Agency Information Collection Activities: Proposed Request and Comment Request, 75488-75492 [E8-29332]
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Federal Register / Vol. 73, No. 239 / Thursday, December 11, 2008 / Notices
Analyst, Office of Entrepreneurial
Development, Small Business
Administration, 409 Street, SW., 6th
floor, Washington, DC 20416.
FOR FURTHER INFORMATION CONTACT:
Rachel Newman Karton, Program
Analyst, Office of Entrepreneurial
Development, 202–619–186,
rachel.newman-karton@sba.gov; Curtis
B. Rich, Management Analyst, 202–205–
7030, curtis.rich@sba.gov.
SUPPLEMENTARY INFORMATION: Each form
is used to notify recipients of grant
awards and cooperative agreement
awards. Form 1222 is used also to
document logistical and budgetary
information gathered from the awardees
application and proposed. Awardees/
Respondents are universities, colleges,
state and local government, for-profit
organizations. Form 1224 is used to
certify the cost sharing by the recipient.
Title: ‘‘Notice of Award and Grant
Cooperative Agreement Sharing
Proposal’’.
Description of Respondents:
Participating Colleges and Grants
Management Offices.
Form Numbers: 1222 and 1224.
Annual Responses: 2,592.
Annual Burden: 202,261.
Jacqueline White,
Chief, Administrative Information Branch.
[FR Doc. E8–29028 Filed 12–10–08; 8:45 am]
BILLING CODE 8025–01–M
SMALL BUSINESS ADMINISTRATION
Small Business Investment
Companies; Increase in Maximum
Leverage Ceiling
defined in 13 CFR 107.50) that a Small
Business Investment Company may
have outstanding at any time. The
maximum Leverage amounts are
adjusted annually based on the increase
in the Consumer Price Index published
by the Bureau of Labor Statistics. The
cited regulation states that the Small
Business Administration will publish
the indexed maximum Leverage
amounts each year in a Notice in the
Federal Register.
Accordingly, effective the date of
publication of this Notice, and until
further notice, the maximum Leverage
amounts under 13 CFR 107.1150(a) are
as stated in the following table:
13 CFR 107.1150(a) sets forth the
maximum amount of Leverage (as
If your leverageable capital is:
Then your maximum leverage is:
(1)
(2)
(3)
(4)
300 percent of Leverageable Capital.
$68,400,000 + [2 x (Leverageable Capital ¥$22,800,000)].
$114,200,000 + (Leverageable Capital $45,700,000).
$137,100,000.
Not over $22,800,000 .........................................................................
Over $22,800,000 but not over $45,700,000 .....................................
Over $45,700,000 but not over $68,600,000 .....................................
Over $68,600,000 ...............................................................................
(Catalog of Federal Domestic Assistance
Program No. 59.011, Small Business
Investment Companies)
Dated: December 2, 2008.
A. Joseph Shepard,
Associate Administrator for Investment.
[FR Doc. E8–29027 Filed 12–10–08; 8:45 am]
BILLING CODE 8025–01–M
SOCIAL SECURITY ADMINISTRATION
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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 a revision to an OMB-approved
information collection.
SSA is soliciting comments on the
accuracy of the agency’s burden
estimate; the need for the information;
its practical utility; ways to enhance its
quality, utility, and clarity; and ways to
minimize the burden on respondents,
including the use of automated
collection techniques or other forms of
information technology. Mail, e-mail, or
fax your comments and
recommendations on the information
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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,
1332 Annex Building,
6401 Security Blvd.,
Baltimore, MD 21235,
Fax: 410–965–6400,
E-mail address: OPLM.RCO@ssa.gov,
I. The information collection below is
pending at SSA. SSA will submit it 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
instrument by calling the SSA Reports
Clearance Officer at 410–965–3758 or by
writing to the email address listed
above.
1. Claimant’s Recent Medical
Treatment—20 CFR 404.1512 and
416.912—0960–0292 Form HA–4631 is
a questionnaire used by SSA to obtain
updated medical evidence. Each
claimant who requests a hearing before
an Administrative Law Judge (ALJ) has
a right to such a hearing once the
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Disability Determination Service (DDS),
at the Reconsideration level, has denied
the claim. SSA requests the claimant
complete and return the HA–4631 if the
claimant’s file does not reflect a
complete medical history. Because the
claimant’s situation may change over
time, as the claimant proceeds through
the appeals process, ALJs must obtain
the information on Form HA–4631 to
update and complete the record and to
verify the accuracy of information
previously provided. It is by this
process, ALJs can ascertain whether the
claimant’s situation has changed. The
ALJ and Hearing Office (HO) staff use
the response to make hearing
arrangements for consultative
examination(s) and the attendance of an
expert witness(es), if appropriate. At the
hearing, the ALJ offers any completed
questionnaires as exhibits and may use
them to refresh the claimant’s memory,
and to inquire into the matters at issue.
The respondents are claimant’s
requesting hearings on entitlement to
benefits based on disability under Titles
II and/or XVI of the Social Security Act.
Type of Request: Extension of an
OMB-Approved Information Collection.
Number of Respondents: 350,000.
Frequency of Response: 1.
Average Burden Per Response: 10
minutes.
Estimated Annual Burden: 58,333
hours.
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Federal Register / Vol. 73, No. 239 / Thursday, December 11, 2008 / Notices
2. Medicaid Use Report—20 CFR
416.268—0960–0267. SSA uses the
information required by this regulation
to determine if an individual is entitled
to special Title XVI Supplemental
Security Income (SSI) payments and,
consequently, to Medicaid benefits. The
Respondents are SSI recipients for
whom SSA has stopped payments based
on earnings.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 60,000.
Frequency of Response: 1.
Average Burden Per Response: 3
minutes.
Estimated Annual Burden: 3,000
hours.
3. Application for Parent’s Insurance
Benefits—20 CFR 404.370–404.374, 20
CFR 404.601–404.603—0960–0012. The
Social Security Administration uses
Form SSA–7 to collect information used
to entitle an individual to his or her
parent’s insurance benefits. The
respondents are claimants who wish to
apply to receive their parent’s insurance
benefits.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 315.
Frequency of Response: 1.
Average Burden Per Response: 15
minutes.
Estimated Annual Burden: 79 hours.
4. Partnership Questionnaire—20 CFR
404.1080–1082—0960–0025. The Social
Security Administration uses the
information reported on Form SSA–
7104 to establish several aspects of
eligibility for Social Security benefits,
including the accuracy of reported
partnership earnings, the veracity of a
retirement, and lag earnings. The
respondents are applicants for, and
recipients of, Social Security Old Age,
Survivors, and Disability Insurance
Benefits.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 12,350.
Frequency of Response: 1.
Average Burden Per Response: 30
minutes.
Estimated Annual Burden: 6,175
hours.
5. Request for Waiver of Overpayment
Recovery or Change in Repayment
Notice—20 CFR 404.502—404.513,
404.515 and 20 CFR 416.550—416.570,
416.572–0960–0037. The overpaid
individual uses the SSA–632–BK to
request a waiver of recovery of an
overpayment. The individual explains
why they feel they are without fault in
causing the overpayment and provides
financial information, so SSA can
determine whether recovery would
cause financial hardship. If the
individual agrees to repay the
overpayment, they can use the SSA–
632–BK to inform SSA they want to
repay at a monthly rate that would take
more than thirty-six months to recover
the overpayment. The individual can
also use the SSA–632–BK to request a
different rate of recovery. In those cases,
they must provide financial information
to SSA for a determination of how much
the overpaid person can afford to repay
each month. Respondents are overpaid
beneficiaries or claimants who are
requesting a waiver of recovery of the
overpayment, or a lesser rate of
withholding.
Type of Request: Revision of an OMBapproved information collection.
Number of
respondents
Reason for completing form
Frequency
of response
Average burden per response
400,000
100,000
500,000
1
1
....................
2 hours ....................................................
45 minutes ..............................................
.................................................................
Request Waiver ..................................................................
Request Change ................................................................
Totals ..........................................................................
6. Statement of Funds You Provided
to Another and Statement of Funds You
Received—20 CFR 404.1520(b),
404.1571–.1576, 404.1584–.1593 and
416.971–.976—0960–0059. Form SSA–
821–BK is used by SSA field offices to
obtain work information from recipients
while conducting face-to-face
interviews, telephone interviews and by
mail, during the initial claims process,
during the continuing disability review
process and whenever work issues arise
in SSI claims. SSA’s Processing Centers
and the Office of Disability and
International Operations use the form to
obtain post-adjudicative work issues
from recipients by mail. The primary
purpose of this form is to collect
recipient employment information in
order to determine whether or not
recipients have worked in employment
after becoming disabled and, if so,
whether the work is SGA. SSA will
review and evaluate the data to
determine if the recipient continues to
meet the disability requirement of the
law. The respondents are Social
Security Disability Applicants,
Beneficiaries, and Supplemental
Security Income Applicants.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 300,000.
Frequency of Response: 1.
Average Burden Per Response: 45
minutes.
Estimated Annual Burden: 225,000
hours.
7. Application for Supplemental
Security Income —20 CFR 416.305–
416.335, Subpart C—0960–0444. Form
Number of
respondents
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No. of minutes to complete form
711,135
237,045
19,351
967,531
15
14
18
....................
MSSIC ......................................................................................................................................................
MSSIC/Signature Proxy ...........................................................................................................................
Paper .......................................................................................................................................................
Totals: ...............................................................................................................................................
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Total annual
burden
800,000
75,000
875,000
SSA–8001–BK collects information SSA
uses to determine an applicant’s
eligibility for SSI, and the amount of SSI
benefits. SSA employees secure this
information during interviews
conducted with members of the public
who wish to file for SSI benefits. This
form is used for two purposes: (1) To
formally deny Supplemental Security
Income benefits for non-medical reasons
when information provided by the
applicant results in ineligibility; OR (2)
to establish a disability claim, but defer
the complete development of nonmedical issues until the disability is
approved. The respondents are
recipients for Supplemental Security
Income benefits.
Type of Request: Extension of an
OMB-approved information collection.
Form type
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Burden
hours
177,784
55,311
5,805
238,900
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Federal Register / Vol. 73, No. 239 / Thursday, December 11, 2008 / Notices
II. SSA has submitted the information
collections listed below 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
410–965–3758, or by writing to the
above listed address.
1. Accelerated Benefits Demonstration
Project—0960–0747
Background
In early 2007, SSA obtained OMB
approval for the Accelerated Benefits
Demonstration Project, a multi-phase
study designed to assess whether
providing new SSDI recipients with
certain benefits would stabilize or
improve their health and help them
return to work early. In this long-term
study, we assigned new SSDI recipients
(i.e., those who had just begun receiving
disability benefits and who had at least
18 months remaining before they
qualified for Medicare) to three groups.
The three groups consisted of: (1) A
control group who would just receive
regular SSDI benefits; (2) a treatment
group who would receive immediate
access to health care benefits; and (3) a
treatment group who would receive
health care benefits and additional care
management, employment, and benefits
services and support. The study, which
research contractors and health care
experts are conducting for SSA, assess
if the health care and other benefits help
beneficiaries improve and return to
work earlier, and asses if there is a
difference between the treatment
groups.
Update/Current ICR
Having (1) Assigned eligible
beneficiaries into one of the three
participant groups described above and
(2) conducted a baseline and six-month
follow-up surveys with these
beneficiaries, SSA is now ready to move
on to the next phase of the study: A 12month follow-up survey. This ICR is for
the 12-month follow-up survey, which
we plan to conduct beginning in March
2009. We will use telephone interviews
for the survey, with in-person follow-up
for non-responders as necessary. We
will attempt to contact all 2,000
participants and expect to complete
follow-up interviews with 1,600 of them
(80 percent). The purpose of the survey
is to explore participants’ experiences
after one year in the program, which
will provide initial data on the effects of
the health care and ‘‘heath care plus’’
treatments. The respondents are SSDI
beneficiaries participating in this study.
Burden Data for 12-Month Follow-Up
Survey
Type of Request: Revision to an
existing OMB-approved information
collection.
Number of Respondents: 1,600.
Frequency of Response: 1.
Average Burden per Response: 45
minutes.
Estimated Annual Burden: 1,200
hours.
2. 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, and XVI.
Type of Request: Revision of an OMBapproved information collection.*11/60.
Number of Respondents: 1,500,000.
Estimated Annual Burden: 248,335
hours.
INDIVIDUALS/HOUSEHOLDS (90%):
Number of
respondents
Average
burden per
response
Total annual
burden
135,000
765,000
450,000
1,350,000
1
1
1
....................
10.5
9.5
10.5
....................
23,625
121,125
78,750
223,500
Frequency
of response
Average
burden per
response
Total annual
burden
13,500
76.500
45,000
135,000
1
1
1
....................
10.5
9.5
10.5
....................
2,363
12,113
7,875
22,351
Number of
respondents
Representative Payee System (RPS) .............................................................................
RPS/Signature Proxy .......................................................................................................
Paper Version ..................................................................................................................
Totals ........................................................................................................................
Frequency
of response
Number of
respondents
Collection method
Frequency
of response
Average
burden per
response
Total annual
burden
1,500
8,500
5,000
15,000
1,500,000
1
1
1
....................
....................
10.5
9.5
10.5
....................
....................
263
1,346
875
2,484
248,335
PRIVATE SECTOR (9%):
Collection method
RPS ..................................................................................................................................
RPS/Signature Proxy .......................................................................................................
Paper Version ..................................................................................................................
Totals ........................................................................................................................
STATE/LOCAL/TRIBAL GOVERNMENT (1%):
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Collection method
RPS ..................................................................................................................................
RPS/Signature Proxy .......................................................................................................
Paper Version ..................................................................................................................
Totals ........................................................................................................................
Grand Total: ......................................................................................................
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Federal Register / Vol. 73, No. 239 / Thursday, December 11, 2008 / Notices
3. Report on Individual With Mental
Impairment—20 CFR 404.1513 &
416.913—0960–0058
SSA uses Form SSA–824 to obtain
medical evidence from medical sources
who have treated the claimant for a
mental impairment. SSA uses the
information collected on this form to
establish whether a claimant filing for
disability benefits has a mental
impairment that meets the statutory
Number of
respondents
Type of respondents
Frequency
of response
Average
burden per
response
Total annual
burden
25,000
25,000
50,000
1
1
....................
36
36
....................
15,000
15,000
30,000
Private Sector ..................................................................................................................
State DDSs (State/Local Government) ...........................................................................
Totals ........................................................................................................................
4. SSI Notice of Interim Assistance
Reimbursement (IAR)—0960–0546
Within this Notice, the phrase ‘‘IAR
agency’’ refers to either a state or a local
agency that receives Interim Assistance
Reimbursement (IAR).
Section 1631(g) of the Social Security
Act authorizes SSA to reimburse an IAR
agency from an individual’s retroactive
Supplemental Security Income (SSI)
payment for assistance the IAR agency
gave the individual for meeting basic
needs while an SSI claim was pending
or SSI payments were suspended or
terminated. The state or local agency
must have an IAR agreement with SSA
to participate in the IAR program.
The individual receiving the IAR
payment must sign an authorization
form with an IAR agency to allow SSA
to repay the IAR agency for funds paid
in advance prior to SSA’s determination
on the individual’s claim. The
authorization represents the
individual’s intent to file for SSI if he/
she has not filed an application prior to
SSA receiving the authorization.
Agencies who wish to enter into an
IAR agreement with SSA must meet the
following requirements:
definition of disability in the Social
Security Act. The respondents are
mental impairment treatment facilities.
Type of Request: Extension of an
OMB-approved information collection.
(a) Reporting Requirements: Each IAR
agency agrees to: (1) Notify SSA of
receipt of an authorization for initial
claims or cases being appealed, and
submit a copy of that authorization
either through a manual or electronic
process; (2) inform SSA of the amount
of reimbursement; (3) submit a written
request for dispute resolution on a
determination; (4) notify SSA of interim
assistance paid (using the SSA–8125 or
the SSA–L8125–F6); (5) inform SSA of
any deceased claimants who participate
in the IAR program; and (6) review and
sign an agreement with SSA.
(b) Recordkeeping Requirements: The
IAR agencies agree to retain all notices,
agreement, authorizations, and
accounting forms for the period defined
in the IAR agreement for the purposes
of SSA verifying transactions covered
under the agreement.
(c) Third Party Disclosure
Requirements: Each participating IAR
agency must agree to send written
notices from the IAR agency to the
recipient regarding payment amounts
and appeal rights.
(d) Periodic Review of Agency
Accounting Process: The IAR agency
must make available for SSA review and
verification the IAR accounting records
of paid cases. SSA conducts reviews
either onsite or through the mail of the
authorization forms, notices to the
claimant and accounting forms. Upon
completion of the review, SSA provides
a written report of findings to the IAR
agency director.
SSA is currently in the process of
automating the IAR process. SSA
completed Phase 1 of the automated
process, called eIAR, in June 2008 by
creating a database that will allow realtime updates for IAR cases. Phase 2
(targeted for 2009) will eliminate the
paper Forms SSA–8125 and SSA–
L8125–F6. SSA will receive and send all
exchanges of information through
electronic mail (e-mail) and a secure
Internet site. The eIAR process will
store IAR agency accounting and SSA
payment data for use by SSA regional
office staff for auditing the IAR agency
records. The IAR agency will have
access to IAR information (past and
present) for their purposes. Respondents
are IAR agencies.
Type of Request: Revision of an OMBapproved information collection.
REPORTING REQUIREMENTS
Number of
respondents
Type of request
Frequency
of response
11
26
39
2
39
39
39
20
39
8,856
792
577
1
1282
1282
2564
2
1
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Notification of Receipt of Authorization (Electronic Process) ..................
Submission of copy of Authorization (Manual Process) ..........................
Notification to SSA of Amount of Reimbursement ..................................
Request for Determination—Dispute Resolution .....................................
Form SSA–8125 ......................................................................................
Form SSA–L8125–F6 ..............................................................................
eIAR Process ...........................................................................................
Notification to SSA of Deceased Claimant ..............................................
Review/Signing Agreements ....................................................................
Number of
responses
97,416
20,592
22,503
2
49,998
49,998
99,996
40
39
1Hours.
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Average
burden per
response
(minutes)
Estimated
annual burden hours
(hours)
1
3
30
15
10
10
8
15
112
1624
1030
11,252
1
8,333
8,333
13,333
10
468
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Federal Register / Vol. 73, No. 239 / Thursday, December 11, 2008 / Notices
RECORDKEEPING REQUIREMENTS
Number of
respondents
Frequency
of response
39
39
3,189
3,189
Maintenance of Authorization Forms .......................................................
Maintenance of Accounting Forms and Notices ......................................
Number of
responses
124,371
124,371
Average
burden per
response
(minutes)
Estimated
annual burden hours
3
3
6219
6219
Average
burden per
response
(minutes)
Estimated
annual burden hours
7
2621
Average
burden per
response
(hours)
Estimated
annual burden hours
3
16
4
36
192
24
Average
burden per
response
Estimated
annual burden hours
....................
59,695
THIRD PARTY DISCLOSURE REQUIREMENTS
Number of
respondents
Frequency
of response
39
576
Written Notice from IAR agency to Recipient Regarding Amount of
Payment ...............................................................................................
Number of
responses
22,464
PERIODIC REVIEW OF AGENCY ACCOUNTING PROCESS
Number of
respondents
Frequency
of response
12
12
6
1
1
1
Retrieve and Consolidate Authorization and Accounting Forms .............
Participate in Periodic Review .................................................................
Correct Administrative and Accounting Discrepancies ............................
Number of
responses
12
12
6
TOTAL ADMINISTRATIVE BURDEN
Number of
respondents
Frequency
of response
39
....................
Totals ................................................................................................
5. General Request for Social Security
Records—eFOIA—20 CFR 402.130—
0960–0716
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SSA uses the information collected on
this electronic request for Social
Security records to respond to the
public’s request for information under
the Freedom of Information Act (FOIA).
SSA also tracks the number and type of
requests, fees charged and payment
amounts, and whether SSA responds
within the required 20 days.
Respondents are members of the public
including individuals, institutions, or
agencies requesting information/
documents under FOIA.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 5,000.
Frequency of Response: 1.
Average Burden Per Response: 3
minutes.
Estimated Annual Burden: 250 hours.
Dated: December 5, 2008.
John Biles,
Reports Clearance Officer, Center for Reports
Clearance, Social Security Administration.
[FR Doc. E8–29332 Filed 12–10–08; 8:45 am]
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SOCIAL SECURITY ADMINISTRATION
Social Security Disability Program
Demonstration Project: Benefit Offset
Pilot Demonstration
Social Security Administration.
Notice.
AGENCY:
ACTION:
SUMMARY: We are announcing our plans
to terminate the Benefit Offset Pilot
Demonstration (BOPD) project, which
relates to the disability program under
title II of the Social Security Act (the
Act). In this demonstration, we are
testing modifications to current program
rules that apply to working title II
disability beneficiaries. We are also
modifying current rules for making
outcome payments to providers of
services under the Ticket to Work and
Self-Sufficiency program (Ticket to
Work program).
DATES: Effective Dates: Effective January
1, 2009, we are terminating the
alternative program rules for treatment
group participants of the BOPD who
have not completed their trial work
periods as of December 31, 2008. We are
continuing the alternative program rules
for treatment group participants of the
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Number of
responses
611,820
demonstration who have completed
their trial work periods as of December
31, 2008, until they complete their 72month reentitlement periods.
FOR FURTHER INFORMATION CONTACT:
Mark Green by e-mail at
mark.green@ssa.gov, by telephone at
(410) 965–9852, or by mail at Social
Security Administration, Office of
Program Development and Research, 3–
E–26 Operations Building, 6401
Security Boulevard, Baltimore, MD
21235.
SUPPLEMENTARY INFORMATION: We are
conducting this project under the
demonstration authority provided in
section 234 of the Act.
Treatment of Work Activity Under
Current Title II Disability Program
Rules
Section 222(c) of the Act and 20 CFR
404.1592 provide title II disability
beneficiaries with a 9-month trial work
period. During the trial work period, a
title II disability beneficiary may test his
ability to work and still be considered
disabled.
Sections 223(a)(1) and 202(d)(1),
(e)(1), and (f)(1) of the Act provide that
E:\FR\FM\11DEN1.SGM
11DEN1
]]>Agencies
[Federal Register Volume 73, Number 239 (Thursday, December 11, 2008)]
[Notices]
[Pages 75488-75492]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E8-29332]
=======================================================================
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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 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 a revision to an OMB-approved information
collection.
SSA is soliciting comments on the accuracy of the agency's burden
estimate; the need for the information; its practical utility; ways to
enhance its quality, utility, and clarity; and ways to minimize the
burden on respondents, including the use of automated collection
techniques or other forms of information technology. Mail, e-mail, or
fax your comments and recommendations on the information collection(s)
to the OMB Desk Officer and the SSA Reports Clearance Officer to the
addresses or fax numbers listed below.
(OMB),
Office of Management and Budget,
Attn: Desk Officer for SSA,
Fax: 202-395-6974.
E-mail address: OIRA_Submission@omb.eop.gov.
(SSA), Social Security Administration, DCBFM,
Attn: Reports Clearance Officer,
1332 Annex Building,
6401 Security Blvd.,
Baltimore, MD 21235,
Fax: 410-965-6400,
E-mail address: OPLM.RCO@ssa.gov,
I. The information collection below is pending at SSA. SSA will
submit it 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 instrument by calling the SSA Reports
Clearance Officer at 410-965-3758 or by writing to the email address
listed above.
1. Claimant's Recent Medical Treatment--20 CFR 404.1512 and
416.912--0960-0292 Form HA-4631 is a questionnaire used by SSA to
obtain updated medical evidence. Each claimant who requests a hearing
before an Administrative Law Judge (ALJ) has a right to such a hearing
once the Disability Determination Service (DDS), at the Reconsideration
level, has denied the claim. SSA requests the claimant complete and
return the HA-4631 if the claimant's file does not reflect a complete
medical history. Because the claimant's situation may change over time,
as the claimant proceeds through the appeals process, ALJs must obtain
the information on Form HA-4631 to update and complete the record and
to verify the accuracy of information previously provided. It is by
this process, ALJs can ascertain whether the claimant's situation has
changed. The ALJ and Hearing Office (HO) staff use the response to make
hearing arrangements for consultative examination(s) and the attendance
of an expert witness(es), if appropriate. At the hearing, the ALJ
offers any completed questionnaires as exhibits and may use them to
refresh the claimant's memory, and to inquire into the matters at
issue. The respondents are claimant's requesting hearings on
entitlement to benefits based on disability under Titles II and/or XVI
of the Social Security Act.
Type of Request: Extension of an OMB-Approved Information
Collection.
Number of Respondents: 350,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 58,333 hours.
[[Page 75489]]
2. Medicaid Use Report--20 CFR 416.268--0960-0267. SSA uses the
information required by this regulation to determine if an individual
is entitled to special Title XVI Supplemental Security Income (SSI)
payments and, consequently, to Medicaid benefits. The Respondents are
SSI recipients for whom SSA has stopped payments based on earnings.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 60,000.
Frequency of Response: 1.
Average Burden Per Response: 3 minutes.
Estimated Annual Burden: 3,000 hours.
3. Application for Parent's Insurance Benefits--20 CFR 404.370-
404.374, 20 CFR 404.601-404.603--0960-0012. The Social Security
Administration uses Form SSA-7 to collect information used to entitle
an individual to his or her parent's insurance benefits. The
respondents are claimants who wish to apply to receive their parent's
insurance benefits.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 315.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 79 hours.
4. Partnership Questionnaire--20 CFR 404.1080-1082--0960-0025. The
Social Security Administration uses the information reported on Form
SSA-7104 to establish several aspects of eligibility for Social
Security benefits, including the accuracy of reported partnership
earnings, the veracity of a retirement, and lag earnings. The
respondents are applicants for, and recipients of, Social Security Old
Age, Survivors, and Disability Insurance Benefits.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 12,350.
Frequency of Response: 1.
Average Burden Per Response: 30 minutes.
Estimated Annual Burden: 6,175 hours.
5. Request for Waiver of Overpayment Recovery or Change in
Repayment Notice--20 CFR 404.502--404.513, 404.515 and 20 CFR 416.550--
416.570, 416.572-0960-0037. The overpaid individual uses the SSA-632-BK
to request a waiver of recovery of an overpayment. The individual
explains why they feel they are without fault in causing the
overpayment and provides financial information, so SSA can determine
whether recovery would cause financial hardship. If the individual
agrees to repay the overpayment, they can use the SSA-632-BK to inform
SSA they want to repay at a monthly rate that would take more than
thirty-six months to recover the overpayment. The individual can also
use the SSA-632-BK to request a different rate of recovery. In those
cases, they must provide financial information to SSA for a
determination of how much the overpaid person can afford to repay each
month. Respondents are overpaid beneficiaries or claimants who are
requesting a waiver of recovery of the overpayment, or a lesser rate of
withholding.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Total
Reason for completing form Number of Frequency Average burden per response annual
respondents of response burden
----------------------------------------------------------------------------------------------------------------
Request Waiver............................ 400,000 1 2 hours...................... 800,000
Request Change............................ 100,000 1 45 minutes................... 75,000
Totals................................ 500,000 ........... ............................. 875,000
----------------------------------------------------------------------------------------------------------------
6. Statement of Funds You Provided to Another and Statement of
Funds You Received--20 CFR 404.1520(b), 404.1571-.1576, 404.1584-.1593
and 416.971-.976--0960-0059. Form SSA-821-BK is used by SSA field
offices to obtain work information from recipients while conducting
face-to-face interviews, telephone interviews and by mail, during the
initial claims process, during the continuing disability review process
and whenever work issues arise in SSI claims. SSA's Processing Centers
and the Office of Disability and International Operations use the form
to obtain post-adjudicative work issues from recipients by mail. The
primary purpose of this form is to collect recipient employment
information in order to determine whether or not recipients have worked
in employment after becoming disabled and, if so, whether the work is
SGA. SSA will review and evaluate the data to determine if the
recipient continues to meet the disability requirement of the law. The
respondents are Social Security Disability Applicants, Beneficiaries,
and Supplemental Security Income Applicants.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 300,000.
Frequency of Response: 1.
Average Burden Per Response: 45 minutes.
Estimated Annual Burden: 225,000 hours.
7. Application for Supplemental Security Income --20 CFR 416.305-
416.335, Subpart C--0960-0444. Form SSA-8001-BK collects information
SSA uses to determine an applicant's eligibility for SSI, and the
amount of SSI benefits. SSA employees secure this information during
interviews conducted with members of the public who wish to file for
SSI benefits. This form is used for two purposes: (1) To formally deny
Supplemental Security Income benefits for non-medical reasons when
information provided by the applicant results in ineligibility; OR (2)
to establish a disability claim, but defer the complete development of
non-medical issues until the disability is approved. The respondents
are recipients for Supplemental Security Income benefits.
Type of Request: Extension of an OMB-approved information
collection.
------------------------------------------------------------------------
No. of
Number of minutes to Burden
Form type respondents complete hours
form
------------------------------------------------------------------------
MSSIC............................ 711,135 15 177,784
MSSIC/Signature Proxy............ 237,045 14 55,311
Paper............................ 19,351 18 5,805
Totals:...................... 967,531 ........... 238,900
------------------------------------------------------------------------
[[Page 75490]]
II. SSA has submitted the information collections listed below 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 410-965-3758,
or by writing to the above listed address.
1. Accelerated Benefits Demonstration Project--0960-0747
Background
In early 2007, SSA obtained OMB approval for the Accelerated
Benefits Demonstration Project, a multi-phase study designed to assess
whether providing new SSDI recipients with certain benefits would
stabilize or improve their health and help them return to work early.
In this long-term study, we assigned new SSDI recipients (i.e., those
who had just begun receiving disability benefits and who had at least
18 months remaining before they qualified for Medicare) to three
groups. The three groups consisted of: (1) A control group who would
just receive regular SSDI benefits; (2) a treatment group who would
receive immediate access to health care benefits; and (3) a treatment
group who would receive health care benefits and additional care
management, employment, and benefits services and support. The study,
which research contractors and health care experts are conducting for
SSA, assess if the health care and other benefits help beneficiaries
improve and return to work earlier, and asses if there is a difference
between the treatment groups.
Update/Current ICR
Having (1) Assigned eligible beneficiaries into one of the three
participant groups described above and (2) conducted a baseline and
six-month follow-up surveys with these beneficiaries, SSA is now ready
to move on to the next phase of the study: A 12-month follow-up survey.
This ICR is for the 12-month follow-up survey, which we plan to conduct
beginning in March 2009. We will use telephone interviews for the
survey, with in-person follow-up for non-responders as necessary. We
will attempt to contact all 2,000 participants and expect to complete
follow-up interviews with 1,600 of them (80 percent). The purpose of
the survey is to explore participants' experiences after one year in
the program, which will provide initial data on the effects of the
health care and ``heath care plus'' treatments. The respondents are
SSDI beneficiaries participating in this study.
Burden Data for 12-Month Follow-Up Survey
Type of Request: Revision to an existing OMB-approved information
collection.
Number of Respondents: 1,600.
Frequency of Response: 1.
Average Burden per Response: 45 minutes.
Estimated Annual Burden: 1,200 hours.
2. 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, and XVI.
Type of Request: Revision of an OMB-approved information
collection.*11/60.
Number of Respondents: 1,500,000.
Estimated Annual Burden: 248,335 hours.
Individuals/Households (90%):
----------------------------------------------------------------------------------------------------------------
Average Total
Collection method Number of Frequency burden per annual
respondents of response response burden
----------------------------------------------------------------------------------------------------------------
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%):
----------------------------------------------------------------------------------------------------------------
Average Total
Collection method Number of Frequency burden per annual
respondents of response response burden
----------------------------------------------------------------------------------------------------------------
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%):
----------------------------------------------------------------------------------------------------------------
Average Total
Collection method Number of Frequency burden per annual
respondents of response response burden
----------------------------------------------------------------------------------------------------------------
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
----------------------------------------------------------------------------------------------------------------
[[Page 75491]]
3. Report on Individual With Mental Impairment--20 CFR 404.1513 &
416.913--0960-0058
SSA uses Form SSA-824 to obtain medical evidence from medical
sources who have treated the claimant for a mental impairment. SSA uses
the information collected on this form to establish whether a claimant
filing for disability benefits has a mental impairment that meets the
statutory definition of disability in the Social Security Act. The
respondents are mental impairment treatment facilities.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average Total
Type of respondents Number of Frequency burden per annual
respondents of response response burden
----------------------------------------------------------------------------------------------------------------
Private Sector.............................................. 25,000 1 36 15,000
State DDSs (State/Local Government)......................... 25,000 1 36 15,000
Totals.................................................. 50,000 ........... ........... 30,000
----------------------------------------------------------------------------------------------------------------
4. SSI Notice of Interim Assistance Reimbursement (IAR)--0960-0546
Within this Notice, the phrase ``IAR agency'' refers to either a
state or a local agency that receives Interim Assistance Reimbursement
(IAR).
Section 1631(g) of the Social Security Act authorizes SSA to
reimburse an IAR agency from an individual's retroactive Supplemental
Security Income (SSI) payment for assistance the IAR agency gave the
individual for meeting basic needs while an SSI claim was pending or
SSI payments were suspended or terminated. The state or local agency
must have an IAR agreement with SSA to participate in the IAR program.
The individual receiving the IAR payment must sign an authorization
form with an IAR agency to allow SSA to repay the IAR agency for funds
paid in advance prior to SSA's determination on the individual's claim.
The authorization represents the individual's intent to file for SSI if
he/she has not filed an application prior to SSA receiving the
authorization.
Agencies who wish to enter into an IAR agreement with SSA must meet
the following requirements:
(a) Reporting Requirements: Each IAR agency agrees to: (1) Notify
SSA of receipt of an authorization for initial claims or cases being
appealed, and submit a copy of that authorization either through a
manual or electronic process; (2) inform SSA of the amount of
reimbursement; (3) submit a written request for dispute resolution on a
determination; (4) notify SSA of interim assistance paid (using the
SSA-8125 or the SSA-L8125-F6); (5) inform SSA of any deceased claimants
who participate in the IAR program; and (6) review and sign an
agreement with SSA.
(b) Recordkeeping Requirements: The IAR agencies agree to retain
all notices, agreement, authorizations, and accounting forms for the
period defined in the IAR agreement for the purposes of SSA verifying
transactions covered under the agreement.
(c) Third Party Disclosure Requirements: Each participating IAR
agency must agree to send written notices from the IAR agency to the
recipient regarding payment amounts and appeal rights.
(d) Periodic Review of Agency Accounting Process: The IAR agency
must make available for SSA review and verification the IAR accounting
records of paid cases. SSA conducts reviews either onsite or through
the mail of the authorization forms, notices to the claimant and
accounting forms. Upon completion of the review, SSA provides a written
report of findings to the IAR agency director.
SSA is currently in the process of automating the IAR process. SSA
completed Phase 1 of the automated process, called eIAR, in June 2008
by creating a database that will allow real-time updates for IAR cases.
Phase 2 (targeted for 2009) will eliminate the paper Forms SSA-8125 and
SSA-L8125-F6. SSA will receive and send all exchanges of information
through electronic mail (e-mail) and a secure Internet site. The eIAR
process will store IAR agency accounting and SSA payment data for use
by SSA regional office staff for auditing the IAR agency records. The
IAR agency will have access to IAR information (past and present) for
their purposes. Respondents are IAR agencies.
Type of Request: Revision of an OMB-approved information
collection.
Reporting Requirements
----------------------------------------------------------------------------------------------------------------
Estimated
Average annual
Type of request Number of Frequency Number of burden per burden
respondents of response responses response hours
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
Notification of Receipt of Authorization 11 8,856 97,416 1 1624
(Electronic Process)..........................
Submission of copy of Authorization (Manual 26 792 20,592 3 1030
Process)......................................
Notification to SSA of Amount of Reimbursement. 39 577 22,503 30 11,252
Request for Determination--Dispute Resolution.. 2 1 2 15 1
Form SSA-8125.................................. 39 1282 49,998 10 8,333
Form SSA-L8125-F6.............................. 39 1282 49,998 10 8,333
eIAR Process................................... 39 2564 99,996 8 13,333
Notification to SSA of Deceased Claimant....... 20 2 40 15 10
Review/Signing Agreements...................... 39 1 39 \1\12 468
----------------------------------------------------------------------------------------------------------------
\1\Hours.
[[Page 75492]]
Recordkeeping Requirements
----------------------------------------------------------------------------------------------------------------
Average Estimated
Number of Frequency Number of burden per annual
respondents of response responses response burden
(minutes) hours
----------------------------------------------------------------------------------------------------------------
Maintenance of Authorization Forms............. 39 3,189 124,371 3 6219
Maintenance of Accounting Forms and Notices.... 39 3,189 124,371 3 6219
----------------------------------------------------------------------------------------------------------------
Third Party Disclosure Requirements
----------------------------------------------------------------------------------------------------------------
Average Estimated
Number of Frequency Number of burden per annual
respondents of response responses response burden
(minutes) hours
----------------------------------------------------------------------------------------------------------------
Written Notice from IAR agency to Recipient 39 576 22,464 7 2621
Regarding Amount of Payment...................
----------------------------------------------------------------------------------------------------------------
Periodic Review of Agency Accounting Process
----------------------------------------------------------------------------------------------------------------
Average Estimated
Number of Frequency Number of burden per annual
respondents of response responses response burden
(hours) hours
----------------------------------------------------------------------------------------------------------------
Retrieve and Consolidate Authorization and 12 1 12 3 36
Accounting Forms..............................
Participate in Periodic Review................. 12 1 12 16 192
Correct Administrative and Accounting 6 1 6 4 24
Discrepancies.................................
----------------------------------------------------------------------------------------------------------------
Total Administrative Burden
----------------------------------------------------------------------------------------------------------------
Estimated
Number of Frequency Number of Average annual
respondents of response responses burden per burden
response hours
----------------------------------------------------------------------------------------------------------------
Totals..................................... 39 ........... 611,820 ........... 59,695
----------------------------------------------------------------------------------------------------------------
5. General Request for Social Security Records--eFOIA--20 CFR 402.130--
0960-0716
SSA uses the information collected on this electronic request for
Social Security records to respond to the public's request for
information under the Freedom of Information Act (FOIA). SSA also
tracks the number and type of requests, fees charged and payment
amounts, and whether SSA responds within the required 20 days.
Respondents are members of the public including individuals,
institutions, or agencies requesting information/documents under FOIA.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 5,000.
Frequency of Response: 1.
Average Burden Per Response: 3 minutes.
Estimated Annual Burden: 250 hours.
Dated: December 5, 2008.
John Biles,
Reports Clearance Officer, Center for Reports Clearance, Social
Security Administration.
[FR Doc. E8-29332 Filed 12-10-08; 8:45 am]
BILLING CODE 4191-02-P
