[Federal Register Volume 75, Number 14 (Friday, January 22, 2010)]
[Notices]
[Pages 3778-3781]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-1115]


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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, a collection in use without an OMB number, and 
new 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 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#91ded8c3d0cec2e4f3fcf8e2e2f8feffd1fefcf3bff4fee1bff6fee7"><span class="__cf_email__" data-cfemail="551a1c07140a062037383c26263c3a3b153a38377b303a257b323a23">[email protected]</span></a>.

[[Page 3779]]

(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#eca3bca0a1c2beafa3ac9f9f8dc28b839a"><span class="__cf_email__" data-cfemail="024d524e4f2c50414d427171632c656d74">[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 
March 23, 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. Waiver of Supplemental Security Income (SSI) Payment 
Continuation--20 CFR 416.1400-416.1422--0960-NEW. SSA collects the 
information on Form SSA 263-U2 to determine whether an individual meets 
the provisions of the Social Security Act regarding waiver of payment 
continuation. Recipients must use Form SSA 263-U2 when they are 
awaiting a determination on their appeal and have decided to stop their 
payment continuation. SSA needs the information on the form as proof 
respondents no longer want their payments to continue. Respondents are 
recipients of SSI payments who wish to discontinue receipt of payment 
while awaiting a determination on their appeal.
    Type of Request: Existing information collection in use without an 
OMB number.
    Number of Respondents: 3,000.
    Frequency of Response: 1.
    Average Burden per Response: 5 minutes.
    Estimated Annual Burden: 250 hours.
    2. Notice Regarding Substitution of Party upon Death of Claimant--
Reconsideration of Disability Cessation--20 CFR 404.917-404.921 and 
416.1407-416.1421--0960-0351. When a claimant dies before we make a 
determination on that person's request for reconsideration of their 
disability cessation, SSA seeks a qualified substitute party to pursue 
the appeal. If SSA locates a qualified substitute party, the agency 
will use Form SSA-770 to collect information about whether to pursue or 
withdraw the reconsideration request. The information Form SSA-770 
collects is the basis of the decision to continue or discontinue the 
appeals process. Respondents are substitute applicants who are pursuing 
a reconsideration request for a deceased claimant.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 1,200.
    Frequency of Response: 1.
    Average Burden per Response: 5 minutes.
    Estimated Annual Burden: 100 hours.
    3. Application for Benefits under the Italy-U.S. International 
Social Security Agreement--20 CFR 404.1925--0960-0445. SSA collects 
information using Form SSA-2582 based on the United States-Italy 
agreement effective November 1, 1978. Article 19.2 of that agreement 
provides that an applicant for benefits can file an application with 
either country. Article 4.3 of the Protocol to the Agreement dictates 
the country receiving the application will forward agreed-upon forms 
and applications to the other country. As agreed upon by the United 
States and Italian Social Security agencies, individuals filing an 
application for U.S. benefits directly with one of the Italian Social 
Security agencies must complete Form SSA-2528. The SSA-2528 is 
mandatory for respondents living in Italy who wish to file an 
application for U.S. benefits. SSA uses the SSA-2528 to establish age, 
relationship, citizenship, marriage, death, military service, or to 
evaluate a family bible or other family record when determining 
eligibility for benefits. The Italian Social Security agencies assist 
applicants in completing Form SSA-2528 and then forward the application 
to SSA for processing. The respondents are individuals living in Italy 
who wish to file for U.S. Social Security benefits.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 250.
    Frequency of Response: 1.
    Average Burden per Response: 20 minutes.
    Estimated Annual Burden: 83 hours.
    4. Earnings Record Information--20 CFR 404.801-404.803 and 404.821-
404.822--0960-0505. SSA discovered that as many as 70 percent of the 
wage reports it receives for children under age 7 are actually the 
earnings of someone other than the child. To ensure we credit the 
correct person with the reported earnings, SSA decided we should verify 
wage reports for children under age 7 with the children's employers 
before posting to the earnings record. SSA uses Form SSA-L3231-C1 for 
this purpose. The respondents are employers who report earnings for 
children under age 7.
    Type of Information Collection: Revision of an OMB-approved 
information collection.
    Number of Respondents: 20,000.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 3,333 hours.
    5. Work Incentives Planning and Assistance Program--0960-0629. The 
Work Incentives Planning and Assistance (WIPA) program collects 
identifying information from project sites and Community Work 
Incentives Coordinators (CWIC). In addition, the program collects data 
from beneficiaries on background employment, training, benefits, and 
work incentives. SSA is interested in identifying beneficiary outcomes 
under the WIPA program to determine the extent to which beneficiaries 
with disabilities achieve their employment, financial, and health care 
goals. SSA will also use the data in its analysis and future planning 
for Social Security Disability Insurance and SSI programs.
    Type of Request: Extension of an OMB-approved information 
collection.
    Estimated Annual Burden: 5,019 hours.

----------------------------------------------------------------------------------------------------------------
                                                                               Average burden
               Respondent                     Number of       Frequency of      per response    Estimated annual
                                          annual responses      response          (minutes)       burden hours
----------------------------------------------------------------------------------------------------------------
Project Site............................               147                 1                 2                 5
CWIC....................................               422                 1                 2                14
Beneficiary.............................            60,000                 1                 5             5,000
                                         -----------------------------------------------------------------------
    Totals..............................            60,569  ................  ................             5,019
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    6. Beneficiary Interview and Auditor's Observations Form--0960-
0630. SSA's Office of the Inspector General (OIG) will use the 
information collected through Form SSA-322, the Beneficiary Interview 
and Auditor's Observation form, to interview beneficiaries and/or their 
payees to determine if they are complying with their duties and

[[Page 3780]]

responsibilities. SSA will randomly select SSI recipients and Social 
Security beneficiaries who have representative payees as respondents 
for this collection.
    Type of Request: Extension of a previously-approved OMB information 
collection.
    Number of Respondents: 200.
    Frequency of Response: 1.
    Average Burden per Response: 15 minutes.
    Estimated Annual Burden: 50 hours.
    7. Certification of Contents of Document(s) or Record(s)--20 CFR 
404.715f--0960-0689. SSA must secure evidence necessary for individuals 
to establish rights to benefits. Some of the required evidence 
categories include evidence of age, relationship, citizenship, 
marriage, death, and military service. Form SSA-704 allows SSA 
employees, State record custodians, and other custodians of evidentiary 
documents to record information from documents and records to establish 
these types of evidence. State record custodians and other custodians 
of evidentiary documents are the respondents.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 4,800.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 800 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 February 22, 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 email address.
    1. Notification of a Social Security Number (SSN) to an Employer 
for Wage Reporting--20 CFR 422.103--0960-NEW. Individuals applying for 
employment must provide an SSN or indicate they have applied for one. 
The information SSA collects on Form SSA-112 allows SSA to send, at the 
individual's request, the individual's SSN to his or her employer. 
Mailing this information to the employer ensures the employer has the 
correct SSN for the individual, allows SSA to receive correct earnings 
information for wage reporting purposes for the individual, and reduces 
the delay between the initial SSN assignment and delivery of the SSN 
information to the employer. The respondents are individuals who are 
applying for an initial SSN and who ask SSA to mail confirmation of 
their application or the SSN to their employers.
    Type of Request: New information collection.
    Number of Respondents: 375,000.
    Frequency of Response: 1.
    Average Burden per Response: 2 minutes.
    Estimated Annual Burden: 12,500 hours.
    2. Important Information about Your Appeal, Waiver Rights, and 
Repayment Options--20 CFR 404.502-521--0960-NEW. When SSA accidentally 
overpays beneficiaries, the agency uses Form SSA-3105 to inform those 
beneficiaries about their rights to reconsideration, waiver, or a 
different repayment rate. Beneficiaries use Form SSA-3105 to inform SSA 
if they do not agree with SSA's initial overpayment determination, if 
they are unable to repay the overpayment, or to request a waiver for 
repayment to SSA. The respondents are individuals who are overpaid 
claimants and who are requesting a waiver of recovery for the 
overpayment, reconsideration of the overpayment determination, or a 
lesser rate of withholding of the overpayment.
    Type of Request: New information collection.
    Number of Respondents: 800,000.
    Frequency of Response: 1.
    Average Burden per Response: 15 minutes.
    Estimated Annual Burden: 200,000 hours.
    3. Physician's/Medical Officer's Statement of Patient's Capability 
to Manage Benefits--20 CFR 404.2015 and 416.615--0960-0024. SSA 
collects information on Form SSA-787 to determine beneficiaries' 
ability to handle their own benefits. This information assists SSA in 
determining the need for a representative payee. The respondents are 
the beneficiary's physicians or medical officers of the institution in 
which the beneficiary resides.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 120,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 20,000 hours.
    4. Statement for Determining Continuing Eligibility, Supplemental 
Security Income Payment(s)--20 CFR 416.204--0960-0416. SSA uses the 
information from the SSA-8203-BK for high-error-profile (HEP) 
redeterminations of disability to determine whether SSI recipients have 
met and continue to meet all statutory and regulatory requirements for 
SSI eligibility and whether they have been, and are still receiving, 
the correct payment amount. Periodic collection of this information is 
the only way SSA can make these determinations, and collection of this 
information is mandatory under the law. Typically, beneficiaries 
complete this collection in field offices by personal contact (face-to-
face or telephone interview) using the automated Modernized SSI Claim 
System (MSSICS). The respondents are SSI recipients or their 
representative payees.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                               Average burden
            Collection method                 Number of       Frequency of      per response    Estimated annual
                                             respondents        response          (minutes)      burden (hours)
----------------------------------------------------------------------------------------------------------------
MSSICS..................................            94,568                 1                20            31,523
MSSICS/Signature Proxy..................            31,522                 1                19             9,982
Paper...................................            31,522                 1                20            10,507
                                         -----------------------------------------------------------------------
    Totals..............................           157,612  ................  ................            52,012
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    5. Pain Report Child--20 CFR 416.912 and 416.512--0960-0540. 
Disability interviewers and applicants/claimants in self-help 
situations use Form SSA-3371-BK to record information about pain or 
other symptoms of a child who is claiming disability. The State 
Disability Determination Services adjudicators and administrative law 
judges use this information to assess the effects of symptoms on 
functionality to help make a disability determination. The respondents 
are applicants for SSI payments.


[[Page 3781]]


    Note:  This is a correction notice. SSA published this 
information collection as an extension on November 17, 2009, at 74 
FR 59336. 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: 250,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 62,500 hours.
    6. Internet Direct Deposit Application--31 CFR 210--0960-0634. SSA 
uses Direct Deposit/Electronic Funds Transfer (DD/EFT) enrollment 
information received from beneficiaries to facilitate DD/EFT of their 
Social Security benefits with a financial institution. Respondents are 
Social Security beneficiaries who use the Internet to enroll in DD/EFT.

    Note:  This is a correction notice. SSA published this 
information collection as an extension on November 17, 2009, at 74 
FR 59336. 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: 90,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 15,000 hours.
    7. Certificate of Support--20 CFR 404.370, 404.750, 404.408a--0960-
0001. A parent of a deceased, fully insured worker may be entitled to 
Title II benefits on the earnings record of the deceased worker under 
certain conditions. One of the conditions is the parent must have 
received at least one-half support from the deceased worker. The one-
half support requirement also applies to a spouse applicant in 
determining whether Title II benefits are subject to Government Pension 
Offset (GPO). SSA uses the information from Form SSA-760-F4 to 
determine whether the parent of a deceased worker or a spouse applicant 
meets the one-half support requirement. Respondents are parents of 
deceased workers or spouses who may be exempt from GPO.

    Note:  This is a correction notice. SSA published this 
information collection as an extension on October 26, 2009, at 74 FR 
55080. 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: 18,000.
    Frequency of Response: 1.
    Average Burden Per Response: 15 minutes.
    Estimated Annual Burden: 4,500 hours.

    Dated: January 15, 2010.
Elizabeth A. Davidson,
Director, Center for Reports Clearance, Social Security Administration.
[FR Doc. 2010-1115 Filed 1-21-10; 8:45 am]
BILLING CODE 4191-02-P


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