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[Federal Register Volume 65, Number 230 (Wednesday, November 29, 2000)]
[Notices]
[Pages 71195-71197]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-30403]

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SOCIAL SECURITY ADMINISTRATION

Agency Information Collection Activities: Proposed Request and 
Comment Request

    In compliance with Public Law 104-13, the Paperwork Reduction Act 
of 1995, SSA is providing notice of its information collections that 
require submission to the Office of Management and Budget (OMB). The 
Social Security Administration (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 on ways to minimize burden on respondents, including the 
use of automated collection techniques or other forms of information 
technology.
    I. The information collections listed below will be submitted to 
OMB within 60 days from the date of this notice. Therefore, comments 
and recommendations regarding the information collections would be most 
useful if received by the Agency within 60 days from the date of this 
publication. Comments should be directed to the SSA Reports Clearance 
Officer at the address listed at the end of this publication. You can 
obtain a copy of the collection instruments by calling the SSA Reports 
Clearance Officer on (410) 965-4145, or by writing to him at the 
address listed at the end of this publication.
    1. Application for Benefits Under The Federal Mine And Safety And 
Health Act Of 1977, as Amended (Widow's Claim, Child's Claim And 
Dependent's Claim)--0960-0118. Section 402(g) and Section 412(a) of the 
Federal Mine Safety and Health Act provide that those widows, surviving 
children and dependent parents, brothers and sisters who are not 
currently receiving benefits on the deceased miner's account must

[[Page 71196]]

file the appropriate application for Black Lung benefits within 6 
months of the deceased miner's death. Forms SSA-47-F4, SSA-48-F4, and 
SSA-49-F3 are used to collect the information needed by the SSA to 
determine eligibility for benefits. The respondents are widows, 
surviving children and dependents (parents, brothers or sisters) who 
are not currently receiving Black Lung benefits on the deceased miner's 
account.

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                                                                     SSA-47-F4       SSA-48-F4       SSA-49-F3
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Number of Respondents...........................................             600             600             600
Frequency of Response...........................................               1               1               1
Average Burden Per Response (minutes)...........................              11              11              11
Estimated Annual Burden (hours).................................             110             110             110
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    2. Representative Payee Report of Benefits and Dedicated Account--
0960-0576. Form SSA-6233 is used to ensure that the representative 
payee is using the benefits received for the beneficiary's current 
maintenance and personal needs and that expenditures of funds from the 
dedicated account are in compliance with the law. The respondents are 
individuals and organizational representative payees who are required 
by law to establish a separate (``dedicated'') account in a financial 
institution for certain past-due SSI benefits.
    Number of Respondents: 30,000.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 10,000 hours.
    3. Physician's/Medical Officer's Statement of Patient's Capability 
to Manage Benefits--0960-0024. SSA uses the information collected on 
Form SSA-787 to determine an individual's capability, or lack thereof, 
to handle his or her own benefits. The information also provides SSA 
with leads to follow in selecting a representative payee, if needed. 
The respondents are physicians of these beneficiaries.
    Number of Respondents: 120,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 20,000 hours.
    4. Request for Internet Service--Password--0960-NEW. SSA will 
collect and use information to establish a PIN/Password Data File. The 
file will be used to allow customers to conduct electronic business 
with the Agency. SSA will request the following information: Name, 
Social Security Number, Password Request Code, Last Month Payment 
Amount and Director Deposit Account Number (if applicable). The 
respondents are individuals electing to conduct business with SSA in 
the electronic medium.
    Number of Respondents: 250,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 41,667 hours.
    5. Internet Social Security Benefits Applications (also known as 
ISBA)--0960-0618. The ISBA (formerly the Internet Retirement Insurance 
Benefit or IRIB application) is one application that the Commissioner 
of Social Security will prescribe to meet the requirement to file an 
application for title II retirement and/or spouse's benefits. The ISBA 
will be available on the Social Security Administration Internet site 
and will enable individuals to complete the application electronically 
on their own and submit the application over the Internet. Until SSA 
develops an acceptable electronic signature process, applicants will 
also print, sign and mail the IBSA statement with the required evidence 
that supports their application. The information that SSA collects will 
be used to determine entitlement to retirement insurance benefits. The 
respondents are individuals and their spouses, if applicable, who 
choose to apply for title II benefits over the Internet.
    Number of Respondents: 189,764.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Annual Burden: 63,255 hours.
    6. Discrimination Complaint Form--0960-0585. The information 
collected on form SSA-437 will be used by SSA to investigate and 
informally resolve complaints of discrimination based on race, color, 
national, origin, sex, age religion and retaliation in any program or 
activity conducted by SSA. A person who believes that he or she has 
been discriminated against on any of the above bases may file a written 
complaint of discrimination. The information will be used to identify 
the complainant; identify the alleged discriminatory act; ascertain the 
date of such alleged act; obtain the identity of the individual(s)/
facility/component that allegedly discriminated; and ascertain other 
relevant information that would assist in the investigation and 
resolution of the complaints. The respondents are individuals who 
allege discrimination on the grounds described above.
    Number of Respondents: 300.
    Frequency of Response: 1.
    Average Burden Per Response: 1 hour.
    Estimated Annual Burden: 300 hours.
    7. Claimant's Statement When Request for Hearing is Filed and the 
Issue is Disability--0960-0316. SSA requests that a claimant complete 
an HA-4486 when a claim for title II disability benefits or title XVI 
Supplemental Security Income benefits is denied and the claimant wishes 
a hearing before an Administrative Law Judge (ALJ). SSA uses this form 
to obtain updated information on the claimant's medical treatment to 
assist the ALJ in preparing for the hearing and in issuing a decision 
on entitlement to benefits. The respondents are individuals whose 
claims have been denied and who want a hearing before an ALJ.
    Number of Respondents: 442,720.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 110,680.
    II. The information collections listed below have been submitted to 
OMB for clearance. Written comments and recommendations on the 
information collections would be most useful if received within 30 days 
from the date of this publication. Comments should be directed to the 
SSA Reports Clearance Officer and the OMB Desk Officer at the addresses 
listed at the end of this publication. You can obtain a copy of the OMB 
clearance packages by calling the SSA Reports Clearance Officer on 
(410) 965-4145, or by writing to him.
    1. National Teacher Questionnaire (SSA-5665-BK), and Information 
About the Working Age Child (SSA-5665-SUPP)--0960-New. The information 
collected on forms SSA-5665-BK and SSA-5665-Sup is used by the Social 
Security Administration (SSA) and the State Disability Determination 
Services (DDS) to obtain descriptions of children claiming SSI benefits 
based on disability and their ability to function on a daily basis. The 
forms will be used for initial determinations of eligibility, in 
appeals

[[Page 71197]]

and in initial continuing disability reviews.
    These forms are being developed because the forms currently used by 
the DDSs vary in format and content. It was decided that for the sake 
of a uniform national childhood program (and with this information in 
hand and the sensitivity of this population), the time has come for a 
National Teacher Questionnaire and Information About the Working Age 
Child. The respondents are the educational community and small 
businesses that educate and/or employ applicants for Supplemental 
Security Income for the aged, blind, and Disabled.

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                                            SSA-5665-BK    SSA-5665-Sup
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Number of Respondents...................         475,000         125,000
Frequency of Response...................               1               1
Average Burden Per Response (minutes)...           15-20            5-10
Estimated Annual Burden (hours).........         158,333          20,833
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    2. Beneficiary Recontact Report--0960-0536. SSA collects the 
information on Form SSA-1587 to ensure that eligibility for benefits 
continues after entitlement is established. SSA asks children ages 15, 
16, and 17 information about marital status to detect overpayments and 
avoid continuing payment to those no longer entitled. Studies show that 
children who marry fail to report the marriage, which is a terminating 
event. The respondents are applicants for Title II (Old-Age, Survivors 
and Disability Insurance) Children/Beneficiaries who are ages 15, 16, 
and 17.
    Number of Respondents: 982,357.
    Frequency of Response: 1.
    Average Burden Per Response: 3 minutes.
    Estimated Annual Burden: 49,118 hours.
    3. Questionnaire About Employment or Self-Employment Outside the 
United States, 0960-0050. This information is used by SSA to determine 
whether work performed by beneficiaries outside the United States 
(U.S.) is cause for deductions from their monthly benefits; to 
determine which of two work tests (foreign or regular) is applicable; 
and to determine the months, if any, for which deductions should be 
imposed. The respondents are beneficiaries living and working outside 
the U.S.
    Number of Respondents: 20,000.
    Frequency of Response: 1.
    Average Burden Per Response: 12 minutes.
    Estimated Annual Burden: 4,000 hours.
(SSA Address)
Social Security Administration, DCFAM, Attn: Frederick W. Brickenkamp, 
1-A-21 Operations Bldg., 6401 Security Blvd., Baltimore, MD 21235.
(OMB Address)
Office of Management and Budget, OIRA, Attn: Desk Officer for SSA, New 
Executive Office Building, Room 10230, 725 17th St., NW., Washington, 
DC 20503.

    Date: November 22, 2000.
Elizabeth A. Davidson,
Acting Reports Clearance Officer, Social Security Administration.
[FR Doc. 00-30403 Filed 11-28-00; 8:45 am]
BILLING CODE 4191-02-P
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