[Federal Register Volume 77, Number 9 (Friday, January 13, 2012)]
[Notices]
[Pages 2114-2118]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-580]


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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 requiring clearance by the Office of 
Management and Budget (OMB) in compliance with Public Law 104-13, the 
Paperwork Reduction Act (PRA) of 1995, effective October 1, 1995. This 
notice includes revisions and one extension of OMB-approved information 
collections, information collections in use without an OMB number, and 
a new information collection.
    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#d59a9c87948a86a0b7b8bca6a6bcbabb95bab8b7fbb0baa5fbb2baa3"><span class="__cf_email__" data-cfemail="afe0e6fdeef0fcdacdc2c6dcdcc6c0c1efc0c2cd81cac0df81c8c0d9">[email protected]</span></a>.
(SSA), Social Security Administration, DCRDP, Attn: Reports Clearance 
Officer, 107 Altmeyer Building, 6401 Security Blvd., Baltimore, MD 
21235, Fax: (410) 966-2830, Email address: <a href="/cdn-cgi/l/email-protection#8dc2ddc1c0a3dfcec2cdfefeeca3eae2fb"><span class="__cf_email__" data-cfemail="2e617e6263007c6d616e5d5d4f00494158">[email protected]</span></a>.

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 
March 13, 2012. Individuals can obtain copies of the collection 
instruments by calling the SSA Reports Clearance Officer at (410) 965-
8783 or by writing to the above email address.
    1. Request for Documents or Information--20 CFR 404.703--0960-NEW. 
SSA asks individuals applying for Social Security benefits for 
additional information when the information they provided is incomplete 
or insufficient for us to determine their eligibility for benefits. SSA 
uses Form SSA-2118-U2, Request for Documents or Information, to request 
the additional documents or information we need to process individuals' 
claims for benefits. Respondents are claimants for title II Social 
Security Old Age, Survivors, and Disability Insurance (OASDI) benefits.
    Type of Request: Existing collection in use without an OMB number.

----------------------------------------------------------------------------------------------------------------
                                                                                  Average burden     Estimated
              Collection instrument                  Number of     Frequency of    per response    total annual
                                                    respondents      response        (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-2118-U2.....................................           7,500               1               5             625
----------------------------------------------------------------------------------------------------------------

    2. Notice to Show Cause for Failure to Appear--20 CFR 404.938, 
416.1438, 404.957(a)(ii)--0960-NEW. In situations where claimants who 
requested a hearing before an administrative law judge (ALJ) fail to 
appear at their scheduled hearings, the ALJ may reschedule the hearing 
if the claimants establish good cause for missing the hearings. The 
claimants can provide a reason for not appearing at their scheduled 
hearings using Form HA-L90. If the ALJ determines the claimants 
established good cause for failure to appear at the hearings, the ALJ 
will schedule a supplemental hearing; if not, the ALJ makes a claims 
eligibility determination based on the claimants' evidence of record. 
Respondents are claimants seeking to show cause for failure to appear 
at a scheduled hearing before an ALJ.
    Type of Request: Existing collection in use without an OMB number.

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                                                                                 Average burden  Estimated total
            Collection instrument                Number of       Frequency of     per response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
HA-L90 PDF/Paper............................           7,000                1               10            1,167
Electronic Records Express..................          28,000                1               10            4,667
                                             -------------------------------------------------------------------
    Total...................................          35,000   ...............  ...............           5,834
----------------------------------------------------------------------------------------------------------------

    3. Permanent Residence in the United States Under Color of Law 
(PRUCOL)--20 CFR 416.1615 and 416.1618--0960-0451. As discussed in 20 
CFR 416.1415 and 416.1618 of the Code of Federal Regulations, PRUCOL 
aliens must present evidence of their alien status when they apply for 
Supplemental Security Income (SSI) payments, and periodically 
thereafter as part of the eligibility re-determination process for SSI. 
SSA verifies the validity of the PRUCOL evidence for grandfathered 
nonqualified aliens with the Department of Homeland Security (DHS). SSA 
determines whether the individual is PRUCOL based on the DHS response. 
Without this information, SSA is unable to determine whether the 
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.

[[Page 2115]]



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                                                                                Average  burden  Estimated total
            Collection instrument                Number of       Frequency of    per  response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
Personal or Telephone Interview.............           1,300                1                5              108
----------------------------------------------------------------------------------------------------------------

II

    SSA submitted the information collections below to OMB for 
clearance. Your comments regarding the information collections would be 
most useful if OMB and SSA receive them within 30 days from the date of 
this publication. To be sure we consider your comments, we must receive 
them no later than February 13, 2012. Individuals can obtain copies of 
the OMB clearance packages by calling the SSA Reports Clearance Officer 
at (410) 965-8783 or by writing to the above email address.
    1. Homeless with Schizophrenia Presumptive Disability Pilot 
Demonstration--45 CFR 46.101(b)(5)--0960--NEW. The Federal Strategic 
Plan to Prevent and End Homelessness 2010 calls on Federal agencies to 
work in partnership with State and local governments and with the 
private sector to end homelessness. A specific objective of the 
Strategic Plan is to increase economic security by improving access to 
mainstream programs and services.
    In response to and in support of the President's efforts to end 
homelessness, SSA has developed the Homeless with Schizophrenia 
Presumptive Disability Pilot Demonstration, which tests both 
administrative improvements to the SSI application process and 
interventions that provide financial stability to individuals who are 
homeless. The pilot will test strategies that would remove the barriers 
homeless adult applicants with schizophrenia or schizoaffective 
disorder experience when completing the SSI application process.
    SSA uses two key forms to conduct the demonstration: The Research 
Subject Information and Consent Form and the Schizophrenia Presumptive 
Disability Recommendation Form. The consent form provides assurances 
from the participants that they understand the demonstration project 
and voluntarily are consenting to participate in it. The Presumptive 
Disability Recommendation Form, filled out by a medical authority, 
provides information on how the applicant meets the disability criteria 
necessary to qualify for SSI benefits. SSA uses the information in 
making a presumptive disability determination. Respondents are 
homeless, adult SSI applicants with schizophrenia or schizoaffective 
disorder.
    Type of Request: Request for a new information collection.

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                                                                                  Average burden     Estimated
      Collection instrument          Number of     Frequency of      Number of     per  response   total annual
                                    respondents      response        responses       (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
Consent Form....................             200               1           (200)             120             400
PD Recommendation Form..........              16              13           (208)              10              35
                                 -------------------------------------------------------------------------------
    Totals......................             216  ..............           (408)  ..............             435
----------------------------------------------------------------------------------------------------------------

    2. Partnership Questionnaire--20 CFR 404.1080-1082--0960-0025. SSA 
considers partnership income in determining entitlement to Social 
Security benefits. SSA uses information from the SSA-7104 to determine 
several aspects of eligibility for benefits, including the accuracy of 
reported partnership earnings, the veracity of a retirement, and lag 
earnings. The respondents are applicants for, and recipients of, title 
II Social Security OASDI benefits.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                                         Estimated
                                                                                         Average burden    total
       Collection instrument            Number of       Frequency of      (Number of      per response     annual
                                       respondents        response        responses)       (minutes)       burden
                                                                                                          (hours)
------------------------------------------------------------------------------------------------------- -----------
SSA-7104...........................          12,350                1               30            6,175
----------------------------------------------------------------------------------------------------------------

    3. Supplement to Claim of Person Outside the United States--20 CFR 
404.463, 20 CFR 422.505(b) and 20 CFR 407.27(c)--0960-0051. Claimants 
or beneficiaries (both United States {U.S.{time}  citizens and aliens 
entitled to benefits) living outside the U.S. complete Form SSA-21 as a 
supplement to an application for benefits. SSA collects the information 
to determine eligibility for U.S. Social Security benefits for those 
months an alien beneficiary or claimant is outside the U.S., and to 
determine if tax withholding applies. In addition, SSA uses the 
information to terminate Supplemental Medical Insurance coverage for 
recipients who request it, because they are, or will be, out of the 
U.S. The respondents are individuals entitled to Social Security 
benefits who are, will be, or have been residing outside the U.S. for 
three months or longer.

    Note: This is a correction notice. SSA published the incorrect 
burden information for this collection at 76 FR 65315, on 10/20/11. 
We are correcting this error here.

    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 2116]]



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                                                                                                     Estimated
                                                     Number of     Frequency of   Average burden   total annual
              Collection instrument                  responses       response      per response       burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-21 (non-residents)..........................          36,874               1               5           3,073
SSA-21 (U.S. citizens and residents)............           1,941               1              15             485
                                                 ---------------------------------------------------------------
    Totals......................................          38,815  ..............  ..............           3,558
----------------------------------------------------------------------------------------------------------------

    4. Statement of Funds You Provided to Another and Statement of 
Funds You Received--20 CFR 404.1520(b), 404.1571-.1576, 404.1584-.1593 
and 416.971-.976--0960-0059. SSA uses the SSA-821-BK to collect 
recipient employment information to determine whether recipients worked 
after becoming disabled and, if so, whether the work is substantial 
gainful activity (SGA). SSA's field offices use Form SSA-821-BK to 
obtain work information during the initial claims process, the 
continuing disability review process, and for SSI claims involving work 
issues. SSA's processing centers and the Office of Disability and 
International Operations use the form to document post-adjudicative 
work issues with recipients. SSA reviews and evaluates the data to 
determine if the applicant or recipient meets the disability 
requirements of the law. The respondents are applicants and recipients 
of Title II Social Security and SSI disability payments.

    Note: This is a correction notice: SSA published the incorrect 
burden information for this collection at 76 FR 68805, on 11/07/11. 
We provide the correct burden data below.

    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                 Average burden  Estimated total
            Collection instrument                Number of       Frequency of     per response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-821-BK..................................         300,000                1               30          150,000
----------------------------------------------------------------------------------------------------------------

    5. Application for a Social Security Number Card, and the Social 
Security Number Application Process (SSNAP)--20 CFR 422.103-422.110--
0960-0066. SSA collects information on the SS-5 (used in the United 
States) and SS-5-FS (used outside the United States) to issue original 
or replacement Social Security cards. SSA also enters the application 
data into the Social Security Number Application Process (SSNAP) when 
applicants request a new or replacement card via telephone or in 
person.
    In addition, hospitals collect the same information on SSA's behalf 
for newborn children through the Enumeration-at-Birth process. In this 
process, parents of newborns provide hospital birth registration clerks 
with information required to register these newborns. Hospitals send 
this information to State Bureaus of Vital Statistics (BVS), and they 
send the information to SSA's National Computer Center. SSA then 
uploads the data to the SSA mainframe along with all other enumeration 
data, and we assign the newborn a Social Security Number (SSN) and 
issue a Social Security card.
    The respondents for this collection are applicants for original and 
replacement Social Security cards who use any of the modalities 
described above.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                                     Estimated
                                                    Number of     Frequency of    Average burden   total annual
              Application scenario                 respondents      response       per response       burden
                                                                                    (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
Respondents who do not have to provide parents'      10,500,000               1              8.5       1,487,500
 SSNs..........................................
Respondents whom we ask to provide parents'             400,000               1              9            60,000
 SSNs (when applying for original SSN cards for
 children under age 18)........................
Applicants age 12 or older who need to answer         1,100,000               1              9.5         174,167
 additional questions so SSA can determine
 whether we previously assigned an SSN.........
Applicants asking for a replacement SSN card                600               1             60               600
 beyond the new allowable limits (i.e., who
 must provide additional documentation to
 accompany the application)....................
Authorization to SSA to obtain personal                     500               1             15               125
 information cover letter......................
Authorization to SSA to obtain personal                     500               1             15               125
 information follow-up cover letter............
                                                ----------------------------------------------------------------
    Totals.....................................      12,001,600  ..............  ...............       1,722,517
----------------------------------------------------------------------------------------------------------------

    Cost Burden: The state BVSs incur costs of approximately $9.5 
million for transmitting data to SSA's mainframe. However, SSA 
reimburses the states for these costs.
    6. Application for Search of Census Records for Proof of Age--20 
CFR 404.716-0960-0097. When preferred evidence of age is not available 
or the available evidence is not convincing, SSA may ask the U.S. 
Department of Commerce, Bureau of the Census, to search its records to 
establish a claimant's date of birth. SSA collects information from 
claimants using Form SSA-1535-U3 to provide the Census Bureau with 
sufficient identification information to allow an accurate search of 
census records. Additionally, the Census Bureau uses a completed, 
signed SSA-1535-U3 to bill SSA for the search. The respondents are 
applicants for Social Security benefits who need to

[[Page 2117]]

establish their date of birth as a factor of entitlement.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden  Estimated total
            Collection instrument                Number of       Frequency of    per  response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1535-U3.................................          18,030                1               12            3,606
----------------------------------------------------------------------------------------------------------------

    7. Medical Report on Adult with Allegation of Human 
Immunodeficiency Virus Infection; Medical Report on Child with 
Allegation of Human Immunodeficiency Virus Infection--20 CFR 416.933-20 
CFR 416.934--0960-0500. SSA uses Forms SSA-4814-F5 and SSA-4815-F6 to 
collect information necessary to determine if an individual with human 
immunodeficiency virus infection who is applying for SSI disability 
benefits, meets the requirements for presumptive disability payments. 
The respondents are the medical sources of the applicants for SSI 
disability payments.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden  Estimated total
            Collection instrument                Number of       Frequency of    per  response    annual burden
                                                 responses         response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4814-F5.................................          46,200                1               10            7,700
SSA-4815-F6.................................          12,900                1               10            2,150
                                             -------------------------------------------------------------------
    Totals..................................          59,100   ...............  ...............           9,850
----------------------------------------------------------------------------------------------------------------

    8. Modified Benefit Formula Questionnaire--Foreign Pension--0960-
0561. SSA uses Form SSA-308 to determine exactly how much (if any) of a 
foreign pension SSA may use to reduce the amount of title II Social 
Security retirement or disability benefits under the modified benefit 
formula. The respondents are applicants for title II Social Security 
retirement or disability benefits who have foreign pensions.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden  Estimated total
            Collection instrument                Number of       Frequency of    per  response     annual burden
                                                 responses         response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-308.....................................          13,452                1               10            2,242
----------------------------------------------------------------------------------------------------------------

    9. Medicare Subsidy Quality Review Forms--20 CFR 418(b)(5)-0960-
0707. The Medicare Modernization Act of 2003 mandated the creation of 
the Medicare Part D prescription drug coverage program and provides 
certain subsidies for eligible Medicare beneficiaries to help pay for 
the cost of prescription drugs. As part of its stewardship duties of 
the Medicare Part D subsidy program, SSA must conduct periodic quality 
review checks of the information Medicare beneficiaries report on their 
subsidy applications (Form SSA-1020). SSA uses the Medicare Quality 
Review program to conduct these checks. The respondents are applicants 
for the Medicare Part D subsidy whom SSA chose to undergo a quality 
review.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency of     burden per     total annual
              Collection instrument                 respondents      response        response         burden
                                                                                     (minutes         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-9301 (Medicare Subsidy Quality Review Case             3,500               1              30           1,750
 Analysis Questionnaire)........................
SSA-9302 (Notice of Quality Review                         3,500               1              15             875
 Acknowledgement Form for those with Phones)....
SSA-9303 (Notice of Quality Review                           350               1              15              88
 Acknowledgement Form for those without Phones).
SSA-9304 (Checklist of Required Information;      ..............  ..............  ..............  ..............
 burden accounted for with Forms SSA-9302, SSA-
 9303, SSA-9311, SSA-9314)......................
SSA-9308 (Request for Information)..............           7,000               1              15           1,750
SSA-9310 (Request for Documents)................           3,500               1               5             292
SSA-9311 (Notice of Appointment--Denial-Reviewer             450               1              15             113
 Will Call).....................................
SSA-9312 (Notice of Appointment--Denial- Please               50               1              15              13
 Call Reviewer).................................
SSA-9313 (Notice of Quality Review                         2,500               1              15             625
 Acknowledgement Form for those with Phones)....
SSA-9314 (Notice of Quality Review                           500               1              15             125
 Acknowledgement Form for those without Phones).

[[Page 2118]]

 
SSA-8510 (Authorization to the Social Security             3,500               1               5             292
 Administration to Obtain Personal Information).
                                                 ---------------------------------------------------------------
    Totals......................................          24,850  ..............  ..............           5,923
----------------------------------------------------------------------------------------------------------------

    10. Application to Collect a Fee for Payee Service--20 CFR 
416.640.640(a), 416.1103(f)--0960-0719. Sections 205(j)(4)(A) and (B) 
and 1631(a)(2) of the Social Security Act (Act) allow SSA to authorize 
certain organizational representative payees to collect a fee for 
providing payee services. Before an organization may collect this fee, 
they complete and submit Form SSA-445. SSA uses the information to 
determine whether to authorize or deny permission to collect fees for 
payee services. The respondents are private sector businesses or State 
and local government offices applying to become fee-for-service 
organizational representative payees.
    Type of Request: Revision of an OMB-approved information 
collection.

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                                                                                                     Estimated
                                                     Number of     Frequency of   Average burden   total annual
              Collection instrument                  responses       response      per response       burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
Private sector business.........................              90               1              10              15
State/local government offices..................              10               1              10               2
                                                 ---------------------------------------------------------------
    Totals......................................             100  ..............  ..............              17
----------------------------------------------------------------------------------------------------------------


    Dated: January 10, 2012.
Faye Lipsky,
Reports Clearance Officer, Office of Regulations and Reports Clearance, 
Social Security Administration.
[FR Doc. 2012-580 Filed 1-12-12; 8:45 am]
BILLING CODE 4191-02-P


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