[Federal Register Volume 60, Number 33 (Friday, February 17, 1995)]
[Notices]
[Pages 9341-9342]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-3672]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Social Security Administration


Agency Forms Submitted to the Office of Management and Budget for 
Clearance

    Normally on Fridays, the Social Security Administration publishes a 
list of information collection packages that have been submitted to the 
Office of Management and Budget (OMB) for clearance in compliance with 
P.L. 96-511, The Paperwork Reduction Act. The following clearance 
packages have been submitted to OMB since the last list was published 
in the Federal Register on January 13, 1995.

(Call Reports Clearance Officer on (410) 965-4142 for copies of 
package.)

    1. Drug Addiction and Alcoholism Referral and Monitoring Agency 
Treatment Requirements Acknowledgement; Drug Addiction and Alcoholism 
Referral and Monitoring Agency Assessment/Referral and Tracking 
Summary--0960-NEW. The information is needed to implement the 
requirements of Public Law 103-296, section 201. The form SSA-386 is 
used by the Social Security Administration to obtain acknowledgement of 
the individual's understanding of his rights and responsibilities as a 
beneficiary receiving drug addiction and alcoholism (DA&A) benefits. 
The form SSA-387 is used to monitor compliance with treatment 
requirements of DA&A beneficiaries and to determine eligibility for and 
retention of DA&A benefits. The respondents are referral and monitoring 
agencies, treatment facilities and [[Page 9342]] beneficiaries who are 
disabled based on DA&A.

Number of Respondents: 184,000
Frequency of Response: One (SSA-386) One per month (SSA-387)
Average Burden Per Response: 5 minutes (SSA-386) 10 minutes (SSA-387)
Estimated Annual Burden: 395,600 hours

    2. Employer Verification of Earnings for Children Under Age 7--
0960-0505. The information on form SSA-L3231-C1 is used by the Social 
Security Administration to ensure that the proper person is credited 
with earnings reported for a minor under age 7. The respondents are 
businesses reporting earnings for children under age 7.

Number of Respondents: 20,000
Frequency of Response: 1
Average Burden Per Response: 10 minutes
Estimated Annual Burden: 3,333 hours

    3. Application for Child's Insurance Benefits--0960-0010. The 
information on form SSA-4-BK is used by the Social Security 
Administration to elicit information needed to determine eligibility of 
benefits to the child of an insured individual retired because of old 
age or disability, and to a surviving child of a deceased worker. The 
respondents are children of fully insured wage earners.

Number of Respondents: 1,740,000
Frequency of Response: 1
Average Burden Per Response: Varies--10.5 or 15.5 minutes, depending on 
type of claim
Estimated Annual Burden: 372,417 hours

    4. Certificate of Responsibility for Welfare and Care of Child Not 
in Applicant's Custody--0960-0019. The information on form SSA-781 is 
used by the Social Security Administration to determine whether the 
``In Care'' entitlement factor is met. The respondents are applicants 
for benefits whose entitlement depends upon having an entitled child of 
the wage earner in their care.

Number of Respondents: 14,000
Frequency of Response: 1
Average Burden Per Response: 10 minutes
Estimated Annual Burden: 2,333 hours
OMB Desk Officer: Laura Oliven

    Written comments and recommendations regarding these information 
collections should be sent directly to the appropriate OMB Desk Officer 
designated above at the following address: Office of Management and 
Budget, OIRA New Executive Office Building, Room 10230 Washington, DC 
20503.

    Date: February 8, 1995.
Charlotte Whitenight,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 95-3672 Filed 2-16-95; 8:45 am]
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