[Federal Register Volume 70, Number 224 (Tuesday, November 22, 2005)]
[Notices]
[Pages 70650-70652]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-22983]


=======================================================================
-----------------------------------------------------------------------

SOCIAL SECURITY ADMINISTRATION


Agency Information Collection Activities: Proposed Request, 
Comment Request and Correction Request

    The Social Security Administration (SSA) publishes a list of 
information collection packages that will require clearance by the 
Office of Management and Budget (OMB) in compliance with Pub. L. 104-
13, the Paperwork Reduction Act of 1995, effective October 1, 1995. The 
information collection packages that may be included in this notice are 
for new information collections, approval of existing information 
collections, revisions to OMB-approved information collections, and 
extensions (no change) 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 on ways to minimize 
burden on respondents, including the use of automated collection 
techniques or other forms of information technology. Written comments 
and recommendations regarding the information collection(s) should be 
submitted to the OMB Desk Officer and the SSA Reports Clearance 
Officer. The information can be mailed and/or faxed to the individuals 
at the addresses and fax numbers listed below:

(OMB), Office of Management and Budget, Attn: Desk Officer for SSA, 
Fax: 202-395-6974.

(SSA), Social Security Administration, DCFAM, Attn: Reports Clearance 
Officer, 1333 Annex Building, 6401 Security Blvd., Baltimore, MD 21235, 
Fax: 410-965-6400.

    I. The information collections listed below are pending at SSA and 
will be submitted to OMB within 60 days from the date of this notice. 
Therefore, your comments should be submitted to SSA within 60 days from 
the date of this publication. You can obtain copies of the collection 
instruments by calling the SSA Reports Clearance Officer at 410-965-
0454 or by writing to the address listed above.
    1. Application for Widow's or Widower's Insurance Benefits--20 CFR 
404.335-.338--0960-0004. SSA uses the information collected on the Form 
SSA-10-BK to determine if the applicant meets the statutory and 
regulatory conditions for entitlement to widow(er)'s benefits. The 
respondents are applicants for Widow(er)'s benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 288,580.
    Frequency of Response: 1.
    Average Burden per Response: 15 minutes.
    Estimated Annual Burden: 72,145 hours.
    2. Application for Parent's Insurance Benefits--20 CFR 404.370-
404.374, 20 CFR 404.601-404.603--0960-0012. Form SSA-7-F6 collects 
information to entitle an individual to his parent's insurance 
benefits. The respondents are individuals who wish to apply to receive 
their parent's insurance benefits.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 1,400.
    Frequency of Response: 1.
    Average Burden per Response: 15 minutes.
    Estimated Annual Burden: 350 hours.
    3. Statement of Marital Relationship (by One of the Parties)--20 
CFR 404.726--0960-0038. SSA uses the information collected on Form SSA-
754-F4 to determine whether the conditions for establishing a common-
law marriage under State law are met. The respondents are applicants 
for spouse's benefits.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 30,000.
    Frequency of Response: 1.
    Average Burden per Response: 30 minutes.
    Estimated Annual Burden: 15,000 hours.
    4. Medical Source Statement of Ability To Do Work Related 
Activities (Physical and Mental)--20 CFR 404.1512-404.1514, 404.912-
404.914, 404.1517, 416.917, 404.1519-404.1520, 416.919-416.920, 
404.946, 416.946--0960-0662. The HA-1151 and HA-1152 are used to 
collect data that is required to determine the residual functional 
capacity (RFC) of individuals who are appealing denied claims for 
benefits based on disability. RFC must be determined to decide cases 
that cannot be decided based on current work activity or on medical 
facts alone. The respondents are medical sources who are paid by SSA to 
provide reports based either on existing medical evidence or on 
consultative examinations conducted for the purposes of the report.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 10,000.
    Frequency of Response: 20.
    Average Burden per Response: 15 minutes.
    Estimated Annual Burden: 50,000 hours.
    5. SSI-Quality Review Case analysis--0960-0133. The form SSA-8508 
is used in a personal interview with a sample of Supplemental Security 
Income (SSI) recipients and covers all elements of SSI eligibility. The 
information is used to assess the effectiveness of SSI policies and 
procedures and to determine payment accuracy rates. The respondents are 
SSI recipients.
    Type of Request: Extension of an OMB-approved information 
collection.

[[Page 70651]]

    Number of Respondents: 3,900.
    Frequency of Response: 1.
    Average Burden per Response: 60 minutes.
    Estimated Annual Burden: 3,900 hours.
    6. Report of New Information in Disability Cases--20 CFR 404.460, 
404.468, 404.408, 404.1588--0960-0071. The information collected on 
Form SSA-612 is used to update the disability records of respondents, 
based on changes reported. The form is used to gather information on a 
number of topics that can affect the beneficiary's or the applicant's 
entitlement to disability benefits. This includes, but is not limited 
to, information about a return to work, improvement in the medical 
condition, Workers' Compensation settlements or representative payee 
issues. The respondents are applicants for and recipients of Title II 
disability benefits.
    Number of Respondents: 27,000.
    Frequency of Response: 1.
    Average Burden per Response: 5 minutes.
    Estimated Annual Burden: 2,250 hours.
    7. Statement of Living Arrangements, In-Kind Support and 
Maintenance--20 CFR, 416.1130-.1148--0960-0174. Form SSA-8006 provides 
a national uniform vehicle for collecting information from SSI 
applicants and recipients about whether they receive income from in-
kind support and maintenance. Responses are used to determine 
eligibility for SSI benefits. The respondents are individuals applying 
for SSI or whose eligibility is being reevaluated.
    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.
    Type of Request: Extension of an OMB-approved information 
collection.
    II. The information collections listed below have been submitted 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 410-965-0454, 
or by writing to the address listed above.
    1. 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. The 
information collected on Form SSA-21 is used to determine the 
continuing entitlement to Social Security benefits and the proper 
benefit amounts for alien beneficiaries living outside the United 
States. It is also used 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.
    2. Report on Individual with Mental Impairment--20 CFR 404.1513, 
416.913--0960-0058. Form SSA-824 is used by SSA to determine the 
claimant's medical status prior to making a disability determination. 
The respondents are physicians, medical directors, medical record 
librarians and other health professionals.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 50,000.
    Frequency of Response: 1.
    Average Burden per Response: 36 minutes.
    Estimated Annual Burden: 30,000 hours.
    3. Claimant's Work Background--20 CFR 404.1565(b), 416.965(b)--
0960-0300. The information collected on Form HA-4633 is needed and used 
to afford claimants their statutory right to a hearing and decision 
under the Social Security Act. The information is used by SSA in cases 
in which claimants for disability benefits have requested a hearing on 
the determination regarding their claim. A completed form provides an 
updated summary of a claimant's past relevant work and helps the 
administrative law judge to better decide whether or not the claimant 
is disabled. The respondents are claimants requesting hearings for 
benefits based on disability under Titles II and/or XVI of the Act.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 120,000.
    Frequency of Response: 1.
    Average Burden per Response: 15 minutes.
    Estimated Annual Burden: 30,000 hours.
    4. Coverage of Employees of State and Local Governments--20 CFR 
404, Subpart M--0960-0425. States (and Interstate Instrumentalities) 
are required to provide wage information and deposit related 
contributions for pre-1987 periods to SSA. The regulations at 20 CFR 
404, Subpart M set forth the rules for States submitting reports of 
deposits and related recordkeeping. 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.
    5. Medical Report on Adult with Allegation of Human 
Immunodeficiency Virus (HIV) Infection; Medical Report on Child with 
Allegation of Human Immunodeficiency Virus (HIV) Infection--20 CFR 
416.993-416.994--0960-0500. Collection of the information on Forms SSA-
4814-F5 and SSA-4815-F6 is necessary for SSA to determine if an 
individual with HIV infection meets the requirements for presumptive 
disability (PD) payments. The SSA Field Office (FO) will mail the 
appropriate form to the claimant's medical source for completion and 
return to the FO. The FO staff will use the information on the form to 
determine if a PD is warranted. The respondents are the medical sources 
of applicants for SSI disability payments.
    Type of Request: Extension 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 hours.
    6. SSI Notice of Interim Assistance Reimbursement (IAR)--0960-0546. 
Forms SSA-8125 and SSA-L8125-F6 are used by SSA to obtain the amount of 
Interim Assistance Reimbursement (IAR) a State is due before it can pay 
IAR to the State in various situations. When SSA releases the first 
retroactive SSI payment the SSA-8125 is filled out by the State for 
accounting and auditing purposes. The SSA-L8125-F6 is only used in 
cases when SSA must ensure that an IAR State does not send a residual 
IAR payment to a recipient who may be affected by the dedicated account 
and installment provision as set forth in Pub. Law 100-203. Respondents 
are State IAR officers.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 50,000.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 8,333 hours.
    III. The information collections listed below have been submitted 
to OMB for clearance. These notices have been

[[Page 70652]]

previously published, and are being republished because changes have 
been made to the collections' burden estimates. 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 410-965-0454, or by writing to the address listed above.
    1. General Request for Social Security Records, eFOIA--20 CFR 
402.130--0960-NEW. The eFOIA is a new electronic form that the public 
can use to request public information from the Agency. SSA uses the 
information collected on this electronic request for Social Security 
records to respond to the public's request for information under the 
rights provided by the Freedom of Information Act (FOIA), and to track 
those requests by amount received, type of request, fees charged and 
responses sent within the required 20 days. Respondents are individuals 
or agencies requesting documents under FOIA.
    Type of Request: New information collection.
    Number of Respondents: 5,000.
    Frequency of Response: 1.
    Average Burden per Response: 3 minutes.
    Estimated Annual Burden: 250 hours.
    2. Application to Collect a Fee for Payee Services--0960-NEW. 
Information requested on form SSA-445 will be used to determine whether 
the applicant meets the requirements to become a fee for service 
organizational payee, and if the applicant has provided all the 
information and documentation required. Based on the information 
provided on form SSA-445, SSA will issue a determination authorizing or 
denying permission to collect fees for payee services. The respondents 
are fee for payee service applicants.
    Type of Request: New information collection.
    Number of Respondents: 100.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 17 hours.

    Dated: November 15, 2005.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 05-22983 Filed 11-21-05; 8:45 am]
BILLING CODE 4191-02-P