[Federal Register Volume 75, Number 92 (Thursday, May 13, 2010)]
[Notices]
[Pages 27036-27041]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-11190]


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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 collection in use without an OMB number.
    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, e-mail, or fax your 
comments and recommendations on the information collection(s) to the 
OMB Desk Officer and SSA Reports Clearance Director to the following 
addresses or fax numbers.

(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#0e41475c4f515d7b6c63677d7d6761604e61636c206b617e20696178"><span class="__cf_email__" data-cfemail="9dd2d4cfdcc2cee8fff0f4eeeef4f2f3ddf2f0ffb3f8f2edb3faf2eb">[email protected]</span></a>.
(SSA), Social Security Administration, DCBFM, Attn: Director, Center 
for Reports Clearance, 1333 Annex Building, 6401 Security Blvd., 
Baltimore, MD 21235, Fax: 410-965-0454, E-mail address: 
<a href="/cdn-cgi/l/email-protection#7c332c3031522e3f333c0f0f1d521b130a"><span class="__cf_email__" data-cfemail="9dd2cdd1d0b3cfded2ddeeeefcb3faf2eb">[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 July 
12, 2010. Individuals can obtain copies of the collection instruments 
by calling the SSA Director for Reports Clearance at 410-965-0454 or by 
writing to the above e-mail address.
    1. Request to Be Selected as a Payee--20 CFR 404.2010-404.2055, 
416.601-416.665--0960-0014. An individual applying to be a 
representative payee for a Social Security or Supplemental Security 
Income (SSI) recipient completes Form SSA-11-BK. SSA obtains 
information from applicant payees regarding their relationship to the 
beneficiary, personal qualifications, concern for the beneficiary's 
well-being, and intended use of benefits if appointed as payee.
    The respondents are individuals, private sector businesses and 
institutions, and state and local government institutions and agencies.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 27037]]



----------------------------------------------------------------------------------------------------------------
                                                                                  Average burden     Estimated
                Collection method                    Number of     Frequency of    per response    annual burden
                                                    respondents      response        (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
                                             Individuals/Households
----------------------------------------------------------------------------------------------------------------
Representative Payee System (RPS)...............         135,000               1            10.5          23,625
RPS/Signature Proxy.............................         765,000               1             9.5         121,125
Paper Version...................................         450,000               1            10.5          78,750
                                                 ---------------------------------------------------------------
    Totals......................................       1,350,000  ..............  ..............         223,500
----------------------------------------------------------------------------------------------------------------
                                                 Private Sector
----------------------------------------------------------------------------------------------------------------
RPS.............................................          13,500               1            10.5           2,363
RPS/Signature Proxy.............................          76,500               1             9.5          12,113
Paper Version...................................          45,000               1            10.5           7,875
                                                 ---------------------------------------------------------------
    Totals......................................         135,000  ..............  ..............          22,351
----------------------------------------------------------------------------------------------------------------
                                          State/Local/Tribal Government
----------------------------------------------------------------------------------------------------------------
RPS.............................................           1,500               1            10.5             263
RPS/Signature Proxy.............................           8,500               1             9.5           1,346
Paper Version...................................           5,000               1            10.5             875
                                                 ---------------------------------------------------------------
    Totals......................................          15,000  ..............  ..............           2,484
                                                 ---------------------------------------------------------------
        Grand Total:............................       1,500,000  ..............  ..............         248,335
----------------------------------------------------------------------------------------------------------------

    2. Representative Payee Evaluation Report--20 CFR 404.2065 & 
416.665--0960-0069. Sections 205(j) and 1631(a)(2) of the Social 
Security Act provide that SSA may appoint a representative payee to 
receive Title II benefits and/or Title XVI payments on behalf of 
individuals unable to manage those funds themselves. SSA requires the 
appointed representative payee to report once per year on how he or she 
used or conserved those funds. When a representative payee fails to 
adequately report to SSA, SSA conducts a face-to-face interview with 
the payee and completes Form SSA-624, Representative Payee Evaluation 
Report, to determine the continued suitability of the representative 
payee to serve as a payee. The respondents are individuals or 
organizations serving as representative payees for individuals 
receiving Title II benefits and/or Title XVI payments, and who fail to 
comply with SSA's statutory annual reporting requirement.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 266,000.
    Frequency of Response: 1.
    Average Burden per Response: 30 minutes.
    Estimated Annual Burden: 133,000 hours.
    3. Waiver of Your Right to Personal Appearance before an 
Administrative Law Judge--20 CFR 404.948(b)(l)(i) and 
416.1448(b)(l)(i)--0960-0284. Applicants for Social Security benefits 
and SSI payments have the statutory right to appear in person (or 
through a representative) and present evidence about their claims at a 
hearing before an Administrative Law Judge (ALJ). If claimants wish to 
waive this right to appear before an ALJ, they must complete a written 
request. The applicants may use SSA Form HA-4608 for this purpose. The 
ALJ uses the information to document an individual's claim to show that 
an oral hearing is not preferred in the appellate process.
    Respondents are claimants or their representatives for Title II 
benefits and/or Title XVI payments who request to waive their right to 
appear in person before an ALJ.
    Type of Request: Revision of an approved-OMB information 
collection.
    Number of Respondents: 12,000.
    Frequency of Response: 1.
    Average Burden per Response: 2 minutes.
    Estimated Annual Burden: 400 hours.
    4. Request for Change in Time/Place of Disability Hearing--20 CFR 
404.914(c)(2) and 416.1414(c)(2)--0960-0348. At the request of the 
claimant or their representative, SSA schedules evidentiary hearings at 
the reconsideration level for claimants of Title II benefits and/or 
Title XVI payments when we deny their claims for disability. When 
claimants or their representatives find they are unable to attend the 
hearing, they complete Form SSA-769 to request a change in time or 
place of the hearing. SSA uses the information as a basis for granting 
or denying requests for changes and for rescheduling disability 
hearings. Respondents are claimants or their representative who wish to 
request a change in the time and/or place of their hearing.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 7,483.
    Frequency of Response: 1.
    Average Burden per Response: 8 minutes.
    Estimated Annual Burden: 998 hours.
    5. Agency/Employer Government Pension Offset Questionnaire--20 CFR 
404.408(a)--0960-0470. When an individual is concurrently receiving 
Social Security spousal or surviving spousal benefits and a Government 
pension, the individual may have the amount of Social Security benefits 
reduced by the Government pension amount. This is the Government 
Pension Offset (GPO). SSA uses Form SSA-L4163 to collect accurate 
pension information from the Federal or state government agency paying 
the pension for purposes of applying the pension offset provision. The 
form is used only when: (1) The claimant does not have the information; 
and (2) the pension-paying agency has not cooperated with the claimant. 
Respondents are state government agencies that have information SSA 
needs to determine if the GPO applies and the amount of offset.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 1,000.

[[Page 27038]]

    Frequency of Response: 1.
    Average Burden per Response: 3 minutes.
    Estimated Annual Burden: 50 hours.
    6. Child Care Dropout Questionnaire--20 CFR 404.211(e)(4)--0960-
0474. The Social Security Act and SSA's regulations permit the 
exclusion, from a disability computation period, of the years an 
individual was caring for his or her (or the spouse's) child under age 
3 if he or she had no earnings in the benefit computation years. We 
call this the child-care dropout exclusion.
    SSA uses the information from Form SSA-4162 to determine if an 
individual qualifies for this exclusion. Respondents are applicants for 
Title II disability benefits.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 2000.
    Frequency of Response: 1.
    Average Burden per Response: 5 minutes.
    Estimated Annual Burden: 167 hours.
    7. Requests for Self-Employment Information, Employee Information, 
Employer Information--20 CFR 422.120--0960-0508. SSA collects 
information on Forms SSA-L2765, SSA-L3365, and SSA-L4002 to credit the 
reported earnings to the proper earnings record. When SSA cannot 
identify Form W-2 wage data for an individual, we place the data in the 
earnings suspense file and send one of the forms cited above to the 
employee (and in certain instances to the employer) to obtain the 
correct name and Social Security number (SSN). If the respondent 
furnishes the name and SSN information that agrees with SSA's records, 
or provides information that resolves the discrepancy, SSA adds the 
reported earnings to the respondent's Social Security record. While SSA 
does not require respondents to provide the information to keep a 
benefit, if they do not furnish the missing or corrected information, 
we cannot credit the wages or self-employment income to the proper 
earnings record. The respondents are self-employed individuals and 
employees whose name and SSN information do not agree with SSA's 
records and their employers.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden     Estimated
               Collection method                    Number of     Frequency of    per response    annual burden
                                                   respondents      response        (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L2765......................................           7,870               1              10            1,312
SSA-L3365......................................         158,334               1              10           26,389
SSA-L4002......................................         218,891               1              10           36,482
                                                ----------------------------------------------------------------
    Totals.....................................         385,095  ..............  ..............           64,183
----------------------------------------------------------------------------------------------------------------

    8. Appointment of Representative--20 CFR 404.1707, 404.1720, 
404.1725, 410.684 and 416.1507--0960-0527. Persons claiming rights or 
benefits under the Social Security Act must notify SSA in writing when 
they appoint an individual to represent them in dealings with SSA. SSA 
uses the information collected on Form SSA-1696-U4 to verify the 
appointment of a representative. It also allows SSA to inform the 
representative of items that affect the recipient's claim, and allows 
the claimant to give permission to his or her appointed representative 
to designate a person to copy claims files. Respondents are applicant/
recipients of Social Security benefits who notify SSA they have 
appointed a person to represent them in their dealings with SSA.
    Number of Respondents: 551,520.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 91,920 hours.
    9. Function Report--Child: Birth to 1st Birthday (SSA-3375), Age 1 
to 3rd Birthday (SSA 3376), Age 3 to 6th Birthday (SSA-3377), Age 6 to 
12th Birthday (SSA-3378), and Age 12 to 18th Birthday (SSA-3379)--20 
CFR 416.912--0960-0542. Forms SSA-3375-BK through SSA-3379-BK request 
information from the child's parent about the child's day-to-day 
functioning. The five different versions of the form contain questions 
about functioning appropriate to a particular age group; thus, 
respondents use only one version for each child.
    The adjudicative team (disability examiners and medical/
psychological consultants) of state Disability Determination Services 
(DDS) offices collect the information on the appropriate version of 
this form (in conjunction with medical and other evidence) to form a 
complete picture of the child's ability to function and his or her 
impairment-related limitations. The adjudicative team uses the 
completed profile to determine whether the child's impairment(s) 
results in marked and severe functional limitations and whether the 
child is disabled. The respondents are parents and/or guardians of 
child applicants for SSI payments.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 500,000.
    Frequency of Response: 1.
    Average Burden per Response: 20 minutes.
    Estimated Annual Burden: 166,667 hours.
    10. Disability Report-Child--20 CFR 416.912--0960-0577--When 
claimants file a claim for childhood disability benefits under the SSI 
program, they must furnish medical and other evidence to prove they are 
disabled. Form SSA-3820 collects various types of information about a 
child's condition from treating sources and/or other medical sources of 
evidence. The DDS evaluators use the information to develop medical and 
school evidence and to assess the alleged disability. The information, 
together with medical evidence, forms the evidentiary basis upon which 
SSA makes its initial disability evaluation. The respondents are 
claimants seeking SSI childhood disability payments.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden     Estimated
               Collection method                    Number of     Frequency of    per response    annual burden
                                                   respondents      response        (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3820 (Paper Form)..........................             500               1              60              500

[[Page 27039]]

 
Electronic Disability Collection System (EDCS).         422,000               1              34          239,133
i3820 (Internet)...............................          93,293               1             120          186,586
                                                ----------------------------------------------------------------
    Totals.....................................         515,793  ..............  ..............          426,219
----------------------------------------------------------------------------------------------------------------

    11. eData Registration--20 CFR 401.45--0960-0757--The eData 
Services Web site allows various external organizations to submit files 
to a variety of SSA systems and in some cases receive return files. The 
users include state/local government agencies, other Federal agencies, 
and some private sector business entities. The SSA systems that process 
data transferred via eData include, but are not limited to, systems 
responsible for disability processing and benefit determination or 
termination. A sponsor within SSA who knows the requestor completes the 
registration form, SSA-118, and submits the information to SSA's User 
Interface Team (UIT). SSA uses the information on Form SSA-118 
(Government-to-Government Services Online Web site Registration Form) 
to maintain the identity of the requestor within eData. Once this is 
completed, SSA provides the requestor with the new password and 
conducts a walkthrough of the eData Web site as necessary. The 
organization can also modify its online account (e.g., address change) 
by completing an online Form SSA-119 (Government-to-Government Service 
Online Web site Account Modification/Deletion Form).
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden     Estimated
               Collection method                    Number of     Frequency of    per response    annual burden
                                                   respondents      response        (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-118........................................             925               1              15              231
SSA-119........................................           2,500               1              15              625
                                                ----------------------------------------------------------------
    Totals.....................................           3,425  ..............  ..............              856
----------------------------------------------------------------------------------------------------------------

    12. Technical Updates to Applicability of the Supplemental Security 
Income (SSI) Reduced Benefit Rate for Individuals Residing in Medical 
Treatment Facilities--20 CFR 404.708(k)--0960-0758. Section 
1611(e)(1)(A) of the Social Security Act states that no resident of a 
public institution is eligible for SSI benefits. However, Sections 
1611(e)(1)(B) and (G) list certain exceptions to this provision that 
make it necessary for SSA to collect information about any SSI 
recipient who enters or leaves a medical treatment facility or other 
public or private institution. SSA's regulation, 20 CFR 404.708(k), 
establishes the reporting guidelines that implement this legislative 
requirement. SSA uses the information to determine eligibility for SSI 
and the payment amount. The respondents are SSI recipients who enter or 
leave an institution.
    Type of Request: Revision of an OMB-approved information 
collection. Number of Respondents: 34,200.
    Frequency of Response: 1.
    Average Burden per Response: 7 minutes.
    Estimated Annual Burden: 3,990 hours.
    13. Statement for Certificate of Election for Reduced Widower(er)'s 
and Surviving Divorced Spouse's Benefits--20 CFR 404.335--0960-0759. 
Section 202(q) of the Social Security Act provides for the authority to 
reduce benefits under certain conditions when elected by a Title II 
beneficiary. However, reduced benefits are not payable to an already 
entitled spouse (or divorced spouse) who:
    <bullet> Is at least age 62 and under full retirement age in the 
month of the number holder's death; and
    <bullet> Is receiving reduced spouse's (or divorced spouse's) 
benefits and either retirement or disability benefits in the month 
before the month of the number holder's death.
    To elect reduced widow(er) benefits, a recipient completes Form 
SSA-4111. SSA uses the information collected on Form SSA-4111 to pay a 
qualified dually entitled widow(er) (or surviving divorced spouse) who 
elects to receive a reduced widow(er) benefit. The respondents are 
qualified dually entitled widow(er)s (or surviving divorced spouse) who 
elect to receive a reduced widow(er) benefit.
    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 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 June 14, 2010. You can obtain a copy of the 
OMB clearance packages by calling the SSA Director for Reports 
Clearance at 410-965-0454 or by writing to the above e-mail address.
    1. Certificate of Responsibility for Welfare and Care of Child Not 
in Applicant's Custody--20 CFR 404.330, 404.339-341 and 404.348-
404.349--0960-0019. SSA uses information from Form SSA-781 to determine 
if non-custodial parents who are filing for spouse's or mother's and 
father's benefits based on having a child in their care meet the in-
care requirements. Respondents are applicants for Title II spouse's 
and/or mother's and father's benefits.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 14,000.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 2,333 hours.
    2. Disability Report-Appeal--20 CFR 404.1512, 416.912, 404.916(c), 
416.1416(c), 405 Subpart C, 422.140--

[[Page 27040]]

0960-0144. SSA requires disability claimants who are appealing an 
unfavorable disability determination to complete Form SSA-3441-BK. This 
form allows claimants to disclose any changes to their disability or 
resources that might influence SSA's unfavorable determination. SSA may 
use the information to: (1) Reconsider and review an initial disability 
determination; (2) review a continuing disability; and (3) evaluate a 
request for a hearing. This information assists the DDS offices and 
ALJs in: (1) Preparing for the appeals and hearings; and (2) issuing a 
determination or decision on an individual's entitlement (initial or 
continuing) to disability benefits. Respondents are individuals who 
appeal a denial, reduction, or cessation of Social Security disability 
income and SSI payments, or who are requesting a hearing before an ALJ.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden     Estimated
               Collection method                    Number of     Frequency of    per response    annual burden
                                                   respondents      response        (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3441 (Paper Form)..........................          12,604               1              45            9,453
Electronic Disability Collect System (EDCS)....         843,090               1              45          632,318
I3441 (Internet Form)..........................         417,268               1             120          834,536
                                                ----------------------------------------------------------------
    Totals.....................................       1,272,962  ..............  ..............        1,476,307
----------------------------------------------------------------------------------------------------------------

    3. Request for Hearing by Administrative Law Judge--20 CFR 404.929, 
404.933, 416.1429, 404.1433, 405.722, 418.1350--0960-0269. When SSA 
denies applicants' or beneficiaries' requests for new or continuing 
benefits, those applicants/beneficiaries are entitled to request a 
hearing to appeal the decision. SSA uses Form HA-501 to document such 
requests. Although SSA collects this information, actual hearings take 
place before ALJs employed by the Department of Health and Human 
Services (HHS). The respondents are: (1) Applicants for or current 
recipients of various Social Security benefits who want to appeal SSA's 
denial of their requests for new or continued benefits; and (2) 
Medicare Part B recipients who must pay the Medicare Part B Income-
Related Monthly Adjustment Amount and want to appeal SSA's decision at 
a hearing before an HHS ALJ.

    Note: This is a correction notice. SSA published this 
information collection as an extension on March 4, 2010 at 75 FR 
9992. 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.
    Number of Respondents: 669,469.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 111,578 hours.
    4. Information about Joint Checking/Savings Accounts--20 CFR 
416.120, 416.1208--0960-0461. SSA considers a person's resources when 
evaluating eligibility for SSI payments. Generally, we consider funds 
in checking and savings accounts to be resources owned by the 
individuals whose names appear on the account. Individuals applying for 
SSI, however, may rebut this assumption of ownership in a joint account 
if they submit certain evidence that establishes the funds do not 
belong to them. SSA uses Form SSA-2574 to collect information from SSI 
applicants/recipients who object to the assumption that they own all or 
part of the funds in a joint checking or savings account bearing their 
names. SSA collects information about the account from both the SSI 
applicant/recipient and other account holder(s). After receiving the 
completed form, SSA determines if we should consider the account to be 
a resource for the SSI applicant/recipient. The respondents are 
applicants and recipients of SSI and individuals who list themselves as 
joint owners of financial accounts with SSI applicants/recipients.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 200,000.
    Frequency of Response: 1.
    Average Burden per Response: 7 minutes.
    Estimated Annual Burden: 23,333 hours.
    5. SSI Monthly Wage Reporting (Telephone)--20 CFR 416.701-732--
0960-0715. SSA requires SSI recipients to report changes that could 
affect their eligibility for and the amount of their SSI payments, such 
as changes in income, resources, and living arrangements. The SSITWR, 
formerly the Statement for SSI Monthly Wage Reporting (Telephone), 
enables SSI recipients to meet these requirements by providing them 
with a fully automated mechanism to report their monthly wages by 
telephone, instead of contacting their local field offices. The SSITWR 
allows callers to report their wages by speaking their responses 
through voice recognition technology or by keying in responses using 
the telephone key pad. To ensure the security of the information 
provided, SSITWR asks callers to provide information SSA can compare 
against our records for authentication purposes. Once the system 
authenticates the identity of the callers, the callers can speak or key 
in their wage data. The respondents are SSI recipients, deemors, and 
representative payees of recipients.

    Note: This is a correction notice: SSA published the incorrect 
burden information for this collection at 75 FR 9992, on March 4, 
2010. We are correcting this error here.

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

----------------------------------------------------------------------------------------------------------------
                                                                                     Estimated
                Collection method                  Frequency of      Number of      completion    Burden (hours)
                                                     reporting      respondents   time (minutes)
----------------------------------------------------------------------------------------------------------------
Training/Instruction............................               1          85,000              35          49,583
SSITWR..........................................              12          85,000               5          85,000
                                                 ---------------------------------------------------------------
    Total.......................................  ..............        * 85,000  ..............         134,583
----------------------------------------------------------------------------------------------------------------



[[Page 27041]]

    Note:* The same 85,000 respondents are completing both 
activities, so the actual total number of respondents is only 
85,000.

    6. Treating Physician Consultative Examination Interest Form--20 
CFR 404.1519g-i--0960-0751. When an applicant for Social Security 
disability benefits has not consulted a physician for a specified 
period preceding the application, SSA will ask the applicant to 
complete a consultative examination (CE). If the applicant has a 
treating physician (TP), SSA sends a medical evidence of record request 
letter and Form SSA-84 to the applicant's TP; the TP completes the SSA-
84 and returns it to SSA to indicate interest in conducting the CE. If 
the TP does not return the SSA-84, SSA assumes the TP is not interested 
in performing the CE. Respondents are disability benefit applicants' 
treating physicians.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 168.
    Frequency of Response: 1.
    Average Burden per Response: 5 minutes.
    Estimated Annual Burden: 14 hours.
    7. Claimant Travel Reimbursement Request--20 CFR 404.999a-d--0960-
0752. SSA sends Form SSA-104 to Social Security benefits recipients 
with a CE appointment notice. To receive reimbursement for their travel 
expenses to the CE, recipients must: (1) Submit an itemized list of 
expenditures for their trip; and (2) complete, sign, and return the 
SSA-104 to SSA. SSA collects this information to determine eligibility 
for and the amount of reimbursement. Respondents are applicants for 
disability claims applying for reimbursement of travel expenses to a 
CE.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 11,092.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 1,849 hours.

    Dated: May 7, 2010.
Faye I. Lipsky,
Acting Center Director, Center for Reports Clearance, Social Security 
Administration.
[FR Doc. 2010-11190 Filed 5-12-10; 8:45 am]
BILLING CODE 4191-02-P


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