Agency Information Collection Activities: Proposed Request and Comment Request, 32697-32700 [E7-11383]
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Federal Register / Vol. 72, No. 113 / Wednesday, June 13, 2007 / Notices
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–2007–41 and should
be submitted on or before July 5, 2007.
For the Commission, by the Division of
Market Regulation, pursuant to delegated
authority.23
Florence E. Harmon,
Deputy Secretary.
[FR Doc. E7–11368 Filed 6–12–07; 8:45 am]
BILLING CODE 8010–01–P
SMALL BUSINESS ADMINISTRATION
[Disaster Declaration #10870]
Vermont Disaster Number VT–00003
Small Business Administration.
Amendment 1.
AGENCY:
ACTION:
SUMMARY: This is an amendment of the
Presidential declaration of a major
disaster for Public Assistance Only for
the State of Vermont (FEMA–1698–DR),
dated 05/04/2007.
Incident: Severe storms and flooding.
Incident Period: 04/15/2007 through
04/21/2007.
Effective Date: 06/04/2007.
Physical Loan Application Deadline
Date: 07/03/2007.
ADDRESSES: Submit completed loan
applications to: U.S. Small Business
Administration, Processing and
Disbursement Center, 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, SW., Suite 6050,
Washington, DC 20416.
SUPPLEMENTARY INFORMATION: The notice
of the President’s major disaster
declaration for Private Non-Profit
organizations in the State of Vermont,
dated 05/04/2007, is hereby amended to
include the following areas as adversely
affected by the disaster.
Primary Counties: Lamoille.
All other information in the original
declaration remains unchanged.
sroberts on PROD1PC70 with NOTICES
(Catalog of Federal Domestic Assistance
Number 59008)
Herbert L. Mitchell,
Associate Administrator for Disaster
Assistance.
[FR Doc. E7–11345 Filed 6–12–07; 8:45 am]
BILLING CODE 8025–01–P
23 17
CFR 200.30–3(a)(12).
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18:30 Jun 12, 2007
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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 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,
faxed or emailed 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, e-mail address:
OIRA_Submission@omb.eop.gov.
SSA, Social Security Administration,
DCBFM, Attn: Reports Clearance
Officer, 1333 Annex Building, 6401
Security Blvd., Baltimore, MD 21235,
Fax: 410–965–6400, e-mail address:
OPLM.RCO@ssa.gov.
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. National 800 Number—Claims
Status—20 CFR 401.45—0960–NEW.
SSA has established a process for
authenticating the information of
individuals who use the automated
telephone services or speak to an agent
to request information from SSA
records. Prior to SSA responding to
requests for personal information
through the automated telephone
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32697
services, we must authenticate the
requester’s information by obtaining the
appropriate identification elements.
This automated telephone service will
provide callers with status of a Social
Security claim which they have filed.
All information provided will then be
compared to the information contained
in our records so that the appropriate
claim is accessed and the respondent is
given the status of that claim.
Respondents are current Social Security
beneficiaries.
Type of Request: Request for a new
information collection.
Number of Respondents: 704,422.
Frequency of Response: 1.
Average Burden per Response: 1
minute.
Estimated Annual Burden: 11,740
hours.
2. Function Report-Child: Birth to 1st
Birthday (SSA–3375), Age 1 to 3rd
Birthday (SSA–3376), Age 3 to 6th
Birthday (SSA–3377), Age 6 to 12th
Birthday (SSA–3378), and Age 12 to
18th Birthday (SSA–3379)—20 CFR
416.912—0960–0542. State Agency
adjudicative teams use the information
gathered by these forms in combination
with other medical function evidence to
form a complete picture of a child’s
ability to function. This information is
used to help determine if a child is
disabled, especially in cases in which
disability cannot be found on medical
grounds alone. The respondents are
applicants for Title XVI childhood
disability benefits and their caregivers.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 550,000.
Frequency of Response: 1.
Average Burden per Response: 20
minutes.
Estimated Annual Burden: 183,333
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. Notice Regarding Substitution of
Party On Death of Claimant—
Reconsideration of Disability
Cessation—20 CFR 404.917–404.921
and 416.1407–416.1421—0960–0351.
Form SSA–770 is used when a claimant
dies before a determination is made on
that person’s request for reconsideration
on his/her disability cessation. SSA
seeks a qualified substitute party to
pursue the appeal. If the qualified
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Federal Register / Vol. 72, No. 113 / Wednesday, June 13, 2007 / Notices
substitute party is located, the SSA–770
is used to collect information regarding
whether to pursue or withdraw the
reconsideration request. The
information collected on the SSA–770
forms the basis of the decision to
continue or discontinue the appeals
process. Respondents are substitute
applicants who are pursuing a
reconsideration request for a deceased
claimant.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 1,200.
Frequency of Response: 1.
Average Burden Per Response: 5
minutes.
Estimated Annual Burden: 100 hours.
2. State Agency Report of Obligations
for SSA Disability Programs (SSA–
4513); Time Report of Personnel
Services for Disability Determination
Services (SSA–4514); State Agency
Schedule of Equipment Purchased for
SSA Disability Programs (SSA–871)—20
CFR 404.1626—0960–0421 (Correction
to Burden Data). Forms SSA–4513,
SSA–4514 and SSA–871 are used to
collect data necessary for detailed
analysis and evaluation of costs
incurred by State Disability
Determination Services (DDS) in making
determinations of disability for SSA.
The data are also utilized in
determining funding levels for each
DDS. Respondents are State DDSs.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 52.
Estimated Annual Burden: 756 hours.
Average burden
per response
(minutes)
Frequency of
response
Respondents
Estimated annual
burden
(hours)
SSA–4513 & Addendum ..........................................................
SSA–4514 ................................................................................
SSA–871 ..................................................................................
52
52
52
4
4
4
90
90
30
312
312
104
Totals ................................................................................
52
..............................
..............................
728
sroberts on PROD1PC70 with NOTICES
Please note: We are correcting the number
of respondents to this collection. In our
notice published March 23, 2007 at 72 FR
13851 we initially state there are 54 State
DDS’s, whereas there are only 52.
3. Subpoena-Disability Hearing—20
CFR 404.916(b)(1) & 416.1416(b)(1)—
0960–0428. Form SSA–1272–U4 is
completed by State and Federal
disability hearing officers to subpoena
evidence or testimony in connection
with hearings required by the Social
Security Act. Actual issuance of the
subpoena will be done by that
appropriate delegated SSA official.
Respondents are disability hearing
officers.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 36.
Frequency of Response: 1.
Average Burden per Response: 30
minutes.
Estimated Annual Burden: 18 hours.
4. Summary of Evidence—20 CFR
404.913(b), 404.914(a), 416.1707,
416.1313(b), 416.1414(a)—0960–0430.
Form SSA–887 is completed by a
Disability Hearing Officer (DHO) from
the claimant’s State Disability
Determination Service (DDS). The DHO
summarizes all medical and vocational
reports that were used to make the nodisability determination. This form,
which is used to prepare for and
conduct the disability hearing, is also
made available to claimants so that they
are aware of the basis for the nodisability decision and they can prepare
for the reconsideration accordingly.
Respondents are Disability Hearing
Officers.
Type of Request: Extension of an
OMB-approved information collection.
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Number of Respondents: 49,000.
Frequency of Response: 1.
Average Burden per Response: 15
minutes.
Estimated Annual Burden: 12,250
hours.
5. Information About Joint Checking/
Savings Accounts—20 CFR 416.1201(b),
416.1208—0960–0461. The SSA–2574 is
used to collect information when a
Supplemental Security Income (SSI)
applicant/recipient objects to the
assumption that he/she owns all or part
of the funds in a joint checking or
savings account which bears his or her
name. Information about the account is
collected from both the SSI applicant/
recipient and other accountholder(s).
These statements regarding ownership
are required to determine whether the
account is a resource of the SSI
claimant. The amount of resources a
person owns is one of the factors
considered in determining eligibility for
SSI. Respondents are applicants and
recipients of SSI and individuals who
are joint owners of financial accounts
with SSI applicants/recipients.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 200,000.
Frequency of Response: 1.
Average Burden per Response: 7
minutes.
Estimated Annual Burden: 23,333
hours.
6. Beneficiary Recontact Form—20
CFR 404.703, 404.705—0960–0502. SSA
must ensure that eligibility for benefits
continues after entitlement. Studies
show that mothers/fathers who marry
fail to report the marriage and or the fact
that they no longer have a child entitled
in their care. SSA uses the SSA–1588–
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OCR–SM to ask mothers/fathers about
their marital status and children in care
to detect overpayments and avoid
continuing payment to those no longer
entitled. Respondents are recipients of
survivor mother/father Social Security
benefits.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 133,400.
Frequency of Response: 1.
Average Burden per Response: 5
minutes.
Estimated Annual Burden: 11,117
hours.
7. Earnings Record Information—20
CFR 404.801–404.803 and 404.821–
404.822—0960–0505. The information
collected by form SSA–L3231–C1 is
used to ensure that the proper person is
credited for working when earnings are
reported for a minor under the age of 7
years. The respondents are businesses
reporting earnings for children under
age 7.
Type of Information Collection:
Extension of an OMB-approved
information collection.
Number of Respondents: 20,000.
Frequency of Response: 1.
Average Burden per Response: 10
minutes.
Estimated Annual Burden: 3,333
hours.
8. Wage Reports and Pension
Information—20 CFR 422.122(b)—0960–
0547. The information collected through
20 CFR 422.122(b) is used by SSA to
identify the requestor of pension plan
information and to confirm the
individual is entitled to the data SSA
provides. Respondents are requestors of
pension plan information.
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Federal Register / Vol. 72, No. 113 / Wednesday, June 13, 2007 / Notices
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 600.
Frequency of Response: 1.
Average Burden per Response: 30
minutes.
Estimated Annual Burden: 300 hours.
9. Youth Transition Process
Demonstration Evaluation Data
Collection—0960–0687.
Background
The Youth Transition Demonstration
YTD projects are intended to help young
people with disabilities make the
transition from school to work. By
waiving certain disability program rules
and offering services to youth who are
either receiving disability benefits or at
risk of receiving them, these projects are
expected to encourage youth to work
and/or continue their education. YTD
projects will be fully implemented in 10
sites across the country. The evaluation
will produce empirical evidence on the
impacts of the waivers and project
services not only on educational
attainment, employment, earnings, and
receipt of benefits by youth with
disabilities but also on the Social
Security Trust Fund and federal income
tax revenues. This type of project is
authorized by sections 1110 and 234 of
the Social Security Act.
Project Description
Given the importance of estimating
YTD impacts as accurately as possible,
the evaluation will be conducted using
rigorous analytic methods based on the
Number of
respondents
random assignment of youth to a
treatment or control group. Several data
collection efforts are planned. These
include (1) baseline interviews with
youth and their parents or guardians
prior to random assignment; (2) followup interviews at 12 and 36 months after
random assignment; (3) interviews and/
or roundtable discussions with local
program administrators, program
supervisors, and service delivery staff;
and (4) focus groups of youth, their
parents, and service providers. The
respondents will be youth with
disabilities who have enrolled in the
project, their parents or guardians,
program staff, and service providers.
Type of Request: Revision of an
existing OMB Clearance.
Average burden per
response
(hours)
Responses per
respondent
Total response
burden
(hours)
Data collection year
Collection
2007 .....................................
Baseline ...............................
Informed Consent ................
12 month follow-up 1 ............
Focus group ........................
Program staff/service provider.
962
962
437
140
32
1
1
1
1
1
0.55
0.83
0.83
1.5
1
529
80
363
210
32
Total 2007 .....................
..............................................
..............................
..............................
................................
1,214
1 We
conduct follow-up interviews only for those baseline respondents who sign consent forms.
sroberts on PROD1PC70 with NOTICES
10. Request for Program
Consultation—20 CFR 404.1601–1661—
0960–New. The Disability
Determination Services (DDS) offices are
staffed by State employees who perform
disability determinations for applicants
for Social Security disability benefits
under Title II and Title XVI of the Social
Security Act. SSA’s federal regional
quality assurance office has the
authority to review DDS determinations,
to assess errors, and to return cases for
corrective action by the DDS.
The information collected on the
Request for Program Consultation (RPC)
will be used by the DDS’s that request
a review of the regional quality
assurance evaluations. The DDS’s use
the RPC to present their rationale that
supports their determinations. The
information collected includes a short
rationale and policy citations
supporting their rebuttal. The RPC team
will use the information to reassess their
initial determination. The respondents
are DDS’s who request a review of the
regional quality assurance
determination.
Type of Request: Request for a new
information collection.
Number of Respondents: 4,500.
Frequency of Response: 1.
Average Burden per Response: 50
minutes.
Estimated Annual Burden: 3,750
hours.
11. Request to Decision Review Board
To Vacate the Administrative Law Judge
Dismissal of Hearing—20 CFR
405.427—0960–NEW. The information
collected on Form SSA–525 will be
used by Social Security
Administration’s Decision Review
Board (Board) when a hearing on a
claim for Title II or Title XVI disability
payments is dismissed and the claimant
requests that the dismissal be vacated.
The Board will use this information to
(1) establish the continued involvement
of the requester in his or her claim; (2)
consider the requester’s arguments for
vacating the dismissal; and (3) vacate or
decline to vacate the administrative law
judge’s dismissal order. The
respondents are Social Security
disability or Supplemental Security
Number of
respondents
Collection format
SSA–3820 (Paper Form) ...........................................................
Electronic Disability Collection System (EDCS) ........................
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500
422,000
Fmt 4703
Sfmt 4703
Income (SSI) claimants who are
requesting that the dismissal be vacated.
Type of Request: Request for a new
information collection.
Number of Respondents: 30,000.
Frequency of Response: 1.
Average Burden Per Response: 10
minutes.
Estimated Annual Burden: 5,000
hours.
12. Medical History and Disability
Report, Disabled Child—20 CFR
416.912—0960–0577. The Social
Security Act requires claimants to
furnish medical and other evidence to
prove they are disabled. The form SSA–
3820 is used to obtain various types of
information about a child’s condition,
his/her treating sources and/or other
medical sources of evidence. The
information collected on the SSA–3820
is needed for the determination of
disability by the State DDSs. The
respondents are applicants for Title XVI
child disability benefits.
Type of Request: Revision to an OMBapproved information collection.
Frequency of
responses
Average burden per responses
1
1
1 hour ............................
34 minutes .....................
E:\FR\FM\13JNN1.SGM
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Estimated
annual burden
(hour)
500
239,133
32700
Federal Register / Vol. 72, No. 113 / Wednesday, June 13, 2007 / Notices
Number of
respondents
Collection format
Frequency of
responses
Estimated
annual burden
(hour)
Average burden per responses
i3820 (Internet) ...........................................................................
39,500
1
2 hours ..........................
79,000
Totals ..................................................................................
462,000
..........................
........................................
318,633
13. Social Security Disability Report—
20 CFR 404.1512 & 416.912—0960–
0579. The Social Security
Administration requires applicants for
disability payments to furnish medical,
work history, and other evidence or
information indicating they have an
impairment which is disabling. This
information is collected by form SSA–
3368, the Adult Disability Report, and is
used by State DDS’s to make disability
determinations for SSA.
The respondents are applicants for
Title II and Title XVI disability benefits.
These applicants may complete the form
using any of the following modalities:
(1) The traditional paper form; (2) an
interview with an SSA field office
representative, using the EDCS; (3) the
Internet (i3368); and (4) a modality, the
i3368–PRO, an Internet form designed
Number of
respondents
Collection format
to be completed by representatives of
applicants for disability payments. The
latter three versions of the form collect
the same information as the paper form,
but may be formatted differently and
include certain enhancements (ex: selfhelp screens) to guide the claimant or
interviewer through the application
process.
Type of Request: Revision to an OMBapproved information collection.
Frequency of
response
Average
burden
per response
(hours)
Estimated
annual
burden
(hours)
9,364
3,138,920
1
1
1
1
9,364
3,138,920
101,135
101,135
1
1
21⁄2
11⁄2
252,837
151,702
Totals ........................................................................................................
sroberts on PROD1PC70 with NOTICES
SSA–3368 (Paper version) ..............................................................................
Field office/EDCS ............................................................................................
i3368 (Internet version; Hour burden varies from 11⁄2–3 hours, depending
on information required) ...............................................................................
i3368–PRO ......................................................................................................
3,350,554
........................
........................
3,552,823
14. Certification of Contents of
Document(s) or Record(s)—20 CFR
404.715ff—0960–0689. SSA must secure
evidence necessary for individuals to
establish rights to benefits. Some of the
types of evidence needed are evidence
of age relationship, citizenship,
marriage, death, and military service.
Form SSA–704 allows SSA employees,
state record custodians, and other
custodians of evidentiary documents to
record information from documents and
records to establish these types of
evidence. SSA employees use this form
but it is also used by state record
custodians and other custodians of
evidentiary documents.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 4,800.
Average Burden per Response: 10
minutes.
Estimated Annual Burden: 800.
15. Waiver of Your Right to Personal
Appearance before an Administrative
Law Judge—20 CFR 404.948(b)(l)(i) and
416.1448(b)(l)(i)—0960–0284. Each
claimant has a statutory right to appear
in person (or through a representative)
and present evidence about his/her
claim at a hearing before an
Administrative Law Judge (ALJ). If a
claimant wishes to waive his/her
statutory right to appear before an ALJ,
he/she must complete a written request.
VerDate Aug<31>2005
19:19 Jun 12, 2007
Jkt 211001
The claimant may use Form HA–4608
for this request. The information
collected is used to document an
individual’s claim to show that an oral
hearing is not preferred in the appellate
process. The respondents are applicants
for Title II benefits and Title XVI
payments who request a hearing.
Number of Respondents: 12,000.
Frequency of Response: 1.
Average Burden per Response: 2
minutes.
Estimated Annual Burden: 400 hours.
Dated: June 7, 2007.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security
Administration.
[FR Doc. E7–11383 Filed 6–12–07; 8:45 am]
BILLING CODE 4191–02–P
DEPARTMENT OF STATE
[Public Notice 5833]
Bureau of Political-Military Affairs:
Directorate of Defense Trade Controls;
Notifications to the Congress of
Proposed Commercial Export Licenses
SUMMARY: Notice is hereby given that
the Department of State has forwarded
the attached Notifications of Proposed
Export Licenses to the Congress on the
dates indicated pursuant to sections
36(c) and 36(d) and in compliance with
PO 00000
Frm 00095
Fmt 4703
Sfmt 4703
section 36(f) of the Arms Export Control
Act (22 U.S.C. 2776).
DATES: Effective Date: As shown on each
of the 13 letters.
FOR FURTHER INFORMATION CONTACT: Ms.
Susan M. Clark, Director, Office of
Defense Trade Controls Licensing,
Directorate of Defense Trade Controls,
Bureau of Political-Military Affairs,
Department of State (202) 663–2023.
SUPPLEMENTARY INFORMATION: Section
36(f) of the Arms Export Control Act
mandates that notifications to the
Congress pursuant to sections 36(c) and
36(d) must be published in the Federal
Register when they are transmitted to
Congress or as soon thereafter as
practicable.
March 30, 2007.
Hon. Nancy Pelosi, Speaker of the House of
Representatives.
Dear Madam Speaker: Pursuant to Section
36(c) of the Arms Export Control Act, I am
transmitting, herewith, certification of a
proposed license for the export of defense
articles or defense services sold
commercially under a contract in the amount
of $50,000,000 or more.
The transaction contained in the attached
certification involves the export of technical
data, defense services and defense articles for
the VINASAT–1 commercial
communications satellite to Vietnam.
The United States Government is prepared
to license the export of these items having
taken into account political, military,
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]]>Agencies
[Federal Register Volume 72, Number 113 (Wednesday, June 13, 2007)]
[Notices]
[Pages 32697-32700]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E7-11383]
-----------------------------------------------------------------------
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, faxed or emailed 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, e-mail address: OIRA--Submission@omb.eop.gov.
SSA, Social Security Administration, DCBFM, Attn: Reports Clearance
Officer, 1333 Annex Building, 6401 Security Blvd., Baltimore, MD 21235,
Fax: 410-965-6400, e-mail address: OPLM.RCO@ssa.gov.
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. National 800 Number--Claims Status--20 CFR 401.45--0960-NEW. SSA
has established a process for authenticating the information of
individuals who use the automated telephone services or speak to an
agent to request information from SSA records. Prior to SSA responding
to requests for personal information through the automated telephone
services, we must authenticate the requester's information by obtaining
the appropriate identification elements. This automated telephone
service will provide callers with status of a Social Security claim
which they have filed. All information provided will then be compared
to the information contained in our records so that the appropriate
claim is accessed and the respondent is given the status of that claim.
Respondents are current Social Security beneficiaries.
Type of Request: Request for a new information collection.
Number of Respondents: 704,422.
Frequency of Response: 1.
Average Burden per Response: 1 minute.
Estimated Annual Burden: 11,740 hours.
2. Function Report-Child: Birth to 1st Birthday (SSA-3375), Age 1
to 3rd Birthday (SSA-3376), Age 3 to 6th Birthday (SSA-3377), Age 6 to
12th Birthday (SSA-3378), and Age 12 to 18th Birthday (SSA-3379)--20
CFR 416.912--0960-0542. State Agency adjudicative teams use the
information gathered by these forms in combination with other medical
function evidence to form a complete picture of a child's ability to
function. This information is used to help determine if a child is
disabled, especially in cases in which disability cannot be found on
medical grounds alone. The respondents are applicants for Title XVI
childhood disability benefits and their caregivers.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 550,000.
Frequency of Response: 1.
Average Burden per Response: 20 minutes.
Estimated Annual Burden: 183,333 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. Notice Regarding Substitution of Party On Death of Claimant--
Reconsideration of Disability Cessation--20 CFR 404.917-404.921 and
416.1407-416.1421--0960-0351. Form SSA-770 is used when a claimant dies
before a determination is made on that person's request for
reconsideration on his/her disability cessation. SSA seeks a qualified
substitute party to pursue the appeal. If the qualified
[[Page 32698]]
substitute party is located, the SSA-770 is used to collect information
regarding whether to pursue or withdraw the reconsideration request.
The information collected on the SSA-770 forms the basis of the
decision to continue or discontinue the appeals process. Respondents
are substitute applicants who are pursuing a reconsideration request
for a deceased claimant.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 1,200.
Frequency of Response: 1.
Average Burden Per Response: 5 minutes.
Estimated Annual Burden: 100 hours.
2. State Agency Report of Obligations for SSA Disability Programs
(SSA-4513); Time Report of Personnel Services for Disability
Determination Services (SSA-4514); State Agency Schedule of Equipment
Purchased for SSA Disability Programs (SSA-871)--20 CFR 404.1626--0960-
0421 (Correction to Burden Data). Forms SSA-4513, SSA-4514 and SSA-871
are used to collect data necessary for detailed analysis and evaluation
of costs incurred by State Disability Determination Services (DDS) in
making determinations of disability for SSA. The data are also utilized
in determining funding levels for each DDS. Respondents are State DDSs.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 52.
Estimated Annual Burden: 756 hours.
----------------------------------------------------------------------------------------------------------------
Average burden
Respondents Frequency of per response Estimated annual
response (minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4513 & Addendum................. 52 4 90 312
SSA-4514............................ 52 4 90 312
SSA-871............................. 52 4 30 104
---------------------------------------------------------------------------
Totals.......................... 52 ................. ................. 728
----------------------------------------------------------------------------------------------------------------
Please note: We are correcting the number of respondents to this
collection. In our notice published March 23, 2007 at 72 FR 13851 we
initially state there are 54 State DDS's, whereas there are only 52.
3. Subpoena-Disability Hearing--20 CFR 404.916(b)(1) &
416.1416(b)(1)--0960-0428. Form SSA-1272-U4 is completed by State and
Federal disability hearing officers to subpoena evidence or testimony
in connection with hearings required by the Social Security Act. Actual
issuance of the subpoena will be done by that appropriate delegated SSA
official. Respondents are disability hearing officers.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 36.
Frequency of Response: 1.
Average Burden per Response: 30 minutes.
Estimated Annual Burden: 18 hours.
4. Summary of Evidence--20 CFR 404.913(b), 404.914(a), 416.1707,
416.1313(b), 416.1414(a)--0960-0430. Form SSA-887 is completed by a
Disability Hearing Officer (DHO) from the claimant's State Disability
Determination Service (DDS). The DHO summarizes all medical and
vocational reports that were used to make the no-disability
determination. This form, which is used to prepare for and conduct the
disability hearing, is also made available to claimants so that they
are aware of the basis for the no-disability decision and they can
prepare for the reconsideration accordingly. Respondents are Disability
Hearing Officers.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 49,000.
Frequency of Response: 1.
Average Burden per Response: 15 minutes.
Estimated Annual Burden: 12,250 hours.
5. Information About Joint Checking/Savings Accounts--20 CFR
416.1201(b), 416.1208--0960-0461. The SSA-2574 is used to collect
information when a Supplemental Security Income (SSI) applicant/
recipient objects to the assumption that he/she owns all or part of the
funds in a joint checking or savings account which bears his or her
name. Information about the account is collected from both the SSI
applicant/recipient and other accountholder(s). These statements
regarding ownership are required to determine whether the account is a
resource of the SSI claimant. The amount of resources a person owns is
one of the factors considered in determining eligibility for SSI.
Respondents are applicants and recipients of SSI and individuals who
are joint owners of financial accounts with SSI applicants/recipients.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 200,000.
Frequency of Response: 1.
Average Burden per Response: 7 minutes.
Estimated Annual Burden: 23,333 hours.
6. Beneficiary Recontact Form--20 CFR 404.703, 404.705--0960-0502.
SSA must ensure that eligibility for benefits continues after
entitlement. Studies show that mothers/fathers who marry fail to report
the marriage and or the fact that they no longer have a child entitled
in their care. SSA uses the SSA-1588-OCR-SM to ask mothers/fathers
about their marital status and children in care to detect overpayments
and avoid continuing payment to those no longer entitled. Respondents
are recipients of survivor mother/father Social Security benefits.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 133,400.
Frequency of Response: 1.
Average Burden per Response: 5 minutes.
Estimated Annual Burden: 11,117 hours.
7. Earnings Record Information--20 CFR 404.801-404.803 and 404.821-
404.822--0960-0505. The information collected by form SSA-L3231-C1 is
used to ensure that the proper person is credited for working when
earnings are reported for a minor under the age of 7 years. The
respondents are businesses reporting earnings for children under age 7.
Type of Information Collection: Extension of an OMB-approved
information collection.
Number of Respondents: 20,000.
Frequency of Response: 1.
Average Burden per Response: 10 minutes.
Estimated Annual Burden: 3,333 hours.
8. Wage Reports and Pension Information--20 CFR 422.122(b)--0960-
0547. The information collected through 20 CFR 422.122(b) is used by
SSA to identify the requestor of pension plan information and to
confirm the individual is entitled to the data SSA provides.
Respondents are requestors of pension plan information.
[[Page 32699]]
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 600.
Frequency of Response: 1.
Average Burden per Response: 30 minutes.
Estimated Annual Burden: 300 hours.
9. Youth Transition Process Demonstration Evaluation Data
Collection--0960-0687.
Background
The Youth Transition Demonstration YTD projects are intended to
help young people with disabilities make the transition from school to
work. By waiving certain disability program rules and offering services
to youth who are either receiving disability benefits or at risk of
receiving them, these projects are expected to encourage youth to work
and/or continue their education. YTD projects will be fully implemented
in 10 sites across the country. The evaluation will produce empirical
evidence on the impacts of the waivers and project services not only on
educational attainment, employment, earnings, and receipt of benefits
by youth with disabilities but also on the Social Security Trust Fund
and federal income tax revenues. This type of project is authorized by
sections 1110 and 234 of the Social Security Act.
Project Description
Given the importance of estimating YTD impacts as accurately as
possible, the evaluation will be conducted using rigorous analytic
methods based on the random assignment of youth to a treatment or
control group. Several data collection efforts are planned. These
include (1) baseline interviews with youth and their parents or
guardians prior to random assignment; (2) follow-up interviews at 12
and 36 months after random assignment; (3) interviews and/or roundtable
discussions with local program administrators, program supervisors, and
service delivery staff; and (4) focus groups of youth, their parents,
and service providers. The respondents will be youth with disabilities
who have enrolled in the project, their parents or guardians, program
staff, and service providers.
Type of Request: Revision of an existing OMB Clearance.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Number of Responses per Average burden per Total response
Data collection year Collection respondents respondent response (hours) burden (hours)
--------------------------------------------------------------------------------------------------------------------------------------------------------
2007....................................... Baseline...................... 962 1 0.55 529
Informed Consent.............. 962 1 0.83 80
12 month follow-up \1\........ 437 1 0.83 363
Focus group................... 140 1 1.5 210
Program staff/service provider 32 1 1 32
------------------------------------------------------------------------------------------------------------
Total 2007............................. .............................. ................. ................. .................. 1,214
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ We conduct follow-up interviews only for those baseline respondents who sign consent forms.
10. Request for Program Consultation--20 CFR 404.1601-1661--0960-
New. The Disability Determination Services (DDS) offices are staffed by
State employees who perform disability determinations for applicants
for Social Security disability benefits under Title II and Title XVI of
the Social Security Act. SSA's federal regional quality assurance
office has the authority to review DDS determinations, to assess
errors, and to return cases for corrective action by the DDS.
The information collected on the Request for Program Consultation
(RPC) will be used by the DDS's that request a review of the regional
quality assurance evaluations. The DDS's use the RPC to present their
rationale that supports their determinations. The information collected
includes a short rationale and policy citations supporting their
rebuttal. The RPC team will use the information to reassess their
initial determination. The respondents are DDS's who request a review
of the regional quality assurance determination.
Type of Request: Request for a new information collection.
Number of Respondents: 4,500.
Frequency of Response: 1.
Average Burden per Response: 50 minutes.
Estimated Annual Burden: 3,750 hours.
11. Request to Decision Review Board To Vacate the Administrative
Law Judge Dismissal of Hearing--20 CFR 405.427--0960-NEW. The
information collected on Form SSA-525 will be used by Social Security
Administration's Decision Review Board (Board) when a hearing on a
claim for Title II or Title XVI disability payments is dismissed and
the claimant requests that the dismissal be vacated. The Board will use
this information to (1) establish the continued involvement of the
requester in his or her claim; (2) consider the requester's arguments
for vacating the dismissal; and (3) vacate or decline to vacate the
administrative law judge's dismissal order. The respondents are Social
Security disability or Supplemental Security Income (SSI) claimants who
are requesting that the dismissal be vacated.
Type of Request: Request for a new information collection.
Number of Respondents: 30,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 5,000 hours.
12. Medical History and Disability Report, Disabled Child--20 CFR
416.912--0960-0577. The Social Security Act requires claimants to
furnish medical and other evidence to prove they are disabled. The form
SSA-3820 is used to obtain various types of information about a child's
condition, his/her treating sources and/or other medical sources of
evidence. The information collected on the SSA-3820 is needed for the
determination of disability by the State DDSs. The respondents are
applicants for Title XVI child disability benefits.
Type of Request: Revision to an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Estimated
Collection format Number of Frequency of Average burden per annual burden
respondents responses responses (hour)
----------------------------------------------------------------------------------------------------------------
SSA-3820 (Paper Form)............... 500 1 1 hour................. 500
Electronic Disability Collection 422,000 1 34 minutes............. 239,133
System (EDCS).
[[Page 32700]]
i3820 (Internet).................... 39,500 1 2 hours................ 79,000
---------------------------------------------------------------------------
Totals.......................... 462,000 ............... ....................... 318,633
----------------------------------------------------------------------------------------------------------------
13. Social Security Disability Report--20 CFR 404.1512 & 416.912--
0960-0579. The Social Security Administration requires applicants for
disability payments to furnish medical, work history, and other
evidence or information indicating they have an impairment which is
disabling. This information is collected by form SSA-3368, the Adult
Disability Report, and is used by State DDS's to make disability
determinations for SSA.
The respondents are applicants for Title II and Title XVI
disability benefits. These applicants may complete the form using any
of the following modalities: (1) The traditional paper form; (2) an
interview with an SSA field office representative, using the EDCS; (3)
the Internet (i3368); and (4) a modality, the i3368-PRO, an Internet
form designed to be completed by representatives of applicants for
disability payments. The latter three versions of the form collect the
same information as the paper form, but may be formatted differently
and include certain enhancements (ex: self-help screens) to guide the
claimant or interviewer through the application process.
Type of Request: Revision to an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average
Number of Frequency of burden per Estimated
Collection format respondents response response annual burden
(hours) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3368 (Paper version)........................ 9,364 1 1 9,364
Field office/EDCS............................... 3,138,920 1 1 3,138,920
i3368 (Internet version; Hour burden varies from 101,135 1 2\1/2\ 252,837
1\1/2\-3 hours, depending on information
required)......................................
i3368-PRO....................................... 101,135 1 1 \1/2\ 151,702
---------------------------------------------------------------
Totals...................................... 3,350,554 .............. .............. 3,552,823
----------------------------------------------------------------------------------------------------------------
14. Certification of Contents of Document(s) or Record(s)--20 CFR
404.715ff--0960-0689. SSA must secure evidence necessary for
individuals to establish rights to benefits. Some of the types of
evidence needed are evidence of age relationship, citizenship,
marriage, death, and military service. Form SSA-704 allows SSA
employees, state record custodians, and other custodians of evidentiary
documents to record information from documents and records to establish
these types of evidence. SSA employees use this form but it is also
used by state record custodians and other custodians of evidentiary
documents.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 4,800.
Average Burden per Response: 10 minutes.
Estimated Annual Burden: 800.
15. Waiver of Your Right to Personal Appearance before an
Administrative Law Judge--20 CFR 404.948(b)(l)(i) and
416.1448(b)(l)(i)--0960-0284. Each claimant has a statutory right to
appear in person (or through a representative) and present evidence
about his/her claim at a hearing before an Administrative Law Judge
(ALJ). If a claimant wishes to waive his/her statutory right to appear
before an ALJ, he/she must complete a written request. The claimant may
use Form HA-4608 for this request. The information collected is used to
document an individual's claim to show that an oral hearing is not
preferred in the appellate process. The respondents are applicants for
Title II benefits and Title XVI payments who request a hearing.
Number of Respondents: 12,000.
Frequency of Response: 1.
Average Burden per Response: 2 minutes.
Estimated Annual Burden: 400 hours.
Dated: June 7, 2007.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. E7-11383 Filed 6-12-07; 8:45 am]
BILLING CODE 4191-02-P
