[Federal Register Volume 79, Number 211 (Friday, October 31, 2014)]
[Notices]
[Pages 64872-64874]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-25860]


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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 104-13, the 
Paperwork Reduction Act of 1995, effective October 1, 1995. This notice 
includes revisions and extensions 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 ways to minimize burden 
on respondents, including the use of automated collection techniques or 
other forms of information technology. Mail, email, or fax your 
comments and recommendations on the information collection(s) to the 
OMB Desk Officer and SSA Reports Clearance Officer at the following 
addresses or fax numbers.

(OMB) Office of Management and Budget, Attn: Desk Officer for SSA, Fax: 
202-395-6974, Email address: <a href="/cdn-cgi/l/email-protection#400f0912011f1335222d293333292f2e002f2d226e252f306e272f36"><span class="__cf_email__" data-cfemail="36797f6477696543545b5f45455f595876595b541853594618515940">[email protected]</span></a>.
(SSA) Social Security Administration, OLCA, Attn: Reports Clearance 
Director, 3100 West High Rise, 6401 Security Blvd., Baltimore, MD 
21235, Fax: 410-966-2830, Email address: <a href="/cdn-cgi/l/email-protection#632c314d3106130c1117104d200f060211020d0006231010024d040c15"><span class="__cf_email__" data-cfemail="fdb2afd3af988d928f898ed3be91989c8f9c939e98bd8e8e9cd39a928b">[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 
December 30, 2014. Individuals can obtain copies of the collection 
instruments by writing to the above email address.
    1. Modified Benefit Formula Questionnaire-Foreign Pension--0960-
0561. SSA uses Form SSA-308 to determine exactly how much (if any) of a 
foreign pension may be used to reduce the amount of Title II Social 
Security retirement or disability benefits under the modified benefit 
formula. The respondents are applicants for Title II Social Security 
retirement or disability benefits who have foreign pensions.
    Type of Request: Extension of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Frequency of     burden per       Estimated
             Modality of completion                  responses       response        response      total annual
                                                                                     (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-308.........................................          13,452               1              10           2,242
Greenberg cases.................................           1,666               1              60           1,666
                                                 ---------------------------------------------------------------
    Totals......................................          15,118  ..............  ..............           3,908
----------------------------------------------------------------------------------------------------------------

    2. Filing Claims Under the Federal Tort Claims Act--20 CFR 429.101-
429.110--0960-0667. The Federal Tort Claims Act is the legal mechanism 
for compensating persons injured by negligent or wrongful acts that 
occur during the performance of official duties by Federal employees. 
In accordance with the law, SSA accepts monetary claims filed under the 
Federal Tort Claims Act for damages against the United States, loss of 
property, personal injury, or death resulting from an SSA employee's 
wrongful act or omission. The regulation sections cleared under this 
information collection request require claimants to provide information 
SSA can use to investigate and determine whether to make an award, 
compromise, or settlement under the Federal Tort Claims Act. The 
respondents are individuals or entities making a claim under the 
Federal Tort Claims Act.
    Type of Request: Extension of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Frequency of     burden per       Estimated
             Modality of completion                  responses       response        response      total annual
                                                                                     (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
429.102; 429.103 \1\............................               1  ..............  ..............               1
429.104(a)......................................              11               1               5               1
429.104(b)......................................              43               1               5               4
429.104(c)......................................               1               1               5               0
429.106(b)......................................               6               1              10               1
                                                 ---------------------------------------------------------------
    Totals......................................              62  ..............  ..............               7
----------------------------------------------------------------------------------------------------------------
\1\ The 1 hour represents a placeholder burden. We are not reporting a burden for this collection because
  respondents complete OMB-approved Form SF-95.

    II. SSA submitted the information collections below to OMB for 
clearance. Your comments regarding the information collections would be 
most useful if OMB and SSA receive them 30 days from the date of this 
publication. To be sure we consider your comments, we must receive them 
no later than December 1, 2014. Individuals can obtain copies of the 
OMB clearance package by writing to <a href="/cdn-cgi/l/email-protection#1f504d314d7a6f706d6b6c315c737a7e6d7e717c7a5f6c6c7e31787069"><span class="__cf_email__" data-cfemail="b7f8e599e5d2c7d8c5c3c499f4dbd2d6c5d6d9d4d2f7c4c4d699d0d8c1">[email protected]</span></a>.
    1. Partnership Questionnaire--20 CFR 404.1080-1082--0960-0025. SSA 
considers partnership income in determining entitlement to Social 
Security benefits. SSA uses information from Form SSA-7104 to determine

[[Page 64873]]

several aspects of eligibility for benefits, including the accuracy of 
reported partnership earnings, the veracity of a retirement, and lag 
earnings. The respondents are applicants for, and recipients of, Title 
II Social Security Old Age, Survivors, and Disability Insurance 
benefits.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                                      Total
                                                 Number of       Frequency of   Average  burden     estimated
           Modality of completion                responses         response      per  response    annual burden
                                                                                   (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-7104....................................          12,350                1               30            6,175
----------------------------------------------------------------------------------------------------------------

    2. Statement of Marital Relationship (By one of the parties)--20 
CFR 404.726--0960-0038. SSA must obtain a signed statement from a 
spousal applicant if the applicant claims a common-law marriage to the 
insured in a state in which such marriages are recognized, and no 
formal marriage documentation exists. SSA uses information we collect 
on Form SSA-754-F4 to determine if an individual applying for spousal 
benefits meets the criteria of common-law marriage under state law. The 
respondents are applicants for spouse's Social Security benefits or 
Supplemental Security Income (SSI) payments.

    Note:  This is a correction notice. SSA published this 
information collection as a revision on August 28, 2014, at 79 FR 
51387. Since we are no longer revising this information collection, 
it is now an extension of an OMB-approved information collection.

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

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden  Estimated total
           Modality of completion                Number of       Frequency of    per  response    annual burden
                                                 responses         response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-754-F4..................................          30,000                1               30           15,000
----------------------------------------------------------------------------------------------------------------

    3. Workers' Compensation/Public Disability Questionnaire--20 CFR 
404.408--0960-0247. Section 224 of the Social Security Act (Act) 
provides for the reduction of disability insurance benefits (DIB) when 
the combination of DIB and any workers' compensation (WC) or certain 
Federal, State or local public disability benefits (PDB) exceeds 80 
percent of the worker's pre-disability earnings. SSA field office staff 
conducts face-to-face interviews with applicants using the electronic 
WC/PDB screens in the Modernized Claims System (MCS) to determine if 
the worker's receipt of WC or PDB payments will cause a reduction of 
DIB. The respondents are applicants for the Title II DIB.
    Type of Request: Extension of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                                      Total
                                                 Number of       Frequency of   Average  burden     estimated
           Modality of completion                responses         response      per  response    annual burden
                                                                                   (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
MCS.........................................         248,000                1               15           62,000
----------------------------------------------------------------------------------------------------------------

    4. Medicaid Use Report--20 CFR 416.268--0960-0267. Section 20 CFR 
416.268 of the Code of Federal Regulations requires SSA to determine 
eligibility for (1) special SSI cash payments and for (2) special SSI 
eligibility status for a person who works despite a disabling 
condition. It also explains how, in order to qualify for special SSI 
eligibility status, an individual must establish that termination of 
eligibility for benefits under Title XIX of the Act would seriously 
inhibit the ability to continue employment. SSA uses the information 
required by this regulation to determine if an individual is entitled 
to special Title XVI SSI payments and, consequently, to Medicaid. The 
respondents are SSI recipients for whom SSA has stopped payments based 
on earnings.
    Type of Request: Extension of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden  Estimated total
           Modality of completion                Number of       Frequency of    per  response    annual burden
                                                 responses         response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
20 CFR 416.268..............................          60,000                1                3            3,000
----------------------------------------------------------------------------------------------------------------

    5. Medical Report on Adult with Allegation of Human 
Immunodeficiency Virus Infection; Medical Report on Child with 
Allegation of Human Immunodeficiency Virus Infection--20 CFR 416.933-20 
CFR 416.934--0960-0500. Section 1631(e)(i) of the Act authorizes the 
Commissioner of SSA to gather information to make a determination about 
an applicant's claim for SSI payments; this procedure is the 
presumptive disability (PD). SSA uses Forms SSA-4814-F5 and SSA-4815-F6 
to collect information necessary to determine if an individual with 
human immunodeficiency virus infection, who is applying for SSI 
disability benefits, meets the requirements for PD. The respondents are 
the medical sources of the applicants for SSI disability payments.

[[Page 64874]]

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

----------------------------------------------------------------------------------------------------------------
                                                                                      Average          Total
                                                     Number of     Frequency of     burden per       estimated
             Modality of completion                  responses       response        response      total annual
                                                                                     (minutes)    burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4814-F5.....................................          46,200               1              10           7,700
SSA-4815-F6.....................................          12,900               1              10           2,150
                                                 ---------------------------------------------------------------
    Totals......................................          59,100                                           9,850
----------------------------------------------------------------------------------------------------------------


    Dated: October 27, 2014.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2014-25860 Filed 10-30-14; 8:45 am]
BILLING CODE 4191-02-P


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