[Federal Register Volume 74, Number 78 (Friday, April 24, 2009)]
[Notices]
[Pages 18782-18786]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-9318]


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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 revisions and extensions of OMB-approved 
Information Collections and a new 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

[[Page 18783]]

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#84cbcdd6c5dbd7f1e6e9edf7f7edebeac4ebe9e6aae1ebf4aae3ebf2"><span class="__cf_email__" data-cfemail="aae5e3f8ebf5f9dfc8c7c3d9d9c3c5c4eac5c7c884cfc5da84cdc5dc">[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#9bd4cbd7d6b5c9d8d4dbe8e8fab5fcf4ed"><span class="__cf_email__" data-cfemail="0c435c4041225e4f434c7f7f6d226b637a">[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. To be 
sure we consider your comments, we must receive them no later than June 
23, 2009. 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. Social Security Benefits Application--20 CFR 404.310-.311, 
.315-.322, .330-.333, .601-.603, and .1501-.1512--0960-0618. This 
collection comprises the various application modalities for retirement, 
survivors, and disability benefits. These modalities include paper 
forms (SSA Forms SSA-1, SSA-2, and SSA-16), Modernized Claims System 
(MCS) screens for in-person field office interview applications, and 
the Internet-based iClaim application. This information collection 
request (ICR) will expand the potential user base for the iClaim.
    Type of Collection: Revision to an existing OMB-approved 
information collection.
    Paper Forms/Accompanying MCS Screens Burden Information:

                                                   Form SSA-1
----------------------------------------------------------------------------------------------------------------
                                                                                  Average burden     Estimated
                Collection method                    Number of     Frequency of     per response   annual burden
                                                    respondents      response          (min)          (hours)
----------------------------------------------------------------------------------------------------------------
MCS.............................................         172,200               1              11          31,570
MCS/Signature Proxy.............................       1,549,800               1              10         258,300
Paper...........................................          21,000               1              11           3,850
Medicare-only MCS...............................         299,000               1               7          34,883
Medicare-only Paper.............................           1,000               1               7             117
                                                 ---------------------------------------------------------------
    Totals......................................       2,043,000  ..............  ..............         328,720
----------------------------------------------------------------------------------------------------------------


                                                   Form SSA-2
----------------------------------------------------------------------------------------------------------------
                                                                                  Average burden     Estimated
                Collection method                    Number of     Frequency  of    per response   annual burden
                                                    respondents      response          (min)          (hours)
----------------------------------------------------------------------------------------------------------------
MCS.............................................          36,860               1              15           9,215
MCS/Signature Proxy.............................         331,740               1              14          77,406
Paper...........................................           3,800               1              15             950
                                                 ---------------------------------------------------------------
    Totals......................................         372,400  ..............  ..............          87,571
----------------------------------------------------------------------------------------------------------------


                                                   Form SSA-16
----------------------------------------------------------------------------------------------------------------
                                                                                  Average burden     Estimated
                Collection method                    Number of     Frequency  of    per response   annual burden
                                                    respondents      response          (min)          (hours)
----------------------------------------------------------------------------------------------------------------
MCS.............................................         218,657               1              20          72,886
MCS/Signature Proxy.............................       1,967,913               1              19         623,172
Paper...........................................          24,161               1              20           8,054
                                                 ---------------------------------------------------------------
    Totals......................................       2,210,731  ..............  ..............         704,112
----------------------------------------------------------------------------------------------------------------


                                            iClaim Burden Information
----------------------------------------------------------------------------------------------------------------
                                                                                  Average burden     Estimated
                    Form type                        Number of     Frequency of     per response   annual burden
                                                    respondents      response          (min)          (hours)
----------------------------------------------------------------------------------------------------------------
iClaim 3rd Party................................          28,118               1              15           7,030
iClaim Applicant after 3rd Party Completion.....          28,118               1               5           2,343
First Party iClaim..............................         541,851               1              15         135,463
Medicare-only iClaim............................         200,000               1              10          33,333
                                                 ---------------------------------------------------------------
    Totals......................................         798,087  ..............  ..............         178,169
----------------------------------------------------------------------------------------------------------------


[[Page 18784]]

    Aggregate Public Reporting Burden: 1,298,572 hours.
    2. Electronic Records Express (Third Parties)--20 CFR 404.1700-
404.1715--0960-0767. Electronic Records Express is an online system 
that enables medical providers and various third party representatives 
to submit disability claimant information electronically to SSA as part 
of the disability application process. We are revising this OMB number 
to add new functionality for third parties who use this system.
    Type of Request: Revision of an existing OMB-approved information 
collection.
    Number of Respondents: 66,000.
    Frequency of Response: 40.
    Average Burden per Response: 1 minute.
    Estimated Annual Burden: 44,000 hours.
    3. Registration of Individual for Appointed Representative 
Services--0960-0732. SSA uses Form SSA-1699 to register the following 
people:
    <bullet> Individuals appointed as representatives;
    <bullet> Individuals who will perform advocacy services on behalf 
of an appointed representative;
    <bullet> Individuals who will act on behalf of an appointed 
representative and want access to our electronic services;
    <bullet> Individuals who will serve as administrators for an entity 
appointed as a representative.

By registering these individuals, SSA: (1) Authenticates and authorizes 
them to do business with us; (2) allows them access to our records for 
the claimants they represent; (3) facilitates direct payment of 
authorized fees to appointed representatives; and (4) collects 
information needed to meet Internal Revenue Service (IRS) requirements 
to issue specific IRS forms, if we pay these representatives in excess 
of a specific amount ($600).
    This ICR is for changes we will implement later in the year. The 
respondents are appointed claimant representatives.
    Type of Request: Revision to an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                  Average burden     Estimated
               Collection  method                    Number of     Frequency of     per response   annual burden
                                                    respondents      response          (min)          (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1699 (paper form)...........................          52,800               1              30          26,400
Internet-based SSA-1699.........................          13,200               1              22           4,840
                                                 ---------------------------------------------------------------
    Totals......................................          66,000  ..............  ..............          31,240
----------------------------------------------------------------------------------------------------------------

    4. State Agency Report of Obligations for SSA Disability Programs 
(SSA-4513); Time Report of Personnel Services for Disability 
Determination Services (SSA-4514); State Agency Schedule of Equipment 
Purchased for SSA Disability Programs (SSA-871)--20 CFR 404.1626--0960-
0421. SSA uses Forms SSA-4513, SSA-4514, and SSA-871 to collect data 
necessary for detailed analysis and evaluation of costs State 
Disability Determination Services (DDS) incur in making disability 
determinations for SSA. SSA also utilizes the data to determine funding 
levels for each DDS. Respondents are State DDSs.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 54.
    Estimated Annual Burden: 756 hours.

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                       Average burden       Estimated
                                                                   Respondents      Frequency of      Total annual      per response      annual burden
                                                                                      response          responses           (min)            (hours)
--------------------------------------------------------------------------------------------------------------------------------------------------------
SSA-4513 & Addendum...........................................                54                 4               216                90               324
SSA-4514......................................................                54                 4               216                90               324
SSA-871.......................................................                54                 4               216                30               108
                                                               -----------------------------------------------------------------------------------------
    Total.....................................................               162  ................  ................  ................               756
--------------------------------------------------------------------------------------------------------------------------------------------------------

    5. Application for Special Benefits for World War II Veterans--20 
CFR 408, Subparts B, C and D--0960-0615. Title VIII of the Social 
Security Act (Special Benefits for Certain World War II Veterans) 
allows a qualified World War II veteran who resides outside the United 
States to receive monthly payments. The regulations set out the 
requirements an individual needs to meet to qualify for and become 
entitled to Special Veterans Benefits (SVB). SSA uses Form SSA-2000-F6 
to elicit the information necessary to determine entitlement to SVB. 
The respondents are individuals who are applying for SVB under Title 
VIII of the Social Security Act.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                               Average burden       Estimated
               Section No.                    Number of       Frequency of      per response      annual burden
                                             respondents        response            (min)            (hours)
----------------------------------------------------------------------------------------------------------------
Sec.   408.202(d); Sec.   408.210; Sec.                100                 1                20                33
  408.230(a); Sec.   408.305; Sec.  Sec.
   408.310-.315.........................
Sec.   408.232(a).......................                 1                 1                15                 0
Sec.   408.320..........................                 1                 1                15                 0
Sec.   408.340..........................                 1                 1                15                 0
Sec.   408.345..........................                 1                 1                15                 0
Sec.   408.351(d) & (f).................                 1                 1                30                 1
Sec.   408.355(a).......................                 1                 1                15                 0
Sec.   408.360(a).......................                 1                 1                15                 0
Sec.   408.404(c).......................                 6                 1                15                 2
Sec.  Sec.   408.410-.412...............                 6                 1                15                 2

[[Page 18785]]

 
Sec.   408.420(a), (b)..................                71                 1                15                18
Sec.  Sec.   408.430 & .432.............                66                 1                30                33
Sec.   408.435(a), (b), (c).............                71                 1                15                18
Sec.   408.437(b), (c), (d).............                 6                 1                30                 3
                                         -----------------------------------------------------------------------
    Totals..............................               333  ................  ................               110
----------------------------------------------------------------------------------------------------------------

    II. SSA has submitted the information collections listed below to 
OMB for clearance. Your comments on 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 May 26, 2009. 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 e-mail address.
    1. Request for Withdrawal of Application--20 CFR 404.640--0960-
0015. Individuals complete Form SSA-521 to request withdrawal of an 
application for benefits. SSA uses the information from Form SSA-521 to 
process the request for withdrawal. The respondents are applicants for 
Old Age, Survivors, and Disability Insurance (OASDI) benefits.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 100,000.
    Frequency of Response: 1.
    Average Burden per Response: 5 minutes.
    Estimated Annual Burden: 8,333 hours.
    2. Application for Search of Census Records for Proof of Age--20 
CFR 404.716--0960-0097. SSA uses the information from Form SSA-1535-U3 
to provide the Census Bureau with identification information sufficient 
to allow an accurate search of census records to establish proof of age 
for an individual applying for Social Security benefits. When preferred 
evidence of age is not available and the available evidence is not 
convincing, SSA may request the U.S. Department of Commerce, Bureau of 
the Census, to search its records to establish a claimant's date of 
birth. The Census Bureau uses the information from a completed, signed 
SSA-1535-U3 to bill SSA for the search. The respondents are applicants 
for Social Security benefits who need to establish their date of birth 
as a factor of entitlement.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 18,030.
    Frequency of Response: 1.
    Average Burden per Response: 12 minutes.
    Estimated Annual Burden: 3,606 hours.
    3. Workers' Compensation/Public Disability Questionnaire--20 CFR 
404.408--0960-0247. Section 224 of the Social Security Act provides for 
the reduction of disability insurance benefits (DIB) when the 
combination of DIB and any workers' compensation (WC) and/or certain 
Federal, State, or local public disability benefits (PDB) exceeds 80 
percent of the worker's average current earnings. SSA uses Form SSA-546 
to collect the data necessary to determine if the worker's receipt of 
WC/PDB payments will cause a reduction of DIB. The respondents are 
applicants for Title II DIB.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 100,000.
    Frequency of Response: 1.
    Average Burden per Response: 15 minutes.
    Estimated Annual Burden: 25,000 hours.
    4. Claimant's Medication--20 CFR 404.1512, 416.912--0960-0289. In 
cases where a claimant is requesting a hearing after denial of his or 
her claim for Social Security benefits, SSA uses Form HA-4632 to 
request information from the claimant regarding the medications he or 
she is using. This information helps the Administrative Law Judge 
hearing the case to inquire fully into the medical treatment the 
claimant is receiving and the effect of medications on the claimant's 
medical impairments and functional capacity. Respondents are applicants 
for OASDI benefits and/or Supplemental Security Income (SSI) payments.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 200,000.
    Frequency of Response: 1.
    Average Burden per Response: 15 minutes.
    Estimated Annual Burden: 50,000 hours.
    5. Statement of Funds You Provided to Another and Statement of 
Funds You Received--20 CFR 416.1103(f)--0960-0481. Forms SSA-2854 and 
SSA-2855 collect information on an SSI beneficiary's allegations that 
he or she borrowed funds informally from a non-commercial lender; e.g., 
a relative or friend. The borrower/beneficiary and the lender of the 
funds complete these statements. SSA requires information from Forms 
SSA-2854 and SSA-2855 to determine whether the proceeds from the 
transaction are income to the borrower. If the transaction constitutes 
a bona fide loan, the proceeds are not income to the borrower. Form 
SSA-2855 (Statement of Funds You Received) requests information from 
the SSI applicant/recipient by personal interview. Form SSA-2854 
(Statement of Funds You Provided to Another) requests information by 
mail from the other party to the transaction. The respondents are SSI 
recipients who informally borrow money and those persons who lend the 
funds.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 40,000.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 6,667 hours.
    6. Self-Employment/Corporate Officer Questionnaire--20 CFR 
404.435(e), 404.446--0960-0487. SSA uses Form SSA-4184 to develop 
earnings and corroborate the claimant's allegations of retirement when 
the claimant is self-employed or a corporate officer. SSA uses the 
information to determine an individual's OASDI benefit amount. The 
respondents are self-employed individuals or corporate officers who 
apply for OASDI benefits.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 50,000.
    Frequency of Response: 1.
    Average Burden per Response: 20 minutes.
    Estimated Annual Burden: 16,667 hours.

    Note: This is a correction notice. SSA published this 
information collection as an extension on February 17, 2009 at 74 FR 
7506. Since we are revising the Privacy Act Statement, this is now a 
revision.

    7. Application for SSA Employee Testimony--20 CFR 403.100-155--

[[Page 18786]]

0960-0619. SSA regulations at 20 CFR 403.100-155 establish policies and 
procedures for an individual, organization, or governmental entity to 
request official agency information, records, or testimony of an agency 
employee in a legal proceeding when the agency is not a party. The 
request, which must be in writing to the Commissioner, must fully set 
out the nature and relevance of the sought testimony. Respondents are 
individuals or entities who request testimony from SSA employees in a 
legal proceeding.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 100.
    Frequency of Response: 1.
    Average Burden per Response: 60 minutes.
    Estimated Annual Burden: 100 hours.
    8. Authorization for the Social Security Administration To Obtain 
Account Records from a Financial Institution and Request for Records 
(Medicare Low-Income Subsidy)--0960-0729. Under the aegis of the 
Medicare Modernization Act of 2003, Medicare beneficiaries can apply 
for a subsidy for the Medicare Prescription Drug Plan (Part D) program. 
In some cases, SSA will verify the details of applicants' accounts at 
financial institutions to determine if they are eligible for the 
subsidy. Form SSA-4640 gives SSA the authority to contact financial 
institutions about applicants' accounts. Financial institutions will 
also use the form to verify the information SSA requested. The 
respondents are applicants for the Medicare Part D program subsidy and 
financial institutions where applicants have accounts.
    Type of Request: Extension of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                         Medicare part D
                                       subsidy applicants    Financial institutions             Totals
----------------------------------------------------------------------------------------------------------------
Number of Respondents..............  10,000................  10,000................  20,000.
Frequency of Response..............  1.....................  1.....................  1.
Average Burden per Response          1 minute..............  4 minutes.............  5 minutes.
 (minutes).
Estimated Annual Burden (hours)....  167 hours.............  667 hours.............  834 hours.
----------------------------------------------------------------------------------------------------------------

    Total Estimated Annual Burden: 834 hours.
    9. Request To Pay Civil Monetary Penalty by Installment Agreement--
20 CFR 498-0960-NEW. SSA uses Form SSA-640 to obtain the information 
necessary to determine a repayment rate for individuals who have a 
civil monetary penalty imposed on them for fraudulent conduct related 
to SSA-administered programs. SSA needs this financial information to 
ensure the repayment rate is in the best interest of both the 
individual and the agency. The respondents are recipients of Social 
Security benefits and non-entitled individuals who must pay a civil 
monetary penalty.
    Type of Request: New information collection.
    Number of Respondents: 400.
    Frequency of Response: 1.
    Average Burden per Response: 120 minutes.
    Estimated Annual Burden: 800 hours.

    Dated: April 17, 2009.
John Biles,
Reports Clearance Officer, Center for Reports Clearance, Social 
Security Administration.
[FR Doc. E9-9318 Filed 4-23-09; 8:45 am]
BILLING CODE 4191-02-P


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