[Federal Register Volume 77, Number 69 (Tuesday, April 10, 2012)]
[Notices]
[Pages 21616-21618]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-8546]


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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 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#612e2833203e3214030c081212080e0f210e0c034f040e114f060e17"><span class="__cf_email__" data-cfemail="a0efe9f2e1fff3d5c2cdc9d3d3c9cfcee0cfcdc28ec5cfd08ec7cfd6">[email protected]</span></a>.
(SSA), Social Security Administration, DCRDP, Attn: Reports Clearance 
Director, 107 Altmeyer Building, 6401 Security Blvd., Baltimore, MD 
21235, Fax: 410-966-2830, Email address: <a href="/cdn-cgi/l/email-protection#cc839c8081e29e8f838cbfbfade2aba3ba"><span class="__cf_email__" data-cfemail="c58a958988eb97868a85b6b6a4eba2aab3">[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 June 
11, 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 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)

[[Page 21617]]

must notify SSA about their WC/PDB, so the agency can compute the 
correct reduction of Social Security disability payments. SSA considers 
the claimants the primary sources of verification; therefore, if 
claimants provide necessary evidence, such as a copy of their award 
notice, benefit check, etc., that is sufficient.
    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
            Collection instrument                Number of       Frequency of     per response     total annual
                                                respondents        response        (minutes)      burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1709....................................         120,000                1               15           30,000
----------------------------------------------------------------------------------------------------------------

    2. Claimant's Medication--20 CFR 404.1512, 416.912--0960-0289. In 
cases where claimants request a hearing after denial of their claim for 
Social Security benefits, SSA uses Form HA-4632 to obtain information 
from the claimant about medications they are using. This information 
helps the administrative law judge overseeing the case to fully 
investigate (1) the claimant's medical treatment and (2) the effects of 
the medications on the claimant's medical impairment and functional 
capacity. The respondents are applicants (or their representatives) for 
Social Security benefits or payments requesting a hearing to contest an 
agency denial of their claim.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Frequency  of    burden per       Estimated
                Collection method                   respondents      response        response      total annual
                                                                                     (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
HA-4632 (paper).................................          20,000               1              15           5,000
Electronic Records Express......................         180,000               1              15          45,000
                                                 ---------------------------------------------------------------
    Total.......................................         200,000  ..............  ..............          50,000
----------------------------------------------------------------------------------------------------------------

    3. Representative Payee Report--Special Veterans Benefits--20 CFR 
408.665--0960-0621. Title VIII of the Social Security Act allows for 
payment of monthly Social Security benefits to qualified World War II 
veterans residing outside the United States. An SSA-appointed 
representative payee may receive and manage the monthly payment for the 
beneficiary's use and benefit. SSA uses the information from Form SSA-
2001-F6 to determine if the payee is using the benefits properly on 
behalf of the beneficiary. Respondents are persons or organizations who 
act on behalf of beneficiaries who receive Special Veterans Benefits 
and live outside the United States.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden     Estimated
            Collection instrument                Number of      Frequency  of     per response     total annual
                                                respondents        response        (minutes)      burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-2001-F6.................................             100                1               10               17
----------------------------------------------------------------------------------------------------------------

    4. Representative Payment Policies Regulation--20 CFR 404.2011, 
404.2025, 416.611, 416.625--0960-0679. If SSA determines it may cause 
substantial harm for beneficiaries to receive their payments directly, 
beneficiaries may dispute that decision. To do so, beneficiaries must 
provide SSA with information the agency will use to re-evaluate its 
determination. In addition, after SSA selects a representative payee to 
receive benefits on a beneficiary's behalf, the payees provide SSA with 
information on their continuing relationship and responsibility for the 
beneficiaries, and explain how they use the beneficiaries' payments. 
This Information Collection Request includes the CFR citations that 
mandate the above provisions.
    Type of Request: Extension of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Frequency  of    burden per       Estimated
                   CFR Section                      respondents      response        response      annual burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
404.2011(a)(1), 416.611(a)(1)...................             250               1              15              63
404.2025, 416.625...............................           3,000               1               6             300
                                                 ---------------------------------------------------------------
    Totals......................................           3,250  ..............  ..............             363
----------------------------------------------------------------------------------------------------------------


[[Page 21618]]

    II. SSA submitted the information collection below to OMB for 
clearance. Your comments regarding the information collection 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 May 10, 2012. Individuals can obtain copies of the 
OMB clearance packages by calling the SSA Reports Clearance Director at 
410-965-8783 or by writing to the above email address.
    Third Party Liability Information Statement--42 CFR 433.136-
433.139--0960-0323. 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.
    To reduce Medicaid costs, Medicaid state agencies must identify 
third party insurers liable for medical care or services for Medicaid 
beneficiaries. Regulations at 42 CFR 433.136-433.139 require Medicaid 
state agencies to obtain this information on Medicaid applications and 
redeterminations as a condition of Medicaid eligibility. 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. Under the Medicaid 
agreements, SSA obtains third party liability information using Form 
SSA-8019, and provides that information to the Medicaid state agencies. 
The respondents are SSI claimants and recipients.

    Note:  This is a correction notice: SSA published this 
information collection as an extension on January 31, 2012 at 77 FR 
4854. Since we are revising the Privacy Act Statement, this is now a 
revision of an OMB-approved information collection.

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

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Frequency  of    burden per       Estimated
              Collection instrument                  responses       response        response      total annual
                                                                                     (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-8012 Paper form.............................             130               1               5              11
Modernized SSI Claims System (MSSICS)...........          66,904               1               5           5,575
                                                 ---------------------------------------------------------------
    Totals......................................          67,034  ..............  ..............           5,586
----------------------------------------------------------------------------------------------------------------


    Dated: April 5, 2012.
Faye Lipsky,
Reports Clearance Director, Office of Regulations and Reports 
Clearance, Social Security Administration.
[FR Doc. 2012-8546 Filed 4-9-12; 8:45 am]
BILLING CODE 4191-02-P


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