Agency Information Collection Activities: Proposed Request and Comment Request, 30464-30467 [E6-7995]
Download as PDF
<![CDATA[
30464
Federal Register / Vol. 71, No. 102 / Friday, May 26, 2006 / Notices
compensation, but would be reimbursed
for any travel-related expenses incurred,
if applicable. If a Hearing Panelist is
also a member of the Board, any Board
or Standing Committee meetings that
are held on the same day as the hearing
would be considered a single meeting
for the purposes of compensation.
Issuance of Decisions
If an Offer of Settlement (‘‘Offer’’) is
submitted to the BCC before a hearing
commences, even if the Hearing
Panelists are selected, the Committee
would still consider the Offer and, if
accepted, issue a decision. If an Offer is
submitted after a hearing commences,
however, the Exchange staff would
promptly submit its position with
respect to such Offer. The Hearing
Panelists would then determine whether
to consider the Offer and, if considered,
whether to accept or reject the Offer.10
A decision issued by the Hearing
Panel would be considered final. Any
appeal of the decision would be taken
directly to the Exchange’s Board of
Governors.
The purpose of the proposal is to
replace the current BCC hearing process
described above to make it more
efficient. By having a permanent and
independent Hearing Officer and prescreened, qualified Hearing Panelists,
the formal hearing process should be
expedited and the sanctioning process
reconciled so that sanctions for similar
misconduct are imposed more
uniformly given that the same Hearing
Officer would preside over all hearings.
Pre-screening Hearing Panelists and
compensating them should also help to
ensure that qualified panelists are
selected to serve on Exchange Hearing
Panels. In addition, the Exchange
believes that having the Hearing Panel
issue a final decision directly, without
having to go to the BCC for review and
approval, should help expedite the
issuance of decisions.
2. Statutory Basis
jlentini on PROD1PC65 with NOTICES
The Exchange believes that its
proposal is consistent with section 6(b)
of the Act 11 in general, and furthers the
objectives of sections 6(b)(5), 6(b)(6) and
6(b)(7) of the Act 12 in particular, in that
this proposal should help to: (i) Protect
investors and the public interest; (ii)
appropriately discipline members,
10 The BCC will continue to hear any current
matters through their completion if a hearing has
already commenced. Thus, if the proposed rule
change is approved by the Commission and
implemented in the middle of an ongoing hearing,
the BCC will hear that matter through its
completion and will issue the decision accordingly.
11 15 U.S.C. 78f(b).
12 15 U.S.C. 78f(b)(5), (6) and (7).
VerDate Aug<31>2005
16:12 May 25, 2006
Jkt 208001
member organizations and persons
associated with members or member
organizations; and (iii) provide a fair
procedure for the disciplining of
members, member organizations and
persons associated with members or
member organizations.
B. Self-Regulatory Organization’s
Statement on Burden on Competition
The Exchange does not believe that
the proposed rule change will impose
any burden on competition that is not
necessary or appropriate in furtherance
of the purposes of the Act.
C. Self-Regulatory Organization’s
Statement on Comments on the
Proposed Rule Change Received From
Members, Participants or Others
No written comments were either
solicited or received.
III. Date of Effectiveness of the
Proposed Rule Change and Timing for
Commission Action
Within 35 days of the date of
publication of this notice in the Federal
Register or within such longer period (i)
as the Commission may designate up to
90 days of such date if it finds such
longer period to be appropriate and
publishes its reasons for so finding or
(ii) as to which the Phlx consents, the
Commission will:
(A) By order approve such proposed
rule change, or
(B) Institute proceedings to determine
whether the proposed rule change
should be disapproved.
The Commission is considering
granting accelerated approval of the
proposed rule change at the end of a 15day comment period.13
IV. Solicitation of Comments
Interested persons are invited to
submit written data, views, and
arguments concerning the foregoing,
including whether the proposed rule
change, as amended, is consistent with
the Act. Comments may be submitted by
any of the following methods:
Electronic Comments
• Use the Commission’s Internet
comment form (https://www.sec.gov/
rules/sro.shtml); or
• Send an e-mail to rulecomments@sec.gov. Please include File
Number SR–Phlx–2005–65 on the
subject line.
13 The Phlx has requested accelerated approval of
this proposed rule change prior to the 30th day after
the date of publication of the notice of the filing
thereof.
PO 00000
Frm 00100
Fmt 4703
Sfmt 4703
Paper Comments
• Send paper comments in triplicate
to Nancy M. Morris, Secretary,
Securities and Exchange Commission,
100 F Street, NE., Washington, DC
20549–1090.
All submissions should refer to File
Number SR–Phlx–2005–65. This file
number should be included on the
subject line if e-mail is used. To help the
Commission process and review your
comments more efficiently, please use
only one method. The Commission will
post all comments on the Commission’s
Internet Web site (https://www.sec.gov/
rules/sro.shtml). Copies of the
submission, all subsequent
amendments, all written statements
with respect to the proposed rule
change that are filed with the
Commission, and all written
communications relating to the
proposed rule change between the
Commission and any person, other than
those that may be withheld from the
public in accordance with the
provisions of 5 U.S.C. 552, will be
available for inspection and copying in
the Commission’s Public Reference
Room. Copies of the filing also will be
available for inspection and copying at
the principal office of the Phlx. All
comments received will be posted
without change; the Commission does
not edit personal identifying
information from submissions. You
should submit only information that
you wish to make available publicly. All
submissions should refer to File
Number SR–Phlx–2005–65 and should
be submitted on or before June 12, 2006.
For the Commission, by the Division of
Market Regulation, pursuant to delegated
authority.14
Nancy M. Morris,
Secretary.
[FR Doc. E6–8133 Filed 5–25–06; 8:45 am]
BILLING CODE 8010–01–P
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
14 17
E:\FR\FM\26MYN1.SGM
CFR 200.30–3(a)(12).
26MYN1
30465
Federal Register / Vol. 71, No. 102 / Friday, May 26, 2006 / Notices
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,
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. Function Report—Adult—Third
Party—20 CFR 404.1512, 416.912—
0960–0635. The information collected
on the SSA–3380-BK is needed to make
determinations on SSI and SSDI
disability claims. This information is
necessary for case development and
adjudication, and is used by State
Disability Determination Services
evaluators as an evidentiary source used
in the disability evaluation process. The
respondents are third parties familiar
with the functional limitations (or lack
thereof) of claimants who apply for
Social Security benefits and
Supplemental Security Income
disability payments.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 1,000,000.
Frequency of Response: 1.
Average Burden per Response: 60
minutes.
Estimated Annual Burden: 1,000,000
hours.
2. Request for Internet Services—
Password Authentication—20 CFR
401.45—0960–0632. SSA has
established a Password infrastructure
for using its Internet and Automated
Telephone Response services to access
SSA records. These services are
password protected due to the nature of
the information being transmitted or
because the requested information
requires a higher level of protection to
ensure the security and confidentiality
of records. Password Authentication is
used to establish a password process for
verifying the identity of individuals
who choose to use these services for
conducting business with SSA.
Individuals are required to provide
identifying information to SSA, such as
their name, social security number, date
of birth, and a shared secret between
themselves and SSA before they can
create a password. After this
information is stored and verified, SSA
sends the individual their new personal
identification number (PIN) and
password to be used to access SSA’s
password protected services. The
password process allows requestors to
establish their identities with SSA and
create a password which they can then
use to access their own personal
information. The respondents are
persons electing to do business with
SSA through an electronic medium.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 1,630,771.
Frequency of Response: 1.
Average Burden per Response: 10
minutes.
Estimated Annual Burden: 271,795
hours.
3. Statement of Reclamation Action—
31 CFR 210—0960–NEW. Form SSA–
1713 collects information regarding
whether, how and when a Canadian
bank was able to return erroneous
payments made after the death of a
beneficiary who elected to have
payments sent to Canada. The SSA–
1713 is sent with the SSA–1712, an
SSA-generated cover sheet which
provides the Canadian bank with
information regarding the deceased
Number of
respondents
jlentini on PROD1PC65 with NOTICES
CFR Section
404.2011(a)(1) .................................................................................................
416.611(a)(1) ...................................................................................................
VerDate Aug<31>2005
16:12 May 25, 2006
Jkt 208001
PO 00000
Frm 00101
Fmt 4703
Sfmt 4703
beneficiary. In this way, SSA can
reclaim funds which were erroneously
paid. The respondents are Canadian
financial institutions to which Social
Security payments have been made.
Type of Request: Existing Information
Collection in Use Without an OMB
Number.
Number of Respondents: 15.
Frequency of Response: 1.
Average Burden per Response: 5
minutes.
Estimated Annual Burden: 1 hour.
4. Request for Reconsideration—
Disability Cessation—20 CFR 404.909,
416.1409—0960–0349. Form SSA–789–
U4 is used by claimants to request
reconsideration of a determination and
to indicate whether or not they wish to
appear at a disability hearing. This form
can also be used to submit any
additional information/evidence for use
in the reconsidered determination and
to indicate if an interpreter is needed for
the hearing. SSA will use this
information to either arrange for a
hearing or to prepare a decision based
on the evidence of record. The
respondents are applicants or claimants
for Social Security benefits or SSI
payments.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 49,000.
Frequency of Response: 1.
Average Burden per Response: 13
minutes.
Estimated Annual Burden: 10,617
hours
5. Representative Payment Policies
Regulation—20 CFR 404.2011,
404.2025, 416.611, 416.625—0960–
0679. In cases where SSA determines
that it is not in a beneficiary’s best
interest to receive payments directly as
it may cause substantial harm, the
beneficiaries may dispute this decision.
If they do, they provide SSA with
information which SSA will take into
consideration when reevaluating the
decision. Representative payees must
also provide SSA with information
regarding their relationship,
responsibility, and how payments were
used for the beneficiary. Respondents
are beneficiaries and representative
payees.
Type of Request: Revision of an OMBapproved information collection.
Frequency of
response
250
E:\FR\FM\26MYN1.SGM
1
26MYN1
Average
burden per
response
(minutes)
15
Estimated
annual burden
hours
63
30466
Federal Register / Vol. 71, No. 102 / Friday, May 26, 2006 / Notices
Number of
respondents
CFR Section
Average
burden per
response
(minutes)
Frequency of
response
Estimated
annual burden
hours
3,000
1
6
300
Totals ........................................................................................................
jlentini on PROD1PC65 with NOTICES
404.2025 ..........................................................................................................
416.625 ............................................................................................................
3,250
........................
........................
363
Estimated Annual Burden: 363 hours.
6. Psychiatric Review Technique—20
CFR 404.1520(a), 416.920(a)—0960–
0413. The SSA–2506–BK assists the
DDSs 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 52 State DDSs administering the
Title II and Title XVI programs.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 52.
Frequency of Response: 20,595.
Total Annual Responses: 1,070,940.
Average Burden per Response: 15
minutes.
Estimated Annual Burden: 267,735
hours.
7. Disability Hearing Officer’s
Decision—Title XVI Disabled Child (DC)
Continuing Disability Review—20 CFR
404.913–.914, 404.917, 416.994a,
416.1413–.1414, 416.1417—0960–0657.
Form SSA–1209-BK is used by the
disability hearing officer conducting the
disability hearing to prepare and issue
a written reconsidered determination—
specifically for evaluating Title XVI
childhood disability cases. The form
provides the framework for addressing
the crucial elements of the case in a
sequential and logical fashion, and the
completed form is the official document
of the decision. Respondents are
disability hearing officers in State
Disability Determination Services
(DDSs).
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 35,000.
Frequency of Response: 1.
Average Burden per Response: 75
minutes.
Estimated Annual Burden: 43,750
hours.
8. Certificate of Incapacity—5 CFR
890.302(d)—0960–NEW. Rules
governing the Federal Employee Health
Benefits (FEHB) plan state that for
federal employees’ children ages 22 or
over to retain health benefits, they must
VerDate Aug<31>2005
16:12 May 25, 2006
Jkt 208001
be incapable of self-support due to a
disability that (1) pre-dated the child’s
22nd birthday, (2) is very serious, and
(3) can be expected to last at least one
year. Form SSA–604, the Certificate of
Incapacity, is used by physicians to
document and certify such a disability
for their patients who are children of
Federal employees. The respondents are
physicians of federal employees’
children ages 22 or over who are seeking
to retain health benefits under their
parent’s FEHB coverage.
Type of Request: New information
collection.
Number of Respondents: 38.
Frequency of Response: 1.
Average Burden per Response: 45
minutes.
Estimated Annual Burden: 29 hours.
9. Function Report—Adult—20 CFR
404.1512 and 419.912—0960–0681.
Form SSA–3373 is used to collect
information about a disability
applicant’s impairment-related
limitations and ability to function. It
documents the types of information
specified in SSA regulations and
provides disability interviewers with a
convenient means to record information
about how the claimant’s condition
affects his or her ability to function.
This information, together with medical
evidence, forms the evidentiary basis
upon which the initial disability process
is founded. The respondents are Title II
and Title XVI benefits applicants.
Type of Request: Revision to an OMBapproved information collection.
Number of Respondents: 4,005,367.
Frequency of Response: 1.
Average Burden per Response: 60
minutes.
Estimated Annual Burden: 4,005,367.
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. Statement of Employer—20 CFR
404.801–803—0960–0030. The
information collected on Form SSA–
PO 00000
Frm 00102
Fmt 4703
Sfmt 4703
7011—F4 is needed to substantiate
allegations of wages paid to workers
when wages do not appear in SSA’s
records of earnings and the worker has
no proof of said earnings. SSA can use
the information to process claims for
benefits and resolve discrepancies in the
worker’s earnings record. The
respondents are certain employers who
can verify wage allegations made by the
wage earner.
Type of Request: Extension 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. Request for Workers’
Compensation/Public Disability Benefit
Information—20 CFR 404.408(e)—0960–
0098. Section 224 of the Social Security
Act provides for an offset of disability
insurance benefits when workers’
compensation (WC) or public disability
benefits (PDB) is also being received.
The SSA–1709 is used to request and/
or verify information regarding WC/PDB
given to Social Security disability
recipients so that the proper adjustment
is made to their monthly benefits. The
respondents are Federal, State, and local
agencies administering WC/PDB,
insurance carriers, and public or private
self-insured companies.
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.
3. Disability Report-Appeal—20 CFR
404.1512, 416.912, 404.916(c),
416.1416(c)—0960–0144. The SSA–
3441–BK is used to secure updated
resource and condition information
from claimants seeking reconsideration
of denied disability benefits. The
claimant also has the option of
providing the information during a
personal interview or through SSA’s
Internet application. This information
assists the State Disability
Determination Services and
administrative law judges in preparing
E:\FR\FM\26MYN1.SGM
26MYN1
30467
Federal Register / Vol. 71, No. 102 / Friday, May 26, 2006 / Notices
for appeals and hearings and in issuing
a decision. Respondents are individuals
who appeal denial of Social Security
disability income and Supplemental
Security Income (SSI) benefits, cessation
of benefits, or who are requesting a
hearing.
Number of
respondents
Collection method
Type of Request: Revision of an OMBapproved information collection.
Average burden per
response:
(minutes)
Frequency of
response
Estimated annual burden
SSA–3441 (Paper Form) .................................................................................
Electronic Disability Collection System (EDCS) ..............................................
I3441 (Internet Form) .......................................................................................
404,506
635,873
72,341
1
1
1
45
45
120
303,380
476,905
144,682
Totals ........................................................................................................
1,112,720
........................
........................
924,967
Estimated Annual Burden: 924,967
hours.
4. Third Party Liability Information
Statement—42 CFR 433.136–433.139—
0960–0323. Identification of sources of
third party insurance liable for medical
care or services for Medicaid
beneficiaries, which could be used to
reduce Medicaid costs, is required
under 42 U.S.C. 1396a(a)(25). Medicaid
State agencies are mandated under 42
CFR 433.136–.139 to obtain this
information on Medicaid applications
and redeterminations as a condition of
Medicaid eligibility. States are
permitted to 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 SSI eligibility in jurisdictions with
Estimated Annual Burden: 6,128
hours.
5. Claimant Statement About Loan of
Food or Shelter; Statement About Food
or Shelter Provided to Another—20 CFR
416.1130–416.1148—0960–0529. Forms
SSA–5062 and SSA–L5063 are used to
obtain statements about food and/or
shelter provided to an SSI claimant or
recipient. SSA uses this information to
determine whether food and/or shelter
are bona fide loans or should be counted
as income for SSI purposes. This
determination can affect eligibility for
SSI and the amount of SSI benefits
payable. The respondents are claimants/
recipients for SSI benefits and
individuals that provide loans of food
and/or shelter to SSI claimants/
recipients.
Type of Request: Extension of an
OMB-approved information collection.
such agreements are also 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 State agencies which
provide Medicaid under the terms of an
approved plan in Title XIX of the Social
Security Act. The Medicaid State
agencies then use the information
provided to attempt to bill any third
parties liable for medical care, support
or services for a beneficiary to guarantee
that Medicaid remains the payer of last
resort. The respondents are SSI
applicants and beneficiaries.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 73,540.
Frequency of Response: 1.
Average Burden per Response: 5
minutes.
Number of
respondents
Form number
Average burden per
response:
(minutes)
Frequency of
response
Estimated annual burden
SSA–5062 ........................................................................................................
SSA–L5063 ......................................................................................................
65,540
65,540
1
1
10
10
10,923
10,923
Totals ........................................................................................................
131,080
........................
........................
21,846
Estimated Annual Burden: 21,846
hours.
ACTION:
Dated: May 18, 2006.
Elizabeth A. Davidson,
Social Security Administration, Reports
Clearance Officer.
[FR Doc. E6–7995 Filed 5–25–06; 8:45 am]
SUMMARY: In accordance with 20 CFR
402.35(b)(1), the Commissioner of Social
Security gives notice of Social Security
Ruling, SSR 06–01p. This Ruling
provides guidance on the types of
impairments that may result from
tremolite asbestos and how to evaluate
disability claims under titles II and XVI
of the Social Security Act based on
these impairments.
BILLING CODE 4191–02–P
SOCIAL SECURITY ADMINISTRATION
Notice of Social Security ruling.
jlentini on PROD1PC65 with NOTICES
[Social Security Ruling, SSR 06–01p]
DATES:
Titles II and XVI: Evaluating Cases
Involving Tremolite Asbestos-Related
Impairments
FOR FURTHER INFORMATION CONTACT:
AGENCY:
Social Security Administration.
VerDate Aug<31>2005
16:12 May 25, 2006
Jkt 208001
Effective Date: May 25, 2006.
Michelle Hungerman, Office of Medical
Policy, Social Security Administration,
6401 Security Boulevard, Baltimore, MD
21235–6401, 1–410–965–2289 or TTY
PO 00000
Frm 00103
Fmt 4703
Sfmt 4703
1–800–966–5609, for information about
this notice.
Although
we are not required to do so pursuant
to 5 U.S.C. 552(a)(1) and (a)(2), we are
publishing this Social Security Ruling
in accordance with 20 CFR 402.35(b)(1).
Social Security Rulings make
available to the public precedential
decisions relating to this Federal oldage, survivors, disability, supplemental
security income, and special veterans
benefits programs. Social Security
Rulings may be based on determinations
or decisions made at all administrative
levels of adjudication, Federal court
decisions, Commissioner’s decisions,
opinions of the Office of the General
SUPPLEMENTARY INFORMATION:
E:\FR\FM\26MYN1.SGM
26MYN1
]]>Agencies
[Federal Register Volume 71, Number 102 (Friday, May 26, 2006)]
[Notices]
[Pages 30464-30467]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E6-7995]
=======================================================================
-----------------------------------------------------------------------
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
[[Page 30465]]
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,
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. Function Report--Adult--Third Party--20 CFR 404.1512, 416.912--
0960-0635. The information collected on the SSA-3380-BK is needed to
make determinations on SSI and SSDI disability claims. This information
is necessary for case development and adjudication, and is used by
State Disability Determination Services evaluators as an evidentiary
source used in the disability evaluation process. The respondents are
third parties familiar with the functional limitations (or lack
thereof) of claimants who apply for Social Security benefits and
Supplemental Security Income disability payments.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 1,000,000.
Frequency of Response: 1.
Average Burden per Response: 60 minutes.
Estimated Annual Burden: 1,000,000 hours.
2. Request for Internet Services--Password Authentication--20 CFR
401.45--0960-0632. SSA has established a Password infrastructure for
using its Internet and Automated Telephone Response services to access
SSA records. These services are password protected due to the nature of
the information being transmitted or because the requested information
requires a higher level of protection to ensure the security and
confidentiality of records. Password Authentication is used to
establish a password process for verifying the identity of individuals
who choose to use these services for conducting business with SSA.
Individuals are required to provide identifying information to SSA,
such as their name, social security number, date of birth, and a shared
secret between themselves and SSA before they can create a password.
After this information is stored and verified, SSA sends the individual
their new personal identification number (PIN) and password to be used
to access SSA's password protected services. The password process
allows requestors to establish their identities with SSA and create a
password which they can then use to access their own personal
information. The respondents are persons electing to do business with
SSA through an electronic medium.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 1,630,771.
Frequency of Response: 1.
Average Burden per Response: 10 minutes.
Estimated Annual Burden: 271,795 hours.
3. Statement of Reclamation Action--31 CFR 210--0960-NEW. Form SSA-
1713 collects information regarding whether, how and when a Canadian
bank was able to return erroneous payments made after the death of a
beneficiary who elected to have payments sent to Canada. The SSA-1713
is sent with the SSA-1712, an SSA-generated cover sheet which provides
the Canadian bank with information regarding the deceased beneficiary.
In this way, SSA can reclaim funds which were erroneously paid. The
respondents are Canadian financial institutions to which Social
Security payments have been made.
Type of Request: Existing Information Collection in Use Without an
OMB Number.
Number of Respondents: 15.
Frequency of Response: 1.
Average Burden per Response: 5 minutes.
Estimated Annual Burden: 1 hour.
4. Request for Reconsideration--Disability Cessation--20 CFR
404.909, 416.1409--0960-0349. Form SSA-789-U4 is used by claimants to
request reconsideration of a determination and to indicate whether or
not they wish to appear at a disability hearing. This form can also be
used to submit any additional information/evidence for use in the
reconsidered determination and to indicate if an interpreter is needed
for the hearing. SSA will use this information to either arrange for a
hearing or to prepare a decision based on the evidence of record. The
respondents are applicants or claimants for Social Security benefits or
SSI payments.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 49,000.
Frequency of Response: 1.
Average Burden per Response: 13 minutes.
Estimated Annual Burden: 10,617 hours
5. Representative Payment Policies Regulation--20 CFR 404.2011,
404.2025, 416.611, 416.625--0960-0679. In cases where SSA determines
that it is not in a beneficiary's best interest to receive payments
directly as it may cause substantial harm, the beneficiaries may
dispute this decision. If they do, they provide SSA with information
which SSA will take into consideration when reevaluating the decision.
Representative payees must also provide SSA with information regarding
their relationship, responsibility, and how payments were used for the
beneficiary. Respondents are beneficiaries and representative payees.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average
Number of Frequency of burden per Estimated
CFR Section respondents response response annual burden
(minutes) hours
----------------------------------------------------------------------------------------------------------------
404.2011(a)(1).................................. 250 1 15 63
416.611(a)(1)...................................
[[Page 30466]]
404.2025........................................ 3,000 1 6 300
416.625.........................................
---------------- ---------------
Totals...................................... 3,250 .............. .............. 363
----------------------------------------------------------------------------------------------------------------
Estimated Annual Burden: 363 hours.
6. Psychiatric Review Technique--20 CFR 404.1520(a), 416.920(a)--
0960-0413. The SSA-2506-BK assists the DDSs 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 52 State DDSs administering the Title II and Title XVI programs.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 52.
Frequency of Response: 20,595.
Total Annual Responses: 1,070,940.
Average Burden per Response: 15 minutes.
Estimated Annual Burden: 267,735 hours.
7. Disability Hearing Officer's Decision--Title XVI Disabled Child
(DC) Continuing Disability Review--20 CFR 404.913-.914, 404.917,
416.994a, 416.1413-.1414, 416.1417--0960-0657. Form SSA-1209[dash]BK is
used by the disability hearing officer conducting the disability
hearing to prepare and issue a written reconsidered determination--
specifically for evaluating Title XVI childhood disability cases. The
form provides the framework for addressing the crucial elements of the
case in a sequential and logical fashion, and the completed form is the
official document of the decision. Respondents are disability hearing
officers in State Disability Determination Services (DDSs).
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 35,000.
Frequency of Response: 1.
Average Burden per Response: 75 minutes.
Estimated Annual Burden: 43,750 hours.
8. Certificate of Incapacity--5 CFR 890.302(d)--0960-NEW. Rules
governing the Federal Employee Health Benefits (FEHB) plan state that
for federal employees' children ages 22 or over to retain health
benefits, they must be incapable of self-support due to a disability
that (1) pre-dated the child's 22nd birthday, (2) is very serious, and
(3) can be expected to last at least one year. Form SSA-604, the
Certificate of Incapacity, is used by physicians to document and
certify such a disability for their patients who are children of
Federal employees. The respondents are physicians of federal employees'
children ages 22 or over who are seeking to retain health benefits
under their parent's FEHB coverage.
Type of Request: New information collection.
Number of Respondents: 38.
Frequency of Response: 1.
Average Burden per Response: 45 minutes.
Estimated Annual Burden: 29 hours.
9. Function Report--Adult--20 CFR 404.1512 and 419.912--0960-0681.
Form SSA-3373 is used to collect information about a disability
applicant's impairment-related limitations and ability to function. It
documents the types of information specified in SSA regulations and
provides disability interviewers with a convenient means to record
information about how the claimant's condition affects his or her
ability to function. This information, together with medical evidence,
forms the evidentiary basis upon which the initial disability process
is founded. The respondents are Title II and Title XVI benefits
applicants.
Type of Request: Revision to an OMB-approved information
collection.
Number of Respondents: 4,005,367.
Frequency of Response: 1.
Average Burden per Response: 60 minutes.
Estimated Annual Burden: 4,005,367.
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. Statement of Employer--20 CFR 404.801-803--0960-0030. The
information collected on Form SSA-7011--F4 is needed to substantiate
allegations of wages paid to workers when wages do not appear in SSA's
records of earnings and the worker has no proof of said earnings. SSA
can use the information to process claims for benefits and resolve
discrepancies in the worker's earnings record. The respondents are
certain employers who can verify wage allegations made by the wage
earner.
Type of Request: Extension 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. Request for Workers' Compensation/Public Disability Benefit
Information--20 CFR 404.408(e)--0960-0098. Section 224 of the Social
Security Act provides for an offset of disability insurance benefits
when workers' compensation (WC) or public disability benefits (PDB) is
also being received. The SSA-1709 is used to request and/or verify
information regarding WC/PDB given to Social Security disability
recipients so that the proper adjustment is made to their monthly
benefits. The respondents are Federal, State, and local agencies
administering WC/PDB, insurance carriers, and public or private self-
insured companies.
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.
3. Disability Report-Appeal--20 CFR 404.1512, 416.912, 404.916(c),
416.1416(c)--0960-0144. The SSA-3441-BK is used to secure updated
resource and condition information from claimants seeking
reconsideration of denied disability benefits. The claimant also has
the option of providing the information during a personal interview or
through SSA's Internet application. This information assists the State
Disability Determination Services and administrative law judges in
preparing
[[Page 30467]]
for appeals and hearings and in issuing a decision. Respondents are
individuals who appeal denial of Social Security disability income and
Supplemental Security Income (SSI) benefits, cessation of benefits, or
who are requesting a hearing.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden
Collection method Number of Frequency of per response: Estimated
respondents response (minutes) annual burden
----------------------------------------------------------------------------------------------------------------
SSA-3441 (Paper Form)........................... 404,506 1 45 303,380
Electronic Disability Collection System (EDCS).. 635,873 1 45 476,905
I3441 (Internet Form)........................... 72,341 1 120 144,682
---------------- ---------------
Totals...................................... 1,112,720 .............. .............. 924,967
----------------------------------------------------------------------------------------------------------------
Estimated Annual Burden: 924,967 hours.
4. Third Party Liability Information Statement--42 CFR 433.136-
433.139--0960-0323. Identification of sources of third party insurance
liable for medical care or services for Medicaid beneficiaries, which
could be used to reduce Medicaid costs, is required under 42 U.S.C.
1396a(a)(25). Medicaid State agencies are mandated under 42 CFR
433.136-.139 to obtain this information on Medicaid applications and
redeterminations as a condition of Medicaid eligibility. States are
permitted to 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 SSI eligibility in jurisdictions with such
agreements are also 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
State agencies which provide Medicaid under the terms of an approved
plan in Title XIX of the Social Security Act. The Medicaid State
agencies then use the information provided to attempt to bill any third
parties liable for medical care, support or services for a beneficiary
to guarantee that Medicaid remains the payer of last resort. The
respondents are SSI applicants and beneficiaries.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 73,540.
Frequency of Response: 1.
Average Burden per Response: 5 minutes.
Estimated Annual Burden: 6,128 hours.
5. Claimant Statement About Loan of Food or Shelter; Statement
About Food or Shelter Provided to Another--20 CFR 416.1130-416.1148--
0960-0529. Forms SSA-5062 and SSA-L5063 are used to obtain statements
about food and/or shelter provided to an SSI claimant or recipient. SSA
uses this information to determine whether food and/or shelter are bona
fide loans or should be counted as income for SSI purposes. This
determination can affect eligibility for SSI and the amount of SSI
benefits payable. The respondents are claimants/recipients for SSI
benefits and individuals that provide loans of food and/or shelter to
SSI claimants/recipients.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden
Form number Number of Frequency of per response: Estimated
respondents response (minutes) annual burden
----------------------------------------------------------------------------------------------------------------
SSA-5062........................................ 65,540 1 10 10,923
SSA-L5063....................................... 65,540 1 10 10,923
---------------- ---------------
Totals...................................... 131,080 .............. .............. 21,846
----------------------------------------------------------------------------------------------------------------
Estimated Annual Burden: 21,846 hours.
Dated: May 18, 2006.
Elizabeth A. Davidson,
Social Security Administration, Reports Clearance Officer.
[FR Doc. E6-7995 Filed 5-25-06; 8:45 am]
BILLING CODE 4191-02-P
