Document Headings

                    Document headings vary by document type but may contain                    the following:                  
                -                       the agency or agencies that issued and signed a document                    
                -                       the number of the CFR title and the number of each part                      the document amends, proposes to amend, or is directly                      related to                    
                -                       the agency docket number / agency internal file number                    
                -                       the RIN which identifies each regulatory action listed in                      the Unified Agenda of Federal Regulatory and Deregulatory                      Actions                    

                    See the                                          Document Drafting Handbook                                        for more details.                  

###### Social Security Administration

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 to existing 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 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 listed below. 

                    (OMB), Office of Management and Budget, Attn: Desk Officer for SSA, Fax: 202-395-6974, E-mail address:                     *OIRA Submission@omb.eop.gov*.                 

                    (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:                     *OPLM.RCO@ssa.gov.*

The information collections below are pending at SSA. SSA will submit them to OMB within 60 days from the date of this notice. Therefore, your comments would be most helpful if you submit them to SSA within 60 days from the date of this publication. Individuals can obtain copies of these collection instruments by calling the SSA Reports Clearance Officer at 410-965-3758 or by writing to the e-mail address listed above. 

1. Letter to Employer Requesting Information About Wages Earned by Beneficiary—20 CFR 416.703 & 404.801—0960-0034. SSA uses information from Form SSA-L725 to determine and verify a beneficiary's wages when SSA has incomplete or questionable wage data. SSA uses the information on the SSA-L725 to calculate the correct amount of benefits payable and to maintain an accurate record of earnings for the beneficiary. Respondents are small business employers. 

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

*Number of Respondents:*                     150,000.                 

*Frequency of Response:*                     1.                 

*Average Burden per Response:*                     40 minutes.                 

*Estimated Annual Burden:*                     100,000 hours.                 

2. Statement of Care and Responsibility for Beneficiary—20 CFR 404.2020, 404.2025, 408.620, 408.625, 416.620, 416.625—0960-0109. SSA uses information from Form SSA-788 to verify statements of concern made by payee applicants and to identify other potential payees. SSA is concerned with selecting the most qualified representative payee who will use Social Security benefits in the beneficiary's best interest. SSA considers factors such as the payee applicant's capacity to perform payee duties, awareness of the beneficiary's situation and needs, demonstration of past and current concern for the beneficiary's well-being, etc. If the payee applicant does not have custody of the beneficiary, SSA will obtain information from the custodian for evaluation against information provided by the applicant. Respondents are individuals who have custody of the beneficiary in cases where someone else has filed to be the beneficiary's representative payee. 

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

*Number of Respondents:*                     130,000.                 

*Frequency of Response:*                     1.                 

*Average Burden per Response:*                     10 minutes.                 

*Estimated Annual Burden:*                     21,667 hours.                 

3. Application for Special Age 72-or-Over Monthly Payments—20 CFR 404.380-404.384—0960-0096. Form SSA-19-F6 collects the information needed to determine whether a claimant can qualify for Special Age 72 payments. SSA will evaluate eligibility requirements using the data collected on this form. The respondents are individuals who reached age 72 before 1972. 

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

*Number of Respondents:*                     10.                 

*Frequency of Response:*                     1.                 

*Average Burden per Response:*                     10 minutes.                 

*Estimated Annual Burden:*                     2 hours.                 

                    4. Third Party Liability Information Statement—42 CFR 433.136-433.139— 0960-0323. Medicaid state agencies must identify third party insurers liable for medical care or services for Medicaid beneficiaries; this reduces Medicaid costs. Regulations at 42 CFR 433.136-433.139 require Medicaid state agencies to obtain this information on Medicaid applications and redeterminations as a condition of Medicaid eligibility. States may enter into agreements with the Commissioner of Social Security to make Medicaid eligibility determinations for aged, blind, and disabled beneficiaries in those states. Applications for and redeterminations of Supplemental Security Income (SSI) eligibility in jurisdictions with such agreements are applications and redeterminations of Medicaid eligibility. Under these agreements, SSA obtains third party liability information using Form SSA-8019 and provides that information to the Medicaid state agencies. The Medicaid state agencies use the information to bill third parties liable for medical care, support, or services for a beneficiary to guarantee that Medicaid remains the payer of last resort. The                           ( print page 4499)                        respondents are SSI claimants and recipients.                 

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

*Number of Respondents:*                     62,834.                 

*Frequency of Response:*                     1.                 

*Average Burden per Response:*                     5 minutes.                 

*Estimated Annual Burden:*                     5,236 hours.                 

Dated: January 16, 2009. 

John Biles, 

Reports Clearance Officer,  Social Security Administration.

 [FR Doc. E9-1547 Filed 1-23-09; 8:45 am] 

BILLING CODE 4191-02-P