[Federal Register Volume 74, Number 10 (Thursday, January 15, 2009)]
[Notices]
[Pages 2642-2644]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-596]



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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 (Pub. L.) 
104-13, the Paperwork Reduction Act of 1995, effective October 1, 1995. 
This notice includes a revision to an OMB-approved 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 the 
burden on respondents, including the use of automated collection 
techniques or other forms of information technology. Mail, e-mail, or 
fax your comments and recommendations on the information collection(s) 
to the OMB Desk Officer and the SSA Reports Clearance Officer to the 
addresses or fax numbers listed below.

(OMB), Office of Management and Budget, Attn: Desk Officer for SSA, 
Fax: 202-395-6974, E-mail address: <a href="/cdn-cgi/l/email-protection#0847415a49575b7d6a65617b7b6167664867656a266d6778266f677e"><span class="__cf_email__" data-cfemail="eca3a5beadb3bf998e81859f9f858382ac83818ec289839cc28b839a">[email protected]</span></a>.
(SSA), Social Security Administration, DCBFM, Attn: Reports Clearance 
Officer, 1332 Annex Building, 6401 Security Blvd., Baltimore, MD 21235, 
Fax: 410-965-6400, E-mail address: <a href="/cdn-cgi/l/email-protection#e3acb3afaecdb1a0aca3909082cd848c95"><span class="__cf_email__" data-cfemail="226d726e6f0c70616d625151430c454d54">[email protected]</span></a>.

    I. The information collection below is pending at SSA. SSA will 
submit it to OMB within 60 days from the date of this notice. 
Therefore, your comments would be most helpful if you submit them to 
SSA within 60 days from the date of this publication. Individuals can 
obtain copies of the collection instrument by calling the SSA Reports 
Clearance Officer at 410-965-3758 or by writing to the e-mail address 
listed above.
    1. Physician's/Medical Officer's Statement of Patient's Capability 
to Manage Benefits--20 CFR 404.2015 and 416.615--0960-0024. SSA uses 
the information collected on Form SSA-787 to determine an individual's 
capability to handle his or her own benefits. This information assists 
SSA in determining the need for a representative payee. The respondents 
are physicians of the beneficiaries' or medical officers of the 
institution in which the recipients reside.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 24,000.
    Frequency of Response: 1.
    Average Burden per Response: 15 minutes.
    Estimated Annual Burden: 6,000 hours.
    2. Letter to Employer Requesting Wage Information--20 CFR 404.726--
0960-0138. SSA uses Form SSA-L4201 to collect information from 
employers to establish and/or verify wage information for Supplemental 
Security Income (SSI) claimants and recipients. SSA also uses the 
information to determine eligibility and proper payment for SSI. The 
respondents are employers of applicants for and recipients of SSI 
payments.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 133,000.
    Frequency of Response: 1.
    Average Burden per Response: 30 minutes.
    Estimated Annual Burden: 66,500 hours.
    3. Statement of Living Arrangements, In-Kind Support and 
Maintenance--20 CFR 416.1130-416.1148--0960-0174. SSA uses Form SSA-
8006-F4 to establish in-kind support and maintenance for SSI applicants 
and recipients. A recipient's need is the basis for determining SSI 
payments. Need is measured, in part, by the amount of income an 
individual receives. Income includes in-kind support and maintenance in 
the form of food and shelter provided by other persons. Form SSA-8006-
F4 collects information to ensure that recipients are eligible to 
receive SSI payments and to determine the correct amount of payments 
due. The information permits SSA Administrative Law Judges to determine 
the income value of in-kind support and maintenance received by SSI 
applicants and recipients. The respondents are individuals who apply 
for SSI payments, or complete an SSI eligibility redetermination.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 173,380.
    Frequency of Response: 1.
    Average Burden per Response: 7 minutes.
    Estimated Annual Burden: 20,228 hours.
    4. Supplemental Security Income (SSI) Claim Information Notice--20 
CFR 416.210--0960-0324. SSA uses Form SSA-L8050-U3 to collect 
information on whether an SSI recipient is using all sources of 
potential income for his or her own support. SSI supplements other 
income an individual has available. Respondents are SSI applicants or 
recipients who may be eligible for benefits from public or private 
programs.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 7,500.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 1,250 hours.
    5. Permanent Residence Under Color of the Law (PRUCOL)--20 CFR 
416.1615 and 416.1618--0960-0451. As discussed in SSA regulations at 20 
CFR 416.1415 and 416.1618, a PRUCOL alien must present evidence of his/
her alien status at application and periodically thereafter as part of 
the eligibility determination process for SSI. SSA verifies the 
validity of the evidence of PRUCOL for grandfathered nonqualified 
aliens with the Department of Homeland Security (DHS). Based on the DHS 
response, SSA will determine whether the individual is PRUCOL. Without 
this information, SSA is unable to determine whether the individual is 
eligible for SSI payments. The respondents are individuals who have 
alien status and live in the United Sates.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 1,300.
    Frequency of Response: 1.
    Average Burden per Response: 5 minutes.
    Estimated Annual Burden: 108 hours.
    6. QuickStart Automated Enrollment System--31 CFR 210--0960-0564. 
The financial institutions (FIs) collect Direct Deposit (DD)/Electronic 
Funds Transfer (EFT) information from their depositors who are 
enrolling for the first time, or who are changing DD/EFT information. 
Information needed to enroll under QuickStart is included in the 
Department of Treasury's Green Book, which is available online. The 
Department of Treasury's Green Book provides the data elements the 
recipient completes in order to enroll in direct deposit. The recipient 
submits the DD/EFT information electronically; therefore, it is not an 
SSA-prescribed form used to send information to Government agencies. 
SSA collects this information to facilitate electronic payment of 
funds. The respondents are Social Security, SSI recipients, and their 
FIs.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 3,950,000.
    Frequency of Response: 1.
    Average Burden per Response: 3 minutes.
    Estimated Annual Burden: 197,500 hours.
    7. Certification of Low Birth Weight for SSI Eligibility of Funds 
You Provided to Another and Statement of

[[Page 2643]]

Funds You Received--20 CFR 416.931, 416.926a(m), (7) and (8) and 
416.924--0960-0720. Form SSA-3830 assists hospitals and claimants who 
file on behalf of children in providing local field offices (FOs) and 
Disability Determination Services (DDSs) with medical information for 
determining disability of low birth weight infants. FOs use the forms 
as protective filing statements, and the medical information for making 
presumptive disability findings, which allow expedited payment to 
eligible claimants. DDSs use the medical information to determine 
disability and the most appropriate continuing disability review 
diaries. The respondents are hospitals that have information 
identifying low birth weight babies and medical conditions those babies 
may have.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 24,000.
    Frequency of Response: 1.
    Average Burden per Response: 15 minutes.
    Estimated Annual Burden: 6,000 hours.
    II. SSA has submitted the information collections listed below to 
OMB for clearance. Your comments on the information collections would 
be most useful if received by OMB and SSA within 30 days from the date 
of this publication. You can obtain a copy of the OMB clearance 
packages by calling the SSA Reports Clearance Officer at 410-965-3758, 
or by writing to the above listed address.
    1. Application for Mother's or Father's Insurance Benefits--20 CFR 
404.339-404.342, 20 CFR 404.601-404.603--0960-0003. The Social Security 
Act provides for the payment of monthly benefits to the widow or 
widower of an insured individual if the surviving spouse is caring for 
the deceased worker's child who is entitled to Social Security 
benefits. SSA uses the information collected on Form SSA-5-F6 to 
entitle an individual to their mother's or father's insurance benefits 
under the Old Age, Survivors and Disability Insurance (OASDI) program.
    SSA published this information collection in the 60-day Federal 
Register Notice on October 27, 2008 at FR 63761 as an extension of an 
OMB-approved information collection. Since then SSA made revisions and 
has changed the type of request to a revision to an OMB-approved 
information collection.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                     Estimated
                        Collection method                            Number of      completion     Burden hours
                                                                    respondents   time (minutes)
----------------------------------------------------------------------------------------------------------------
MCS.............................................................          26,045              15           6,511
MCS/Signature Proxy.............................................          26,044              14           6,077
Paper...........................................................           1,611              15             403
                                                                 -----------------------------------------------
    Totals......................................................          53,700  ..............          12,991
----------------------------------------------------------------------------------------------------------------

    2. Supplement to Claim of Person Outside the United States--20 CFR 
404.460, 404.463, 422.505(b), 42 CFR 407.27(c)--0960-0051. SSA uses the 
information it collects on Form SSA-21 to determine continuing 
entitlement to Social Security benefits and the proper benefit amounts 
of alien beneficiaries living outside the United States. SSA also uses 
the information to determine whether benefits are subject to 
withholding tax. The respondents are individuals entitled to Social 
Security benefits who are, will be, or have been residing outside the 
United States.
    Type of Request: Revision of an OMB approved information 
collection.
    Number of Respondents: 35,000.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 5,833 hours.
    3. Coverage of Employees of State and Local Governments--20 CFR 
404, Subpart M--0960-0425. The Code of Federal Regulations at 20 CFR 
404, Subpart M prescribes the rules for states submitting reports of 
deposits and related recordkeeping to SSA. States (and interstate 
instrumentalities) are required to provide wage and deposit-related 
contribution information for pre-1987 periods. The respondents are 
state and local governments or interstate instrumentalities.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 52.
    Frequency of Response: 1.
    Average Burden per Response: 1 hour.
    Estimated Annual Burden: 52 hours.
    4. Marital Relationship Questionnaire--20 CFR 416.1826--0960-0460. 
SSA collects information on Form SSA-4178 to determine, for SSI 
purposes, whether unrelated individuals of the opposite sex who live 
together are holding themselves out to the public as husband and wife. 
SSA needs this information to determine whether we are making correct 
payments to SSI couples and individuals. The respondents are applicants 
for and recipients of SSI payments.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 5,100.
    Frequency of Response: 1.
    Average Burden per Response: 5 minutes.
    Estimated Annual Burden: 425 hours.
    5. Medical Report on Child with Allegation of Human 
Immunodeficiency Virus Infection--20 CFR 416.993-416-994--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 (HIV) 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.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 59,100.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 9,850.
    6. Public Information Campaign--0960-0544. Periodically, SSA sends 
various public information materials, including public service 
announcements, news releases, and educational tapes, to public 
broadcasting systems so they can inform the public about various 
programs and activities conducted by SSA. SSA will frequently send 
follow-up business reply cards for these public information materials 
to obtain suggestions for improving them. The respondents are media 
sources who have received public information campaign materials (e.g., 
broadcast television and radio media sources).

[[Page 2644]]

    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 6,000.
    Frequency of Response: 2.
    Average Burden per Response: 1 minute.
    Estimated Annual Burden: 200 hours.
    7. Application to Collect a Fee for Payee Services--416.640.640(a), 
416.1103(f)--0960-0719. SSA uses information it collects on Form SSA-
445 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 a fee-for-
service organizational representative payee. SSA published this 
information collection in the 60-day Federal Register Notice on 
September 17, 2008 at FR 53919 as an extension of an OMB-approved 
information collection. Since then SSA made revisions and has changed 
the type of request to a revision to an OMB-approved information 
collection.
    Type of Request: Revision to an OMB-approved information 
collection.
    Number of Respondents: 100.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 17 hours.

    Dated: January 8, 2009.
John Biles,
Reports Clearance Officer, Center for Reports Clearance, Social 
Security Administration.
[FR Doc. E9-596 Filed 1-14-09; 8:45 am]
BILLING CODE 4191-02-P


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