[Federal Register Volume 74, Number 15 (Monday, January 26, 2009)]
[Notices]
[Pages 4498-4499]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-1547]


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

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 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 <a href="/cdn-cgi/l/email-protection#4a193f28272339392325240a252728642f253a642d253c"><span class="__cf_email__" data-cfemail="4c1f392e21253f3f2523220c23212e6229233c622b233a">[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#450a1509086b17060a053636246b222a33"><span class="__cf_email__" data-cfemail="fbb4abb7b6d5a9b8b4bb88889ad59c948d">[email protected]</span></a>.

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

[[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


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