protection#713e235f2314011e0305025f321d141003101f1214310202105f161e07"><span class="__cf_email__" data-cfemail="2d627f037f485d425f595e036e41484c5f4c434e486d5e5e4c034a425b">[email protected]</span></a>.

    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 employer-
employee 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 OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                                     Estimated
                                                     Number of     Frequency of   Average burden   total annual
             Modality of completion                 respondents      response      per  response      burden
                                                                                     (minutes)        (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
                                                 ---------------------------------------------------------------

[[Page 26737]]

 
    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.

----------------------------------------------------------------------------------------------------------------
                                                                                                     Estimated
                                                     Number of     Frequency of   Average burden   Total annual
             Modality of completion                 rspondents       response      per response       burden
                                                                                     (minutes)        (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 <a href="/cdn-cgi/l/email-protection#ce819ce09cabbea1bcbabde08da2abafbcafa0adab8ebdbdafe0a9a1b8"><span class="__cf_email__" data-cfemail="c38c91ed91a6b3acb1b7b0ed80afa6a2b1a2ada0a683b0b0a2eda4acb5">[email protected]</span></a>.
    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 OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden  Estimated total
           Modality of completion                Number of       Frequency of    per  response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-7-F6--Modernized Claims System and Paper             168                1               15               42
 Versions...................................
----------------------------------------------------------------------------------------------------------------

    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 OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden  Estimated total
           Modality of completion                Number of       Frequency of    per  response    annual burden
                                                respondents        response        (minutes)         (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 self-employment 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 OMB-approved information 
collection.

[[Page 26738]]



----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden  Estimated total
           Modality of completion                Number of       Frequency of    per  response    annual burden
                                                respondents        response        (minutes)         (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 OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden  Estimated total
           Modality of completion                Number of       Frequency of    per  response    annual burden
                                                respondents        response        (minutes)         (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 OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency of     burden per     total annual
             Modality of completion                 respondents      response        response         burden
                                                                                     (minutes)        (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.

----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden  Estimated total
           Modality of completion                Number of       Frequency of     per response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
Personal or Telephone Interview.............           1,049                1                5               87
----------------------------------------------------------------------------------------------------------------


[[Page 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 OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency of     burden per     total annual
             Modality of completion                 respondents      response        response         burden
                                                                                     (minutes)        (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


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