Agency Information Collection Activities: Proposed Request and Comment Request, 75488-75492 [E8-29332]

Download as PDF 75488 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 mstockstill on PROD1PC66 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 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 VerDate Aug<31>2005 17:27 Dec 10, 2008 Jkt 217001 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 PO 00000 Frm 00105 Fmt 4703 Sfmt 4703 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. E:\FR\FM\11DEN1.SGM 11DEN1 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 mstockstill on PROD1PC66 with NOTICES No. of minutes to complete form 711,135 237,045 19,351 967,531 15 14 18 .................... MSSIC ...................................................................................................................................................... MSSIC/Signature Proxy ........................................................................................................................... Paper ....................................................................................................................................................... Totals: ............................................................................................................................................... 17:27 Dec 10, 2008 Jkt 217001 PO 00000 Frm 00106 Fmt 4703 Sfmt 4703 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 VerDate Aug<31>2005 75489 E:\FR\FM\11DEN1.SGM 11DEN1 Burden hours 177,784 55,311 5,805 238,900 75490 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%): mstockstill on PROD1PC66 with NOTICES Collection method RPS .................................................................................................................................. RPS/Signature Proxy ....................................................................................................... Paper Version .................................................................................................................. Totals ........................................................................................................................ Grand Total: ...................................................................................................... VerDate Aug<31>2005 17:27 Dec 10, 2008 Jkt 217001 PO 00000 Frm 00107 Fmt 4703 Sfmt 4703 E:\FR\FM\11DEN1.SGM 11DEN1 75491 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 mstockstill on PROD1PC66 with NOTICES 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. VerDate Aug<31>2005 17:27 Dec 10, 2008 Jkt 217001 PO 00000 Frm 00108 Fmt 4703 Sfmt 4703 E:\FR\FM\11DEN1.SGM 11DEN1 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 75492 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 mstockstill on PROD1PC66 with NOTICES 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] BILLING CODE 4191–02–P VerDate Aug<31>2005 17:27 Dec 10, 2008 Jkt 217001 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 PO 00000 Frm 00109 Fmt 4703 Sfmt 4703 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