Agency Information Collection Activities: Proposed Request and Comment Request, 49352-49354 [05-16660]
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49352
Federal Register / Vol. 70, No. 162 / Tuesday, August 23, 2005 / Notices
Physical Loan Application Deadline
Date: 09/20/2005.
ADDRESSES: Submit completed loan
applications to : U.S. Small Business
Administration, Disaster Area Office 3,
14925 Kingsport Road, Fort Worth, TX
76155.
FOR FURTHER INFORMATION CONTACT: A.
Escobar, Office of Disaster Assistance,
U.S. Small Business Administration,
409 3rd Street, Suite 6050, Washington,
DC 20416.
SUPPLEMENTARY INFORMATION: Notice is
hereby given that as a result of the
President’s major disaster declaration on
07/22/2005, applications for Private
Non-Profit organizations that provide
essential services of a governmental
nature may file disaster loan
applications at the address listed above
or other locally announced locations.
The following areas have been
determined to be adversely affected by
the disaster:
Primary Counties: Corson, Faulk,
Hyde, Potter, Spink, Stanley, Sully.
The Interest Rates are: Other
(Including Non-Profit Organizations)
with Credit Available Elsewhere: 4.750.
Businesses and Non-Profit
Organizations Without Credit Available
Elsewhere: 4.000.
The number assigned to this disaster
for physical damage is 10163.
(Catalog of Federal Domestic Assistance
Number 59008)
Herbert L. Mitchell,
Associate Administrator for Disaster
Assistance.
[FR Doc. 05–16696 Filed 8–22–05; 8:45 am]
BILLING CODE 8025–01–P
SMALL BUSINESS ADMINISTRATION
Administrator’s Line of Succession
Designation, No. 1–A, Revision 26
This document replaces and
supersedes ‘‘Line of Succession
Designation No. 1–A, Revision 25.’’
Line of Succession Designation No. 1–
A, Revision 26
Effective immediately, the
Administrator’s Line of Succession
Designation is as follows:
(a) In the event of my inability to
perform the functions and duties of my
position, or my absence from the office,
the Deputy Administrator will assume
all functions and duties of the
Administrator. In the event the Deputy
Administrator and I are both unable to
perform the functions and duties of the
my position or are absent from our
offices, I designate the officials in listed
order below, if they are eligible to act as
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15:03 Aug 22, 2005
Jkt 205001
Administrator under the provisions of
the Federal Vacancies Reform Act of
1998, to serve as Acting Administrator
with full authority to perform all acts
which the Administrator is authorized
to perform:
(1) Chief Operating Officer.
(2) Chief of Staff.
(3) General Counsel.
(4) Associate Deputy Administrator
for Capital Access.
(5) Associate Deputy Administrator
for Management and Administration.
(6) Designated Agency Ethics Official.
(7) Regional Administrator for Region
6.
(b) Notwithstanding the provisions of
SBA Standard Operating Procedure 00
01 2, ‘‘absence from the office,’’ as used
in reference to myself in paragraph (a)
above, means
(1) I am not present in the office and
cannot be reasonably contacted by
phone or other electronic means, and
there is an immediate business necessity
for the exercise of my authority; or
(2) I am not present in the office and,
upon being contacted by phone or other
electronic means, I determine that I
cannot exercise my authority effectively
without being physically present in the
office.
(c) An individual serving in an acting
capacity in any of the positions listed in
subparagraphs (a)(1) through (7), unless
designated as such by the
Administrator, is not also included in
this Line of Succession. Instead, the
next non-acting incumbent in the Line
of Succession shall serve as Acting
Administrator.
(d) This designation shall remain in
full force and effect until revoked or
superceded in writing by the
Administrator, or by the Deputy
Administrator when serving as Acting
Administrator.
(e) Serving as Acting Administrator
has no effect on the officials listed in
subparagraphs (a)(1) through (7), above,
with respect to their full-time position’s
authorities, duties and responsibilities
(except that such official cannot both
recommend and approve an action).
Dated: August 15, 2005.
Hector V. Barreto,
Administrator.
[FR Doc. 05–16655 Filed 8–22–05; 8:45 am]
BILLING CODE 8025–01–P
SOCIAL SECURITY ADMINISTRATION
Agency Information Collection
Activities: Proposed Request and
Comment Request
The Social Security Administration
(SSA) publishes a list of information
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Sfmt 4703
collection packages that will require
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. The information collection
packages that may be included in this
notice are for new information
collections, approval of existing
information collections, revisions to
OMB-approved information collections,
and extensions (no change) of OMBapproved 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 on ways
to minimize burden on respondents,
including the use of automated
collection techniques or other forms of
information technology. Written
comments and recommendations
regarding the information collection(s)
should be submitted to the OMB Desk
Officer and the SSA Reports Clearance
Officer. The information can be mailed
and/or faxed to the individuals at the
addresses and fax numbers listed below:
(OMB), Office of Management and
Budget, Attn: Desk Officer for SSA, New
Executive Building, Room 10235, 725
17th St., NW., Washington, DC 20503.
Fax: 202–395–6974.
(SSA), Social Security
Administration, DCFAM, Attn: Reports
Clearance Officer, 1333 Annex Building,
6401 Security Blvd., Baltimore, MD
21235. Fax: 410–965–6400.
I. The information collections listed
below are pending at SSA and will be
submitted to OMB within 60 days from
the date of this notice. Therefore, your
comments should be submitted to SSA
within 60 days from the date of this
publication. You can obtain copies of
the collection instruments by calling the
SSA Reports Clearance Officer at 410–
965–0454 or by writing to the address
listed above.
1. Report on Individual with Mental
Impairment—20 CFR 404.1513,
416.913—0960–0058. Form SSA–824 is
used by SSA to determine the claimant’s
medical status prior to making a
disability determination. The
respondents are physicians, medical
directors, medical record librarians and
other health professionals.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden Per Response: 36
minutes.
Estimated Annual Burden: 30,000
hours
2. Supplement to Claim of Person
Outside the United States—20 CFR
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Federal Register / Vol. 70, No. 162 / Tuesday, August 23, 2005 / Notices
404.460, 404.463, 422.505(b), 42 CFR
407.27(c)—0960–0051. The information
collected on Form SSA–21 is used to
determine the continuing entitlement to
Social Security benefits and the proper
benefit amounts of beneficiaries living
outside the United States. It is also used
to determine whether benefits are
subject to withholding tax. The
respondents are individuals entitled to
Social Security benefits who are, will
be, or have been residing outside the
United States.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 35,000.
Frequency of Response: 1.
Average Burden Per Response: 10
minutes.
Estimated Annual Burden: 5,833
hours.
3. Claimant’s Work Background—20
CFR 404.1565(b), 416.965(b)—0960–
0300. The information collected on
Form HA–4633 is needed and used to
afford claimants their statutory right to
a hearing and decision under the Social
Security Act (the Act). The information
is used by the SSA in cases in which
claimants for disability benefits have
requested a hearing on the
determination regarding their claim. A
completed form provides an updated
summary of a claimant’s past relevant
work and helps the administrative law
judge to better decide whether or not the
claimant is disabled. The respondents
are claimants requesting hearings for
benefits based on disability under Titles
II and/or XVI of the Act.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 120,000.
Frequency of Response: 1.
Average Burden Per Response: 15
minutes.
Estimated Annual Burden: 30,000
hours.
4. Medical Report on Adult with
Allegation of Human Immunodeficiency
Virus (HIV) Infection; Medical Report
on Child with Allegation of Human
Immunodeficiency Virus (HIV)
Infection—20 CFR 416.993–416.994—
0960–0500. Collection of the
information on Forms SSA–4814–F5
and SSA–4815–F6 is necessary for SSA
to determine if an individual with
Human Immunodeficiency Virus (HIV)
infection meets the requirements for
presumptive disability (PD) payments.
The SSA Field Office (FO) will,
generally, mail the appropriate form to
the claimant’s medical source for
completion and return to the FO. The
FO staff will use the information on the
form to determine if a PD is warranted.
The respondents are the medical
sources of the applicants for
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Jkt 205001
Supplemental Security Income (SSI)
disability payments.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 59,100.
Frequency of Response: 1.
Average Burden Per Response: 10
minutes.
Estimated Annual Burden: 9,850
hours.
5. Coverage of Employees of State and
Local Governments—20 CFR 404,
Subpart M—0960–0425. States (and
Interstate Instrumentalities) are required
to provide wage information and
deposit related contributions for pre1987 periods to SSA. The regulations at
20 CFR 404, Subpart M set forth the
rules for States submitting reports of
deposits and related recordkeeping. The
respondents are State and Local
Governments or Interstate
Instrumentalities.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 52.
Frequency of Response: 1.
Average Burden Per Response: 1 hour.
Estimated Annual Burden: 52 hours.
6. Information Collection
Requirements for Title VIII of the Social
Security Act—20 CFR 408.202(d),
408.210, 408.230(a), 408.232(a),
408.320, 408.305, 408.310, 408.315,
408.340, 408.345, 408.351(d) and (f),
408.355(a), 408.360(a), 408.404(c),
408.410, 408.412, 408.420(a) and (b),
408.430, 408.432, 408.435(a) and (b),
408.437(b), (c) and (d)—0960–0658.
Section 251 of the ‘‘Foster Care
Independence Act of 1999’’ added Title
VIII to the Social Security Act (Special
Benefits for Certain World War II
Veterans). Title VIII allows, under
certain circumstances, the payment of a
monthly benefit by Social Security to a
qualified World War II veteran who
resides outside the United States. The
accompanying regulations set out the
requirements an individual must meet
in order to qualify for and become
entitled to Special Veterans Benefits
(SVB). The respondents are individuals
who are applying for benefits under
Title VIII of the Social Security Act.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 762.
Frequency of Response: 1.
Average Burden Per Response: 30
minutes.
Estimated Annual Burden: 381 hours.
7. SSI Notice of Interim Assistance
Reimbursement (IAR)—0960–0546.
Forms SSA–8125 and SSA–L8125–F6
are used by SSA to obtain the amount
of Interim Assistance Reimbursement
(IAR) a State is due before it can pay
IAR to the State in various situations.
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49353
These forms are used for that purpose,
and to conduct audits of a State’s
accounting of IAR. Respondents are
State IAR officers.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden Per Response: 10
minutes.
Estimated Annual Burden: 8,333
hours.
II. The information collections listed
below have been submitted to OMB for
clearance. Your comments on the
information collections would be most
useful if received by OMB and SSA
within 30 days from the date of this
publication. You can obtain a copy of
the OMB clearance packages by calling
the SSA Reports Clearance Officer at
410–965–0454, or by writing to the
address listed above.
1. Marriage Certification—20 CFR
404.725—0960–0009. When the worker
and spouse are not filing concurrently,
SSA uses Form SSA–3–F6 to record any
changes/additions to the worker’s
marital history since the worker’s claim
was adjudicated. The marital history of
the claimant’s wife or husband, when
compared to the worker’s marital
history (as supplemented by Form SSA–
3–F6), enables the fact finder to
determine if the claimant has the
necessary relationship to the worker.
Where the spouse and worker were
ceremonially married, the worker’s
statement on his/her marital history that
he/she was ceremonially married to the
claimant’s spouse and the claimant’s
spouse statement that he/she was
ceremonially married to the worker
generally constitute evidence of a
ceremonial marriage in lieu of obtaining
a marriage certificate.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 180,000.
Frequency of Response: 1.
Average Burden Per Response: 5
minutes.
Estimated Annual Burden: 15,000
hours.
2. Request To Be Selected As Payee—
0960–0014. The information collected
on form SSA–11–BK is necessary to
determine the proper payee for a Social
Security beneficiary. The form is
designed to aid the investigation of a
payee applicant. The use of the form
will establish the applicant’s
relationship to the beneficiary, his/her
justification and his/her concern for the
beneficiary, as well as the manner in
which the benefits will be used.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 2,121,686.
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Federal Register / Vol. 70, No. 162 / Tuesday, August 23, 2005 / Notices
Frequency of Response: 1.
Average Burden Per Response: 10.5
minutes.
Estimated Annual Burden: 371,295
hours.
3. Record of SSI Inquiry—20 CFR
416.345—0960–0140. Form SSA–3462
is completed by SSA personnel via
telephone or personal interview, and it
is used to determine potential eligibility
for SSI benefits. The respondents are
individuals who inquire about SSI
eligibility for themselves or someone
else.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 2,134,100.
Frequency of Response: 1.
Average Burden Per Response: 5
minutes.
Estimated Annual Burden: 177,842
hours.
4. Statement for Determining
Continuing Eligibility for Supplemental
Security Income Payments—Adult,
Form SSA–3988; Statement for
Determining Continuing Eligibility for
Supplemental Security Income
Payments—Child, Form SSA–3989—20
CFR Subpart B—416.204–0960—NEW.
savings and a decrease in recipient
inconvenience while still obtaining
timely, accurate data to determine
continuing eligibility through the
process.
Background
The Social Security Act mandates
periodic redeterminations of nonmedical factors relating to SSI
recipient’s continuing eligibility for SSI
payments. SSA studies have indicated
that as many as two-thirds of these
scheduled redeterminations, which are
completed with the assistance of an SSA
employee, do not result in any change
in circumstances that affects the
recipients payment. SSA has conducted
extensive testing of both of the SSA–
3988 and SSA–3989, under OMB
Control Number 0960–0643, and has
validated that these redetermination
formats result in significant operational
Forms SSA–3988 and SSA–3989 will
be used to determine whether SSI
recipients have met and continue to
meet all statutory and regulatory nonmedical requirements for SSI eligibility,
and whether they have been and are still
receiving the correct payment amount.
The SSA–3988 and SSA–3989 are
designed as self-help forms that will be
mailed to recipients or to their
representative payees for completion
and return to SSA. The respondents are
recipients of SSI payments or their
representatives.
Type of Request: New information
collection.
Forms
5. Denial of Title II Benefits to
Fugitive Felons—0960–New.
Specifically, Section 203 of the SSPA
prohibits payment of title II benefits:
• To persons fleeing to avoid
prosecution or custody or confinement
after conviction, under the laws of the
place from which the person flees, for
a crime, or an attempt to commit a
crime, which is a felony under the laws
of the place from which the person
flees; or
• In jurisdictions that do not define
crimes as felonies, where the crime is
punishable by death or imprisonment
for a term exceeding 1 year regardless of
the actual sentence imposed; and
• To persons violating a condition of
probation or parole imposed under
Federal or State law.
To identify claimants who should not
be receiving benefits, the Commissioner
directed that we add specific questions
to title II applications that solicit
information about any outstanding
felony warrants or warrants for parole/
probation violations.
In addition, SSA will collect
supplemental information if a claimant
responds affirmatively to either or both
of the two fugitive felon questions on
title II applications, thereby indicating
that they have an unsatisfied warrant.
Answers to these questions will be used
to verify that a warrant is still
outstanding. An SSA claims
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15:03 Aug 22, 2005
Jkt 205001
650,000
65,000
representative will contact beneficiaries
by telephone to collect the information.
Respondents will be claimants for
benefits who indicated on their
application that they have an
unsatisfied warrant.
Type of Request: New information
collection.
Number of Respondents: 10,000.
Frequency of Response: 1.
Average Burden Per Response: 8
minutes.
Estimated Annual Burden: 1,333
hours.
Dated: August 17, 2005.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security
Administration.
[FR Doc. 05–16660 Filed 8–22–05; 8:45 am]
BILLING CODE 4191–02–P
SOCIAL SECURITY ADMINISTRATION
Privacy Act of 1974, as Amended;
Minor Changes to a System of Records
AGENCY:
Social Security Administration
(SSA).
Notice of minor changes to an
existing system of records.
ACTION:
SUMMARY: In accordance with the
Privacy Act (5 U.S.C. 552a(e)(4)), we are
issuing public notice of our intent to
make housekeeping changes to the
system of records entitled, Recovery of
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Fmt 4703
Sfmt 4703
Average burden
per response
(minutes)
Frequency of
response
Respondents
SSA–3988 ........................................................................................
SSA–3989 ........................................................................................
The Collection
1
1
Estimated
annual burden
(hours)
26
26
281,667
28,167
Overpayments, Accounting and
Reporting (ROAR) SSA/OTSO, 60–0094,
to more accurately describe the records
maintained in this system of records.
The housekeeping changes make the
Privacy Act notice of the ROAR system
of records accurate and up to date. We
invite public comment on this proposal.
This notice is effective upon
publication.
DATES:
Interested individuals may
comment on this publication by writing
to the Deputy Executive Director, Office
of Public Disclosure, Office of the
General Counsel, Social Security
Administration, Room 3–A–6
Operations Building, 6401 Security
Boulevard, Baltimore, Maryland 21235–
6401. All comments received will be
available for public inspection at the
above address.
ADDRESSES:
FOR FURTHER INFORMATION CONTACT:
Contact Ms. Tracie Jennings, Social
Insurance Specialist, Disclosure Policy
Team, Office of Public Disclosure,
Office of the General Counsel, Social
Security Administration, Room 3–A–6
Operations Building, 6401 Security
Boulevard, Baltimore, Maryland 21235–
6401, telephone 410–965–2902, e-mail:
tracie.jennings@ssa.gov.
SUPPLEMENTARY INFORMATION:
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]]>Agencies
[Federal Register Volume 70, Number 162 (Tuesday, August 23, 2005)]
[Notices]
[Pages 49352-49354]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-16660]
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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 that will require 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.
The information collection packages that may be included in this notice
are for new information collections, approval of existing information
collections, revisions to OMB-approved information collections, and
extensions (no change) 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 on ways to minimize
burden on respondents, including the use of automated collection
techniques or other forms of information technology. Written comments
and recommendations regarding the information collection(s) should be
submitted to the OMB Desk Officer and the SSA Reports Clearance
Officer. The information can be mailed and/or faxed to the individuals
at the addresses and fax numbers listed below:
(OMB), Office of Management and Budget, Attn: Desk Officer for SSA,
New Executive Building, Room 10235, 725 17th St., NW., Washington, DC
20503. Fax: 202-395-6974.
(SSA), Social Security Administration, DCFAM, Attn: Reports
Clearance Officer, 1333 Annex Building, 6401 Security Blvd., Baltimore,
MD 21235. Fax: 410-965-6400.
I. The information collections listed below are pending at SSA and
will be submitted to OMB within 60 days from the date of this notice.
Therefore, your comments should be submitted to SSA within 60 days from
the date of this publication. You can obtain copies of the collection
instruments by calling the SSA Reports Clearance Officer at 410-965-
0454 or by writing to the address listed above.
1. Report on Individual with Mental Impairment--20 CFR 404.1513,
416.913--0960-0058. Form SSA-824 is used by SSA to determine the
claimant's medical status prior to making a disability determination.
The respondents are physicians, medical directors, medical record
librarians and other health professionals.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden Per Response: 36 minutes.
Estimated Annual Burden: 30,000 hours
2. Supplement to Claim of Person Outside the United States--20 CFR
[[Page 49353]]
404.460, 404.463, 422.505(b), 42 CFR 407.27(c)--0960-0051. The
information collected on Form SSA-21 is used to determine the
continuing entitlement to Social Security benefits and the proper
benefit amounts of beneficiaries living outside the United States. It
is also used to determine whether benefits are subject to withholding
tax. The respondents are individuals entitled to Social Security
benefits who are, will be, or have been residing outside the United
States.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 35,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 5,833 hours.
3. Claimant's Work Background--20 CFR 404.1565(b), 416.965(b)--
0960-0300. The information collected on Form HA-4633 is needed and used
to afford claimants their statutory right to a hearing and decision
under the Social Security Act (the Act). The information is used by the
SSA in cases in which claimants for disability benefits have requested
a hearing on the determination regarding their claim. A completed form
provides an updated summary of a claimant's past relevant work and
helps the administrative law judge to better decide whether or not the
claimant is disabled. The respondents are claimants requesting hearings
for benefits based on disability under Titles II and/or XVI of the Act.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 120,000.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 30,000 hours.
4. Medical Report on Adult with Allegation of Human
Immunodeficiency Virus (HIV) Infection; Medical Report on Child with
Allegation of Human Immunodeficiency Virus (HIV) Infection--20 CFR
416.993-416.994--0960-0500. Collection of the information on Forms SSA-
4814-F5 and SSA-4815-F6 is necessary for SSA to determine if an
individual with Human Immunodeficiency Virus (HIV) infection meets the
requirements for presumptive disability (PD) payments. The SSA Field
Office (FO) will, generally, mail the appropriate form to the
claimant's medical source for completion and return to the FO. The FO
staff will use the information on the form to determine if a PD is
warranted. The respondents are the medical sources of the applicants
for Supplemental Security Income (SSI) disability payments.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 59,100.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 9,850 hours.
5. Coverage of Employees of State and Local Governments--20 CFR
404, Subpart M--0960-0425. States (and Interstate Instrumentalities)
are required to provide wage information and deposit related
contributions for pre-1987 periods to SSA. The regulations at 20 CFR
404, Subpart M set forth the rules for States submitting reports of
deposits and related recordkeeping. The respondents are State and Local
Governments or Interstate Instrumentalities.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 52.
Frequency of Response: 1.
Average Burden Per Response: 1 hour.
Estimated Annual Burden: 52 hours.
6. Information Collection Requirements for Title VIII of the Social
Security Act--20 CFR 408.202(d), 408.210, 408.230(a), 408.232(a),
408.320, 408.305, 408.310, 408.315, 408.340, 408.345, 408.351(d) and
(f), 408.355(a), 408.360(a), 408.404(c), 408.410, 408.412, 408.420(a)
and (b), 408.430, 408.432, 408.435(a) and (b), 408.437(b), (c) and
(d)--0960-0658. Section 251 of the ``Foster Care Independence Act of
1999'' added Title VIII to the Social Security Act (Special Benefits
for Certain World War II Veterans). Title VIII allows, under certain
circumstances, the payment of a monthly benefit by Social Security to a
qualified World War II veteran who resides outside the United States.
The accompanying regulations set out the requirements an individual
must meet in order to qualify for and become entitled to Special
Veterans Benefits (SVB). The respondents are individuals who are
applying for benefits under Title VIII of the Social Security Act.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 762.
Frequency of Response: 1.
Average Burden Per Response: 30 minutes.
Estimated Annual Burden: 381 hours.
7. SSI Notice of Interim Assistance Reimbursement (IAR)--0960-0546.
Forms SSA-8125 and SSA-L8125-F6 are used by SSA to obtain the amount of
Interim Assistance Reimbursement (IAR) a State is due before it can pay
IAR to the State in various situations. These forms are used for that
purpose, and to conduct audits of a State's accounting of IAR.
Respondents are State IAR officers.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 8,333 hours.
II. The information collections listed below have been submitted to
OMB for clearance. Your comments on the information collections would
be most useful if received by OMB and SSA within 30 days from the date
of this publication. You can obtain a copy of the OMB clearance
packages by calling the SSA Reports Clearance Officer at 410-965-0454,
or by writing to the address listed above.
1. Marriage Certification--20 CFR 404.725--0960-0009. When the
worker and spouse are not filing concurrently, SSA uses Form SSA-3-F6
to record any changes/additions to the worker's marital history since
the worker's claim was adjudicated. The marital history of the
claimant's wife or husband, when compared to the worker's marital
history (as supplemented by Form SSA-3-F6), enables the fact finder to
determine if the claimant has the necessary relationship to the worker.
Where the spouse and worker were ceremonially married, the worker's
statement on his/her marital history that he/she was ceremonially
married to the claimant's spouse and the claimant's spouse statement
that he/she was ceremonially married to the worker generally constitute
evidence of a ceremonial marriage in lieu of obtaining a marriage
certificate.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 180,000.
Frequency of Response: 1.
Average Burden Per Response: 5 minutes.
Estimated Annual Burden: 15,000 hours.
2. Request To Be Selected As Payee--0960-0014. The information
collected on form SSA-11-BK is necessary to determine the proper payee
for a Social Security beneficiary. The form is designed to aid the
investigation of a payee applicant. The use of the form will establish
the applicant's relationship to the beneficiary, his/her justification
and his/her concern for the beneficiary, as well as the manner in which
the benefits will be used.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 2,121,686.
[[Page 49354]]
Frequency of Response: 1.
Average Burden Per Response: 10.5 minutes.
Estimated Annual Burden: 371,295 hours.
3. Record of SSI Inquiry--20 CFR 416.345--0960-0140. Form SSA-3462
is completed by SSA personnel via telephone or personal interview, and
it is used to determine potential eligibility for SSI benefits. The
respondents are individuals who inquire about SSI eligibility for
themselves or someone else.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 2,134,100.
Frequency of Response: 1.
Average Burden Per Response: 5 minutes.
Estimated Annual Burden: 177,842 hours.
4. Statement for Determining Continuing Eligibility for
Supplemental Security Income Payments--Adult, Form SSA-3988; Statement
for Determining Continuing Eligibility for Supplemental Security Income
Payments--Child, Form SSA-3989--20 CFR Subpart B--416.204-0960--NEW.
Background
The Social Security Act mandates periodic redeterminations of non-
medical factors relating to SSI recipient's continuing eligibility for
SSI payments. SSA studies have indicated that as many as two-thirds of
these scheduled redeterminations, which are completed with the
assistance of an SSA employee, do not result in any change in
circumstances that affects the recipients payment. SSA has conducted
extensive testing of both of the SSA-3988 and SSA-3989, under OMB
Control Number 0960-0643, and has validated that these redetermination
formats result in significant operational savings and a decrease in
recipient inconvenience while still obtaining timely, accurate data to
determine continuing eligibility through the process.
The Collection
Forms SSA-3988 and SSA-3989 will be used to determine whether SSI
recipients have met and continue to meet all statutory and regulatory
non-medical requirements for SSI eligibility, and whether they have
been and are still receiving the correct payment amount. The SSA-3988
and SSA-3989 are designed as self-help forms that will be mailed to
recipients or to their representative payees for completion and return
to SSA. The respondents are recipients of SSI payments or their
representatives.
Type of Request: New information collection.
----------------------------------------------------------------------------------------------------------------
Average burden
Forms Respondents Frequency of per response Estimated annual
response (minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3988................................ 650,000 1 26 281,667
SSA-3989................................ 65,000 1 26 28,167
----------------------------------------------------------------------------------------------------------------
5. Denial of Title II Benefits to Fugitive Felons--0960-New.
Specifically, Section 203 of the SSPA prohibits payment of title II
benefits:
To persons fleeing to avoid prosecution or custody or
confinement after conviction, under the laws of the place from which
the person flees, for a crime, or an attempt to commit a crime, which
is a felony under the laws of the place from which the person flees; or
In jurisdictions that do not define crimes as felonies,
where the crime is punishable by death or imprisonment for a term
exceeding 1 year regardless of the actual sentence imposed; and
To persons violating a condition of probation or parole
imposed under Federal or State law.
To identify claimants who should not be receiving benefits, the
Commissioner directed that we add specific questions to title II
applications that solicit information about any outstanding felony
warrants or warrants for parole/probation violations.
In addition, SSA will collect supplemental information if a
claimant responds affirmatively to either or both of the two fugitive
felon questions on title II applications, thereby indicating that they
have an unsatisfied warrant. Answers to these questions will be used to
verify that a warrant is still outstanding. An SSA claims
representative will contact beneficiaries by telephone to collect the
information. Respondents will be claimants for benefits who indicated
on their application that they have an unsatisfied warrant.
Type of Request: New information collection.
Number of Respondents: 10,000.
Frequency of Response: 1.
Average Burden Per Response: 8 minutes.
Estimated Annual Burden: 1,333 hours.
Dated: August 17, 2005.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 05-16660 Filed 8-22-05; 8:45 am]
BILLING CODE 4191-02-P
