Agency Information Collection Activities: Proposed Request and Comment Request, 53919-53922 [E8-21591]
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Federal Register / Vol. 73, No. 181 / Wednesday, September 17, 2008 / Notices
Authority: 15 U.S.C. 636(a)(24); 13 CFR
120.3.
Eric R. Zarnikow,
Associate Administrator, Office of Capital
Access.
[FR Doc. E8–21716 Filed 9–16–08; 8:45 am]
BILLING CODE 8025–01–P
SMALL BUSINESS ADMINISTRATION
Revocation of License of Small
Business Investment Company
Pursuant to the authority granted to
the United States Small Business
Administration by the Final Order of the
United States District Court of
Maryland, Baltimore Division, dated
June 17, 2008, the United States Small
Business Administration hereby revokes
the license of Anthem Capital, L.P., a
Delaware limited partnership, to
function as a small business investment
company under the Small Business
Investment Company License No. 0373–
0200 issued to Anthem Capital, L.P. on
September 26, 1994 and said license is
hereby declared null and void as of June
31, 2008.
United States Small Business
Administration.
Dated: September 8, 2008.
A. Joseph Shepard,
Associate Administrator for Investment.
[FR Doc. E8–21715 Filed 9–16–08; 8:45 am]
BILLING CODE 8025–01–P
SOCIAL SECURITY ADMINISTRATION
pwalker on PROD1PC71 with NOTICES
Agency Information Collection
Activities: Proposed Request and
Comment Request
The Social Security Administration
(SSA) publishes a list of information
collection packages requiring clearance
by the Office of Management and
Budget (OMB) in compliance with
Public Law (Pub. L.) 104–13, the
Paperwork Reduction Act of 1995,
effective October 1, 1995. This notice
includes revisions to OMB-approved
information collections and extensions
(no change) of existing OMB-approved
information collections.
SSA is soliciting comments on the
accuracy of the agency’s burden
estimate; the need for the information;
its practical utility; ways to enhance its
quality, utility, and clarity; and ways to
minimize the burden on respondents,
including the use of automated
collection techniques or other forms of
information technology. Mail, email, or
fax your comments and
recommendations on the information
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17:38 Sep 16, 2008
Jkt 214001
collection(s) to the OMB Desk Officer
and the SSA Reports Clearance Officer
to the addresses or fax numbers listed
below.
(OMB), Office of Management and
Budget, Attn: Desk Officer for SSA,
Fax: 202–395–6974, e-mail address:
OIRA_Submission@omb.eop.gov.
(SSA), Social Security Administration,
DCBFM,Attn: Reports Clearance
Officer,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. SSA will
submit them to OMB within 60 days
from the date of this notice. Therefore,
your comments would be most helpful
if you submit them to SSA within 60
days from the date of this publication.
Individuals can obtain copies of the
collection instruments by calling the
SSA Reports Clearance Officer at 410–
965–0454 or by writing to the e-mail
address listed above.
1. Supplement to Claim of Person
Outside the United States—20 CFR
404.460, 404.463, 422.505(b), 42 CFR
407.27(c)—0960–0051. SSA uses the
information collected from Form SSA–
21 to determine continuing entitlement
to Social Security benefits and the
proper benefit amounts of alien
beneficiaries living outside the United
States. SSA also uses the information 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.
2. Coverage of Employees of State and
Local Governments—20 CFR 404,
Subpart M—0960–0425. The Code of
Federal Regulations at 20 CFR 404
prescribe the rules for states submitting
reports of deposits and related
recordkeeping to SSA. States (and
interstate instrumentalities) are required
to provide wage and deposit-related
contribution information for pre-1987
periods. 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.
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53919
Estimated Annual Burden: 52 hours.
3. Medical Report on Adult with
Allegation of Human Immunodeficiency
Virus Infection; Medical Report on Child
with Allegation of Human
Immunodeficiency Virus Infection—20
CFR 416.993–416.994—0960–0500. SSA
uses Forms SSA–4814–F5 and SSA–
4815–F6 to collect information
necessary to determine if an individual
with Human Immunodeficiency Virus
(HIV) infection, who is applying for
Supplemental Security Income (SSI)
disability benefits, meets the
requirements for presumptive disability
payments. The respondents are the
medical sources of the applicants for
SSI disability payments.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 59,100.
Frequency of Response: 1.
Average Burden per Response: 10
minutes.
Estimated Annual Burden: 9,850
hours.
4. Application To Collect a Fee for
Payee Services—20 CFR 404.2040(a),
416.640(a) 416.1103(f)—0960–0719.
SSA uses Form SSA–445 to collect
information to make a determination
whether to authorize or deny
permission to collect fees for payee
services. The respondents are private
sector businesses or state and local
government offices applying to become
a fee-for-service organizational
representative payee.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 100.
Frequency of Response: 1.
Average Burden per Response: 10
minutes.
Estimated Annual Burden: 17 hours.
5. Request To Be Selected as a
Payee—20 CFR 404.2010–404.2055,
416.601–416.665—0960–0014. An
individual applying to be a
representative payee for a Social
Security or SSI recipient completes
Form SSA–11–BK. SSA designed the
form to aid the investigation of a payee
applicant. SSA uses the information to
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
applicant will use the benefits. The
respondents are representative payee
applicants for Titles II, VIII, XVI.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 1,500,000.
Estimated Annual Burden: 248,335
hours.
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Federal Register / Vol. 73, No. 181 / Wednesday, September 17, 2008 / Notices
Number of
respondents
Collection method
Individuals/Households (90%):
Representative Payee System (RPS) ......................................................
RPS/Signature Proxy ................................................................................
Paper Version .......................................................................................
Frequency of
response
Average
burden per
response
Total annual
burden
1
1
1
10.5
9.5
10.5
23,625
121,125
78,750
Totals .................................................................................................
Private Sector (9%):
RPS ..........................................................................................................
RPS/Signature Proxy ................................................................................
Paper Version ...........................................................................................
1,350,000
........................
........................
223,500
13,500
76.500
45,000
1
1
1
10.5
9.5
10.5
2,363
12,113
7,875
Totals .................................................................................................
State/Local/Tribal Government (1%):
RPS ..........................................................................................................
RPS/Signature Proxy ................................................................................
Paper Version ...........................................................................................
135,000
........................
........................
22,351
1,500
8,500
5,000
1
1
1
10.5
9.5
10.5
263
1,346
875
Totals .................................................................................................
15,000
........................
........................
2,484
Grand Total: ...............................................................................
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135,000
765,000
450,000
1,500,000
........................
........................
248,335
6. Modified Benefit Formula
Questionnaire—Foreign Pension—0960–
0561. SSA uses the information
collected on Form SSA–308 to
determine exactly how much (if any) of
a foreign pension may be used to reduce
the amount of Title II Social Security
retirement or disability benefits under
the modified benefit formula. The
respondents are applicants for Title II
Social Security retirement or disability
benefits who have foreign pensions.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden per Response: 10
minutes.
Estimated Annual Burden: 8,333
hours.
7. Claimant’s Work Background—20
CFR 404.1565(b), 20 CFR 416.965(b)—
0960–0300. SSA uses the information
from form HA–4633 when an individual
has requested a hearing before an
administrative law judge (ALJ) on the
issue of whether or not he or she is
disabled. The completed HA–4633
provides an updated summary of the
individual’s relevant work history,
information the ALJ requires in
assessing a claimant’s disability within
the meaning of the Social Security Act.
The respondents are members of the
public who have filed for disability
benefits under Title II and/or Title XVI
and have requested a hearing before an
ALJ.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 151,000.
Frequency of Response: 1.
Average Burden per Response: 15
minutes.
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Estimated Annual Burden: 37,750
hours.
II. SSA has submitted the information
collections listed below. Your
comments on the information
collections will be most useful if OMB
and SSA receive them within 30 days
from the date of this publication. You
can request a copy of the information
collections by e-mail,
OPLM.RCO@ssa.gov, fax 410–965–6400,
or by calling the SSA Reports Clearance
Officer at 410–965–0454.
1. Statement Regarding Date of Birth
and Citizenship—20 CFR 404.716—
0960–0016. Form SSA–702 collects
information needed when preferred or
other evidence is not available to prove
age or citizenship for an individual
applying for Social Security benefits.
SSA uses the information to establish
age as a factor of entitlement to Social
Security benefits or U.S. citizenship as
a payment factor. Respondents are
individuals with knowledge about the
date of birth and/or citizenship of
applicants for one or more Social
Security benefits who need to establish
their dates of birth as a factor of
entitlement or U.S. citizenship as a
factor of payment.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 1,200.
Frequency of Response: 1.
Average Burden per Response: 10
minutes.
Estimated Annual Burden: 200 hours.
2. Application for Benefits under a
U.S. International Social Security
Agreement—20 CFR 404.1925—0960–
0448. SSA uses information from Form
SSA–2490–BK to determine entitlement
to Social Security benefits from the
United States or from a country that has
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Fmt 4703
Sfmt 4703
entered into a Social Security agreement
with the United States. The respondents
are individuals who are applying for old
age, survivors or disability benefits from
the United States or from a Totalization
agreement country.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 26,700.
Frequency of Response: 1.
Average Burden per Response: 30
minutes.
Estimated Average Burden: 13,350
hours.
3. Plan for Achieving Self-Support—
20 CFR 416.110(e), 416.1180–1182,
416.1225–1227—0960–0559. SSA
collects the information on Form SSA–
545 when an SSI applicant/recipient
desires to use available income and
resources to obtain education and/or
training in order to become selfsupportive. SSA uses the information to
evaluate the recipient’s plan for
achieving self-support to determine
whether to approve the plan under the
provisions of the SSI program. The
respondents are SSI applicants/
recipients who are blind or disabled and
want to develop a plan to go to work.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 7,000.
Frequency of Response: 1.
Average Burden per Response: 2
hours.
Estimated Annual Burden: 14,000
hours.
4. Authorization to Disclose
Information to Social Security
Administration—20 CFR 404.1512 & 20
CFR 416.912—0960–0623. SSA must
obtain sufficient medical evidence to
make eligibility determinations for
Social Security disability benefits and
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Federal Register / Vol. 73, No. 181 / Wednesday, September 17, 2008 / Notices
SSI payments. For SSA to obtain
medical evidence, an applicant must
authorize his or her medical source(s) to
release the information to SSA. The
applicant may use Form SSA–827 to
provide consent for the release of
information. Generally, the State
Disability Determination Service
completes the form(s) based on
information provided by the applicant,
and sends the form(s) to the designated
medical source(s). The respondents are
53921
applicants for Title II benefits and Title
XVI payments.
Type of Request: Revision of a
currently approved information
collection.
READING, SIGNING, AND DATING THE 1ST SSA–827 (10 MINUTES)
Total respondents
Number of
reports
by each
respondent
Total annual
responses
Estimated
number of
minutes per
response
Total burden
hours
3,853,928 .........................................................................................................
1
3,853,928
10
642,321
SIGNING AND DATING THREE ADDITIONAL SSA–827S
Total respondents
Number of
reports
by each
respondent
Total annual
responses
Estimated
number of
minutes per
response
Total burden
hours
3,853,928 .........................................................................................................
3
11,561,784
1
192,696
READING THE EXPLANATION OF THE SSA–827 ON THE INTERNET
Number of
reports by
each
respondent
Total annual
responses
Estimated
number of
minutes per
response
Total burden
hours
586,232 ............................................................................................................
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Total respondents
1
586,232
3
29,312
Collectively:
Number of Respondents: 3,853,928.
Frequency of Response (Average per
case): 4.
Average Burden per Response: 13
minutes to complete all 4 forms.
Average Burden to Read Internet
Instructions: 3 minutes.
Estimated Annual Burden for Reading
Internet Explanation: 29,312.
Estimated Annual Burden to read
instructions and complete the form:
864,329 hours.
5. Review of the Disability Hearing
Officer’s Reconsidered Determinations
Before It Is Issued—20 CFR 404.913–
404.918, 404.1512–404.1515, 404.1589,
416.912–416.915, 416.989, 416.1413–
416.1418, 404.918(d) and 416.1418(d)—
0960–0709. When SSA approves a claim
for Social Security disability benefits or
SSI payments, it periodically conducts a
continuing disability review (CDR)
during which the agency reviews the
claimant’s status to see if his/her
condition has improved to the point
where the claimant is capable of
working. If SSA notifies a claimant that
the agency will cease paying benefits,
the claimant may appeal that
determination. The first appeal gives the
claimant the opportunity for a full
evidentiary hearing before a disability
hearing officer (DHO). A federal
component reviews a small sample of
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Jkt 214001
the DHO’s determinations. It is rare for
the reviewing component to reverse a
DHO determination favorable to the
claimant. Before SSA can produce the
unfavorable determination, the claimant
has 10 days to provide a written
statement explaining why SSA should
not stop payments. That written
statement is the information collected in
this process. Respondents are CDR
claimants whose benefits are going to
cease.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 8.
Frequency of Response: 1.
Average Burden per Response: 60
minutes.
Estimated Annual Burden: 8 hours.
6. Farm Arrangement Questionnaire—
20 CFR 404.1082(c)—0960–0064. When
self-employed workers submit earnings
data to SSA, they cannot count rental
income from a farm unless they
demonstrate ‘‘material participation’’ in
the farm’s operation. A material
participation arrangement means the
farm owners who are seeking to have
earnings counted by SSA must perform
a combination of physical duties,
management decisions, and capital
investment in the farm they are renting
out. In such cases, SSA uses form SSA–
7157, the Farm Arrangement
Questionnaire, to document material
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participation. The respondents are
workers who are renting farmland to
other people and who are involved in
the operation of the farm and want to
claim countable income from their work
there.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 38,000.
Frequency of Response: 1.
Average Burden per Response: 30
minutes.
Estimated Annual Burden: 19,000
hours.
7. Disability Update Report—20 CFR
404.1589–.1595, 416.988–.996—0960–
0511. SSA periodically reviews current
disability cases to determine if the
recipients should continue to receive
disability payments. In cases where
these reviews indicate beneficiaries
might have experienced a medical
improvement, SSA must investigate
further. The agency uses form SSA–455/
SSA–455–OCR–SM, the Disability
Update Report, for this purpose.
Specifically, SSA uses the information it
gathers on this form to determine if (1)
there is enough evidence to warrant
referring the beneficiary for a full
medical CDR (2) the beneficiary’s
impairment has not changed enough to
warrant a CDR; or (3) there are
unresolved work-related issues for the
beneficiary. The respondents are Title II
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Federal Register / Vol. 73, No. 181 / Wednesday, September 17, 2008 / Notices
and Title XVI disability payment
recipients.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 880,000.
Frequency of Response: 1.
Average Burden per Response: 15
minutes.
Estimated Annual Burden: 220,000
hours.
Dated: September 10, 2008.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security
Administration.
[FR Doc. E8–21591 Filed 9–16–08; 8:45 am]
BILLING CODE 4191–02–P
SOCIAL SECURITY ADMINISTRATION
[Docket No. SSA 2008–0046]
Privacy Act of 1974, as Amended;
Computer Matching Program; (SSA/
Centers for Medicare and Medicaid
(CMS) Match Number 1076)
AGENCY:
Social Security Administration
(SSA).
Notice of the renewal of an
existing computer matching program
which is scheduled to expire on October
15, 2008.
ACTION:
SUMMARY: In accordance with the
provisions of the Privacy Act, as
amended, this notice announces the
renewal of an existing computer
matching program that SSA is currently
conducting with CMS.
DATES: SSA will file a report of the
subject matching program with the
Committee on Homeland Security and
Governmental Affairs of the Senate; the
Committee on Oversight and
Government Reform of the House of
Representatives; and the Office of
Information and Regulatory Affairs,
Office of Management and Budget
(OMB). The renewal of the matching
program will be effective as indicated
below.
Interested parties may
comment on this notice by either telefax
to (410) 965–0201 or writing to the
Deputy Commissioner for Budget,
Finance and Management, 800 Altmeyer
Building, 6401 Security Boulevard,
Baltimore, MD 21235–6401. All
comments received will be available for
public inspection at this address.
FOR FURTHER INFORMATION CONTACT: The
Deputy Commissioner for Budget,
Finance and Management as shown
above.
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ADDRESSES:
SUPPLEMENTARY INFORMATION:
VerDate Aug<31>2005
17:38 Sep 16, 2008
Jkt 214001
A. General
The Computer Matching and Privacy
Protection Act of 1988 (Pub. L. 100–
503), amended the Privacy Act (5 U.S.C.
552a) by describing the conditions
under which computer matching
involving the Federal government could
be performed and adding certain
protections for individuals applying for,
and receiving, Federal benefits. Section
7201 of the Omnibus Budget
Reconciliation Act of 1990 (Pub. L. 101–
508) further amended the Privacy Act
regarding protections for such
individuals.
The Privacy Act, as amended,
regulates the use of computer matching
by Federal agencies when records in a
system of records are matched with
other Federal, State or local government
records. It requires Federal agencies
involved in computer matching
programs to:
(1) Negotiate written agreements with
the other agency or agencies
participating in the matching programs;
(2) Obtain the approval of the
matching agreement by the Data
Integrity Boards (DIB) of the
participating Federal agencies;
(3) Publish notice of the computer
matching program in the Federal
Register;
(4) Furnish detailed reports about
matching programs to Congress and
OMB;
(5) Notify applicants and beneficiaries
that their records are subject to
matching; and
(6) Verify match findings before
reducing, suspending, terminating or
denying an individual’s benefits or
payments.
B. SSA Computer Matches Subject to
the Privacy Act
We have taken action to ensure that
all of SSA’s computer matching
programs comply with the requirements
of the Privacy Act, as amended.
Dated: August 27, 2008.
Mary Glenn-Croft,
Deputy Commissioner for Budget, Finance
and Management.
Notice of Computer Matching Program,
Social Security Administration (SSA) With
the Centers for Medicare and Medicaid
(CMS)
A. PARTICIPATING AGENCIES
SSA and CMS.
B. PURPOSE OF THE MATCHING PROGRAM
The purpose of this agreement is to
establish the conditions, terms and
safeguards under which CMS agrees to
the ongoing disclosure of certain skilled
nursing facility admission data by CMS
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Fmt 4703
Sfmt 4703
to SSA. CMS will disclose the data
through a computer matching operation
for SSA’s use in identifying
Supplemental Security Income (SSI)
recipients who did not report their
admission to a facility as required under
applicable provisions of the Social
Security Act (the Act). Such admission
would subject the amount of SSI which
an individual could receive for any
month throughout which the individual
is in such a facility to a reduced benefit
rate. The SSI program provides
payments to aged, blind and disabled
recipients with income and resources
below levels established by law and
regulations.
SSA will use other benefit
information for the Title VIII, Special
Veterans’ Benefits (SVB) determinations
of entitlement and benefit amount.
Other benefit information is defined as
any recurring payment received as an
annuity, pension, retirement or
disability benefit. The match will be
used to identify those SVB beneficiaries
who are no longer residing outside the
United States.
C. AUTHORITY FOR CONDUCTING THE MATCHING
PROGRAM
This Matching Agreement between
SSA and CMS is executed pursuant to
the Privacy Act of 1974 (5 U.S.C. 552a),
as amended (Pub. L. 100–503, the
Computer Matching and Privacy
Protection Act (CMPPA) of 1988), the
Office of Management and Budget
(OMB) Circular A–130, titled
‘‘Management of Federal Information
Resources’’ at 61 FR 6428–6435
(February 20, 1996), and OMB
guidelines pertaining to computer
matching at 54 FR 25818 (June 19,
1989).
Legal authority for the SSI portion of
the matching program described above
is contained in sections 1611(e)(1)(A)
and (B) and 1631(f) of the Act (42 U.S.C.
1382(e)(1)(A) and (B) and 1383(f)); see
also 20 CFR 416.211.
Legal authority for the SVB portion of
the matching program is contained in
sections 801 and 806(a) and (b) of the
Act (42 U.S.C. 1001 and 1006(a) and
(b)).
D. CATEGORIES OF RECORDS AND INDIVIDUALS
COVERED BY THE MATCHING PROGRAM
SSA will provide CMS with a finder
file on a monthly basis extracted from
SSA’s Supplemental Security Income
Record and Special Veterans Benefits
(SSR/SVB), SSA/ODSSIS 60–0103, with
identifying information with respect to
recipients of SSI benefits. CMS will
match the SSA finder file against the
system of records for individuals on the
Long-Term Care Minimum Data Set
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]]>Agencies
[Federal Register Volume 73, Number 181 (Wednesday, September 17, 2008)]
[Notices]
[Pages 53919-53922]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E8-21591]
=======================================================================
-----------------------------------------------------------------------
SOCIAL SECURITY ADMINISTRATION
Agency Information Collection Activities: Proposed Request and
Comment Request
The Social Security Administration (SSA) publishes a list of
information collection packages requiring clearance by the Office of
Management and Budget (OMB) in compliance with Public Law (Pub. L.)
104-13, the Paperwork Reduction Act of 1995, effective October 1, 1995.
This notice includes revisions to OMB-approved information collections
and extensions (no change) of existing OMB-approved information
collections.
SSA is soliciting comments on the accuracy of the agency's burden
estimate; the need for the information; its practical utility; ways to
enhance its quality, utility, and clarity; and ways to minimize the
burden on respondents, including the use of automated collection
techniques or other forms of information technology. Mail, email, or
fax your comments and recommendations on the information collection(s)
to the OMB Desk Officer and the SSA Reports Clearance Officer to the
addresses or fax numbers listed below.
(OMB), Office of Management and Budget, Attn: Desk Officer for SSA,
Fax: 202-395-6974, e-mail address: OIRA_Submission@omb.eop.gov.
(SSA), Social Security Administration, DCBFM,Attn: Reports Clearance
Officer,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. SSA
will submit them to OMB within 60 days from the date of this notice.
Therefore, your comments would be most helpful if you submit them to
SSA within 60 days from the date of this publication. Individuals can
obtain copies of the collection instruments by calling the SSA Reports
Clearance Officer at 410-965-0454 or by writing to the e-mail address
listed above.
1. Supplement to Claim of Person Outside the United States--20 CFR
404.460, 404.463, 422.505(b), 42 CFR 407.27(c)--0960-0051. SSA uses the
information collected from Form SSA-21 to determine continuing
entitlement to Social Security benefits and the proper benefit amounts
of alien beneficiaries living outside the United States. SSA also uses
the information 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.
2. Coverage of Employees of State and Local Governments--20 CFR
404, Subpart M--0960-0425. The Code of Federal Regulations at 20 CFR
404 prescribe the rules for states submitting reports of deposits and
related recordkeeping to SSA. States (and interstate instrumentalities)
are required to provide wage and deposit-related contribution
information for pre-1987 periods. 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.
3. Medical Report on Adult with Allegation of Human
Immunodeficiency Virus Infection; Medical Report on Child with
Allegation of Human Immunodeficiency Virus Infection--20 CFR 416.993-
416.994--0960-0500. SSA uses Forms SSA-4814-F5 and SSA-4815-F6 to
collect information necessary to determine if an individual with Human
Immunodeficiency Virus (HIV) infection, who is applying for
Supplemental Security Income (SSI) disability benefits, meets the
requirements for presumptive disability payments. The respondents are
the medical sources of the applicants for SSI disability payments.
Type of Request: Revision 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.
4. Application To Collect a Fee for Payee Services--20 CFR
404.2040(a), 416.640(a) 416.1103(f)--0960-0719. SSA uses Form SSA-445
to collect information to make a determination whether to authorize or
deny permission to collect fees for payee services. The respondents are
private sector businesses or state and local government offices
applying to become a fee-for-service organizational representative
payee.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 100.
Frequency of Response: 1.
Average Burden per Response: 10 minutes.
Estimated Annual Burden: 17 hours.
5. Request To Be Selected as a Payee--20 CFR 404.2010-404.2055,
416.601-416.665--0960-0014. An individual applying to be a
representative payee for a Social Security or SSI recipient completes
Form SSA-11-BK. SSA designed the form to aid the investigation of a
payee applicant. SSA uses the information to 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
applicant will use the benefits. The respondents are representative
payee applicants for Titles II, VIII, XVI.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 1,500,000.
Estimated Annual Burden: 248,335 hours.
[[Page 53920]]
----------------------------------------------------------------------------------------------------------------
Average
Collection method Number of Frequency of burden per Total annual
respondents response response burden
----------------------------------------------------------------------------------------------------------------
Individuals/Households (90%):
Representative Payee System (RPS)........... 135,000 1 10.5 23,625
RPS/Signature Proxy......................... 765,000 1 9.5 121,125
Paper Version............................. 450,000 1 10.5 78,750
---------------------------------------------------------------
Totals.................................. 1,350,000 .............. .............. 223,500
Private Sector (9%):
RPS......................................... 13,500 1 10.5 2,363
RPS/Signature Proxy......................... 76.500 1 9.5 12,113
Paper Version............................... 45,000 1 10.5 7,875
---------------------------------------------------------------
Totals.................................. 135,000 .............. .............. 22,351
State/Local/Tribal Government (1%):
RPS......................................... 1,500 1 10.5 263
RPS/Signature Proxy......................... 8,500 1 9.5 1,346
Paper Version............................... 5,000 1 10.5 875
---------------------------------------------------------------
Totals.................................. 15,000 .............. .............. 2,484
---------------------------------------------------------------
Grand Total:........................ 1,500,000 .............. .............. 248,335
----------------------------------------------------------------------------------------------------------------
6. Modified Benefit Formula Questionnaire--Foreign Pension--0960-
0561. SSA uses the information collected on Form SSA-308 to determine
exactly how much (if any) of a foreign pension may be used to reduce
the amount of Title II Social Security retirement or disability
benefits under the modified benefit formula. The respondents are
applicants for Title II Social Security retirement or disability
benefits who have foreign pensions.
Type of Request: Revision 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.
7. Claimant's Work Background--20 CFR 404.1565(b), 20 CFR
416.965(b)--0960-0300. SSA uses the information from form HA-4633 when
an individual has requested a hearing before an administrative law
judge (ALJ) on the issue of whether or not he or she is disabled. The
completed HA-4633 provides an updated summary of the individual's
relevant work history, information the ALJ requires in assessing a
claimant's disability within the meaning of the Social Security Act.
The respondents are members of the public who have filed for disability
benefits under Title II and/or Title XVI and have requested a hearing
before an ALJ.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 151,000.
Frequency of Response: 1.
Average Burden per Response: 15 minutes.
Estimated Annual Burden: 37,750 hours.
II. SSA has submitted the information collections listed below.
Your comments on the information collections will be most useful if OMB
and SSA receive them within 30 days from the date of this publication.
You can request a copy of the information collections by e-mail,
OPLM.RCO@ssa.gov, fax 410-965-6400, or by calling the SSA Reports
Clearance Officer at 410-965-0454.
1. Statement Regarding Date of Birth and Citizenship--20 CFR
404.716--0960-0016. Form SSA-702 collects information needed when
preferred or other evidence is not available to prove age or
citizenship for an individual applying for Social Security benefits.
SSA uses the information to establish age as a factor of entitlement to
Social Security benefits or U.S. citizenship as a payment factor.
Respondents are individuals with knowledge about the date of birth and/
or citizenship of applicants for one or more Social Security benefits
who need to establish their dates of birth as a factor of entitlement
or U.S. citizenship as a factor of payment.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 1,200.
Frequency of Response: 1.
Average Burden per Response: 10 minutes.
Estimated Annual Burden: 200 hours.
2. Application for Benefits under a U.S. International Social
Security Agreement--20 CFR 404.1925--0960-0448. SSA uses information
from Form SSA-2490-BK to determine entitlement to Social Security
benefits from the United States or from a country that has entered into
a Social Security agreement with the United States. The respondents are
individuals who are applying for old age, survivors or disability
benefits from the United States or from a Totalization agreement
country.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 26,700.
Frequency of Response: 1.
Average Burden per Response: 30 minutes.
Estimated Average Burden: 13,350 hours.
3. Plan for Achieving Self-Support--20 CFR 416.110(e), 416.1180-
1182, 416.1225-1227--0960-0559. SSA collects the information on Form
SSA-545 when an SSI applicant/recipient desires to use available income
and resources to obtain education and/or training in order to become
self-supportive. SSA uses the information to evaluate the recipient's
plan for achieving self-support to determine whether to approve the
plan under the provisions of the SSI program. The respondents are SSI
applicants/recipients who are blind or disabled and want to develop a
plan to go to work.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 7,000.
Frequency of Response: 1.
Average Burden per Response: 2 hours.
Estimated Annual Burden: 14,000 hours.
4. Authorization to Disclose Information to Social Security
Administration--20 CFR 404.1512 & 20 CFR 416.912--0960-0623. SSA must
obtain sufficient medical evidence to make eligibility determinations
for Social Security disability benefits and
[[Page 53921]]
SSI payments. For SSA to obtain medical evidence, an applicant must
authorize his or her medical source(s) to release the information to
SSA. The applicant may use Form SSA-827 to provide consent for the
release of information. Generally, the State Disability Determination
Service completes the form(s) based on information provided by the
applicant, and sends the form(s) to the designated medical source(s).
The respondents are applicants for Title II benefits and Title XVI
payments.
Type of Request: Revision of a currently approved information
collection.
Reading, Signing, and Dating the 1st SSA-827 (10 Minutes)
----------------------------------------------------------------------------------------------------------------
Estimated
Number of Total annual number of Total burden
Total respondents reports by each responses minutes per hours
respondent response
----------------------------------------------------------------------------------------------------------------
3,853,928................................... 1 3,853,928 10 642,321
----------------------------------------------------------------------------------------------------------------
Signing and Dating Three Additional SSA-827s
----------------------------------------------------------------------------------------------------------------
Estimated
Number of Total annual number of Total burden
Total respondents reports by each responses minutes per hours
respondent response
----------------------------------------------------------------------------------------------------------------
3,853,928................................... 3 11,561,784 1 192,696
----------------------------------------------------------------------------------------------------------------
Reading the Explanation of the SSA-827 on the Internet
----------------------------------------------------------------------------------------------------------------
Estimated
Number of Total annual number of Total burden
Total respondents reports by each responses minutes per hours
respondent response
----------------------------------------------------------------------------------------------------------------
586,232..................................... 1 586,232 3 29,312
----------------------------------------------------------------------------------------------------------------
Collectively:
Number of Respondents: 3,853,928.
Frequency of Response (Average per case): 4.
Average Burden per Response: 13 minutes to complete all 4 forms.
Average Burden to Read Internet Instructions: 3 minutes.
Estimated Annual Burden for Reading Internet Explanation: 29,312.
Estimated Annual Burden to read instructions and complete the form:
864,329 hours.
5. Review of the Disability Hearing Officer's Reconsidered
Determinations Before It Is Issued--20 CFR 404.913-404.918, 404.1512-
404.1515, 404.1589, 416.912-416.915, 416.989, 416.1413-416.1418,
404.918(d) and 416.1418(d)--0960-0709. When SSA approves a claim for
Social Security disability benefits or SSI payments, it periodically
conducts a continuing disability review (CDR) during which the agency
reviews the claimant's status to see if his/her condition has improved
to the point where the claimant is capable of working. If SSA notifies
a claimant that the agency will cease paying benefits, the claimant may
appeal that determination. The first appeal gives the claimant the
opportunity for a full evidentiary hearing before a disability hearing
officer (DHO). A federal component reviews a small sample of the DHO's
determinations. It is rare for the reviewing component to reverse a DHO
determination favorable to the claimant. Before SSA can produce the
unfavorable determination, the claimant has 10 days to provide a
written statement explaining why SSA should not stop payments. That
written statement is the information collected in this process.
Respondents are CDR claimants whose benefits are going to cease.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 8.
Frequency of Response: 1.
Average Burden per Response: 60 minutes.
Estimated Annual Burden: 8 hours.
6. Farm Arrangement Questionnaire--20 CFR 404.1082(c)--0960-0064.
When self-employed workers submit earnings data to SSA, they cannot
count rental income from a farm unless they demonstrate ``material
participation'' in the farm's operation. A material participation
arrangement means the farm owners who are seeking to have earnings
counted by SSA must perform a combination of physical duties,
management decisions, and capital investment in the farm they are
renting out. In such cases, SSA uses form SSA-7157, the Farm
Arrangement Questionnaire, to document material participation. The
respondents are workers who are renting farmland to other people and
who are involved in the operation of the farm and want to claim
countable income from their work there.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 38,000.
Frequency of Response: 1.
Average Burden per Response: 30 minutes.
Estimated Annual Burden: 19,000 hours.
7. Disability Update Report--20 CFR 404.1589-.1595, 416.988-.996--
0960-0511. SSA periodically reviews current disability cases to
determine if the recipients should continue to receive disability
payments. In cases where these reviews indicate beneficiaries might
have experienced a medical improvement, SSA must investigate further.
The agency uses form SSA-455/SSA-455-OCR-SM, the Disability Update
Report, for this purpose. Specifically, SSA uses the information it
gathers on this form to determine if (1) there is enough evidence to
warrant referring the beneficiary for a full medical CDR (2) the
beneficiary's impairment has not changed enough to warrant a CDR; or
(3) there are unresolved work-related issues for the beneficiary. The
respondents are Title II
[[Page 53922]]
and Title XVI disability payment recipients.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 880,000.
Frequency of Response: 1.
Average Burden per Response: 15 minutes.
Estimated Annual Burden: 220,000 hours.
Dated: September 10, 2008.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. E8-21591 Filed 9-16-08; 8:45 am]
BILLING CODE 4191-02-P
