[Federal Register Volume 74, Number 109 (Tuesday, June 9, 2009)]
[Notices]
[Pages 27379-27380]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-13316]


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

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 new collection.
    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 the 
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 the SSA Reports Clearance Officer to the 
addresses or fax numbers shown below.

(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#357a7c67746a664057585c46465c5a5b755a58571b505a451b525a43"><span class="__cf_email__" data-cfemail="5e11170c1f010d2b3c33372d2d3731301e31333c703b312e70393128">[email protected]</span></a>.
(SSA) Social Security Administration, DCBFM, Attn: Reports Clearance 
Officer, 1332 Annex Building, 6401 Security Blvd., Baltimore, MD 21235, 
Fax: 410-965-6400, E-mail address: <a href="/cdn-cgi/l/email-protection#d798879b9af985949897a4a4b6f9b0b8a1"><span class="__cf_email__" data-cfemail="622d322e2f4c30212d221111034c050d14">[email protected]</span></a>.

    I. The information collection below is pending at SSA. SSA will 
submit it 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 
August 10, 2009. Individuals can obtain copies of the collection 
instrument by calling the SSA Reports Clearance Officer at 410-965-3758 
or by writing to the e-mail address we list above.
    1. Psychiatric Review Technique--20 CFR 404.1520a, 416.920a--0960-
0413. The SSA-2506-BK assists the Disability Determination Services 
(DDS) offices in evaluating mental impairments by helping to organize 
and present the mental findings in a clear, concise, and consistent 
manner; consider and evaluate all aspects of the mental impairment 
relevant to the individual's ability to perform work-related mental 
functions; and identify additional evidence needed to determine 
impairment severity.
    The respondents are the State DDSs and Federal DDSs administering 
the Title II and Title XVI programs.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 54.
    Frequency of Response: 27,553.
    Average Burden per Response: 15 minutes.
    Estimated Annual Burden: 371,966 hours.
    2. Certificate of Election for Reduced Spouse's Benefits--20 CFR 
404.421--0960-0398. Reduced benefits are not payable to an already 
entitled spouse, at least age 62 but under full retirement age, who no 
longer has a child in care unless the spouse elects to receive reduced 
benefits. If a spouse decides to elect reduced benefits, they must 
complete Form SSA-25. SSA uses the information collected on Form SSA-25 
to pay a qualified spouse who elects to receive a reduced benefit. 
Respondents are entitled spouses seeking reduced benefits.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 30,000.
    Frequency of Response: 1.
    Average Burden per Response: 2 minutes.
    Estimated Annual Burden: 1,000 hours.
    II. SSA has submitted the information collections we list 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 July 9, 2009. You can obtain a copy of the 
OMB clearance packages by calling the SSA Reports Clearance Officer at 
410-965-3758 or by writing to the above e-mail address.
    1. Statement of Employer--20 CFR 404.801-404.803--0960-0030. SSA 
uses Form SSA-7011-F4 to substantiate allegations of wages paid to 
workers when those wages do not appear in SSA's records of earnings and 
the worker does not have proof of those earnings. SSA uses the 
information from this form to process claims for Social Security 
benefits and to resolve discrepancies in the individual's Social 
Security earnings record. We only send Form SSA-7011-F4 to employers if 
we deem it necessary. We make every effort to locate the earnings 
information within our records before we contact the employer. The 
respondents are employers who can verify wage allegations made by wage 
earners.

    Note: This is a correction notice. SSA published this 
information collection as an extension on April 07, 2009 at 74 FR 
15808. 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: 925,000.
    Frequency of Response: 1.
    Average Burden per Response: 20 minutes.
    Estimated Annual Burden: 308,333 hours.
    2. Statement of Claimant or Other Person--20 CFR 404.702 & 
416.570--0960-0045. SSA uses the SSA-795 to obtain information from 
claimants or other persons having knowledge of facts in connection with 
claims for Supplemental Security Income (SSI) or Social Security 
benefits when there is no standard form to collect the needed 
information. SSA uses the information to process claims for benefits or 
for ongoing issues related to the above programs. The respondents are 
applicants/recipients of SSI or Social Security benefits, or others who 
are in a position to provide information pertinent to the claim(s).
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 305,500.
    Frequency of Response: 1.
    Average Burden per Response: 15 minutes.
    Estimated Annual Burden: 76,375 hours.
    3. Statement of Self-Employment Income--20 CFR 404.101, 404.110,

[[Page 27380]]

404.1096(a)-(d)--0960-0046. SSA collects the information on Form SSA-
766 to expedite the payment of benefits to an individual who is self-
employed and who is establishing insured status. The form elicits the 
information necessary to determine if the individual will have the 
minimum amount of self-employment income for quarters of coverage. 
Respondents are self-employed individuals who may be eligible for 
Social Security benefits.

    Note: This is a correction notice. SSA published this 
information collection as an extension on April 7, 2009 at 74 FR 
15808. 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: 2,500.
    Frequency of Response: 1.
    Average Burden per Response: 5 minutes.
    Estimated Annual Burden: 417 hours.
    4. Certification by Religious Group--20 CFR 404.1075--0960-0093. 
SSA uses information from Form SSA-1458 to determine whether a 
religious group meets the qualifications contained in Section 1402(g) 
of the Internal Revenue Code, which exempts members of certain 
religious groups and sects from payment of Self-Employment Contribution 
Act taxes. The respondents are spokespersons for religious groups or 
sects.
    Type of Request: Extension of an OMB-approved information 
collection.
    Number of Respondents: 180.
    Frequency of Response: 1.
    Average Burden per Response: 15 minutes.
    Estimated Annual Burden: 45 hours.
    5. Instructions for Completion of Federal Assistance Application--
0960-0184. SSA uses information from Form SSA-BK-96 to select grant 
proposals for funding based on their technical merits. This information 
assists the agency in evaluating the soundness of the design of the 
proposed activities, the possibilities of obtaining productive results, 
the adequacy of resources to conduct the activities and the 
relationship to other similar activities of the respondents. The 
respondents are State and local governments, State-designated 
protection and advocacy groups, colleges and universities and profit 
and nonprofit private organizations.

    Note: This is a correction notice. SSA published this 
information collection as an extension on April 7, 2009 at 74 FR 
15808. 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: 400.
    Frequency of Response: 2 hours.
    Average Burden per Response: 14 hours.
    Estimated Annual Burden: 11,200 hours.
    6. Representative Payee Report--Special Veterans Benefits--20 CFR 
408.665--0960-0621. Title VIII of the Social Security Act allows the 
payment of monthly benefits (referred to as Special Veterans Benefits) 
by the Commissioner of Social Security to qualified World War II 
veterans who reside outside the United States. An SSA-appointed 
representative payee may receive and manage the monthly payment for the 
beneficiary's use and benefit. SSA uses the Form SSA-2001-F6 to 
determine if the payee has used the benefits properly and continues to 
demonstrate strong concern for the beneficiary. Respondents are persons 
or organizations who act on behalf of beneficiaries receiving Special 
Veterans Benefits.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 100.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 17 hours.
    7. Request for Deceased Individual's Social Security Record--20 CFR 
402.130--0960-0665. SSA uses the Form SSA-711 to process requests from 
the public for a microprint of the SS-5, Application for Social 
Security Card, for a deceased individual. Respondents are members of 
the public who are requesting deceased individuals' Social Security 
records.

    Note: This is a correction notice. SSA published this 
information collection as an extension on April 7, 2009 at 74 FR 
15808. Since we are revising the Privacy Act Statement, this is now 
a revision of OMB-approved information.

    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 50,000.
    Frequency of Response: 1.
    Average Burden per Response: 7 minutes.
    Estimated Annual Burden: 5,834 hours.
    8. Request for Business Entity Taxpayer Information--0960-0731. SSA 
uses the SSA-1694 to collect information from law firms or other 
business entities that have partners or employees to facilitate direct 
payment of SSA-authorized fees for representing claimants before SSA. 
SSA will use this information to meet any requirement for issuance of a 
Form 1099-MISC. The respondent law firms or other business entities 
that represent claimants before SSA.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 2,000.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 333 hours.
    Type of Request: Revision of an OMB-approved information 
collection.
    9. Electronic Records Express--0960-0753. Electronic Records 
Express (ERE) is a Web-based SSA program that allows medical providers 
to electronically submit disability claimant data to SSA. Medical 
providers and other third parties with connections to disability 
applicants/recipients can use this system. This information collection 
request (ICR) includes the registration process for becoming a 
certified ERE user. We are expanding this ICR to include increased 
functionality by giving medical providers the ability to submit 
invoices electronically. The respondents are medical providers who 
evaluate or treat disability claimants/recipients and other third 
parties.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 17,689.
    Frequency of Response: 1.
    Average Burden per Response: 10 minutes.
    Estimated Annual Burden: 2,948 hours.

III. Correction Notices

    1. Function Report Adult--Third Party--20 CFR 404.1512 & 416.912--
0960-0635. This is a correction notice: SSA inadvertently published 
duplicate notices for this collection at 74 FR 23764 on 5/20/09 and 
again at 74 FR 23916 on 5/21/09. The first publication was in error. 
Therefore, we request comments only for the second publication with a 
submission date no later than July 20, 2009.
    2. Function Report Adult--20 CFR 404.1512 & 416.912--0960-0681. 
This is a correction notice: SSA inadvertently published duplicate 
notices for this collection at 74 FR 23764 on 5/20/09 and again at 74 
FR 23916 on 5/21/09. The first publication was in error. Therefore, we 
request comments only for the second publication with a submission date 
no later than July 20, 2009.

    Dated: June 2, 2009.
John Biles,
Reports Clearance Officer, Center for Reports Clearance, Social 
Security Administration.
[FR Doc. E9-13316 Filed 6-8-09; 8:45 am]
BILLING CODE 4191-02-P


</pre><script data-cfasync="false" src="/cdn-cgi/scripts/5c5dd728/cloudflare-static/email-decode.min.js"></script></body>
</html>