Agency Information Collection Activities: Proposed Request and Comment Request, 7506-7511 [E9-3171]
Download as PDF
<![CDATA[
7506
Federal Register / Vol. 74, No. 30 / Tuesday, February 17, 2009 / Notices
forms is used to receive essential
information from the small business
applicant and the participating lender to
determine eligibility and to properly
evaluate and consider the merits of each
loan request based on each criteria as
character, capacity, credit, collateral,
etc. for the purpose of extending credit
under the 7(a) program.
Title: ‘‘Applications for Business
Loans’’.
Description of Respondents:
Applicants applying for a SBA Loan.
Form Numbers: 4, 4SCH–A, 4I, 4L.
Annual Responses: 21,000.
Annual Burden: 295,505.
ADDRESSES: Send all comments
regarding whether this information
collection is necessary for the proper
performance of the function of the
agency, whether the burden estimates
are accurate, and if there are ways to
minimize the estimated burden and
enhance the quality of the collection, to
Barbara Brannan, Special Assistant,
Office of Surety Bond Guarantee, Small
Business Administration, 409 3rd Street,
8th Floor, Washington, DC 20416.
FOR FURTHER INFORMATION CONTACT:
Barbara Brannan, Special Assistant,
Office of Surety Bond Guarantee
Program, 202–205–6545,
barbara.brannan@sba.gov; Curtis B.
Rich, Management Analyst, 202–205–
7030, curtis.rich@sba.gov.
SUPPLEMENTARY INFORMATION: SBA’s
Surety Bond Guarantee (SBG) Program
was created to encourage surety
companies to provide bonding for small
contractors. The information collected
on these forms is used to evaluate the
capability and potential success of small
contractors in the SBG Program.
Title: ‘‘Surety Bond Guarantee
Assistance’’.
Description of Respondents: Small
Business Contractors Applying for the
Surety Bond.
Form Numbers: 990, 991, 994, 994B,
994F, 994H.
Annual Responses: 17,916.
Annual Burden: 1,959.
SUMMARY: Under the provisions of the
Paperwork Reduction Act (44 U.S.C.
Chapter 35), agencies are required to
submit proposed reporting and
recordkeeping requirements to OMB for
review and approval, and to publish a
notice in the Federal Register notifying
the public that the agency has made
such a submission.
DATES: Submit comments on or before
March 19, 2009. If you intend to
comment but cannot prepare comments
promptly, please advise the OMB
Reviewer and the Agency Clearance
Officer before the deadline.
Copies: Request for clearance (OMB
83–1), supporting statement, and other
documents submitted to OMB for
review may be obtained from the
Agency Clearance Officer.
ADDRESSES: Address all comments
concerning this notice to: Agency
Clearance Officer, Jacqueline White,
Small Business Administration, 409 3rd
Street, SW., 5th Floor, Washington, DC
20416; and OMB Reviewer, Office of
Information and Regulatory Affairs,
Office of Management and Budget, New
Executive Office Building, Washington,
DC 20503.
FOR FURTHER INFORMATION CONTACT:
Jacqueline White, Agency Clearance
Officer, (202) 205–7044.
SUPPLEMENTARY INFORMATION:
Title: Data Collection for SBIR/STTR
Public and Government.
SBA Form Number: N/A.
Frequency: On occasion.
Description of Respondents: All firms
of individuals applying for a Phase I or
Phase II award from the SBIR or STTR
programs.
Responses: 37,000.
Annual Burden: 20,000.
Title: Entrepreneurial Development
Impact Study.
SBA Form Number: 2214.
Frequency: On occasion.
Description of Respondents: SBA
clients.
Responses: 7,378.
Annual Burden: 1,230.
Jacqueline White,
Chief, Administrative Information Branch.
[FR Doc. E9–3182 Filed 2–13–09; 8:45 am]
Curtis B. Rich,
Acting Chief, Administrative Information
Branch.
[FR Doc. E9–3183 Filed 2–13–09; 8:45 am]
BILLING CODE 8025–01–P
BILLING CODE 8025–01–P
sroberts on PROD1PC70 with NOTICES
SMALL BUSINESS ADMINISTRATION
Reporting and Recordkeeping
Requirements Under OMB Review
Small Business Administration.
Notice of Reporting
Requirements Submitted for OMB
Review.
AGENCY:
ACTION:
VerDate Nov<24>2008
19:45 Feb 13, 2009
Jkt 217001
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
PO 00000
Frm 00117
Fmt 4703
Sfmt 4703
by the Office of Management and
Budget (OMB) in compliance with
Public Law (Pub. L.) 104–13, the
Paperwork Reduction Act of 1995,
effective October 1, 1995. This notice
includes revisions and extensions of
OMB-approved Information Collections
and a new 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, email, or
fax your comments and
recommendations on the information
collection(s) to the OMB Desk Officer
and the SSA Reports Clearance Officer
to the addresses or fax numbers listed
below.
(OMB), Office of Management and
Budget, Attn: Desk Officer for
SSA,Fax: 202–395–6974,E-mail
address:
OIRA_Submission@omb.eop.gov.
(SSA), Social Security Administration,
DCBFM,Attn: Reports Clearance
Officer,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. Application for Search of Census
Records for Proof of Age—20 CFR
404.716–0960—0097. SSA uses the
information collected by the SSA–1535–
U3 to provide the Census Bureau with
sufficient identification information for
an accurate search of census records for
proof of age of an individual applying
for Social Security benefits. When
preferred evidence of age is not
available and the available evidence is
not convincing, SSA may request the
U.S. Department of Commerce, Bureau
of the Census, to search its records in
order to establish a claimant’s date of
birth. The Census Bureau uses the
information from a completed, signed
SSA–1535–U3 to bill SSA for the
search. The respondents are applicants
for Social Security benefits who need to
establish their date of birth as a factor
of entitlement.
E:\FR\FM\17FEN1.SGM
17FEN1
7507
Federal Register / Vol. 74, No. 30 / Tuesday, February 17, 2009 / Notices
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 18,030.
Frequency of Response: 1.
Average Burden Per Response: 12
minutes.
Estimated Annual Burden: 3,606
hours.
2. Youth Transition Process
Demonstration Evaluation Data
Collection—0960–0687.
Background
The purpose of the Youth Transition
Demonstration (YTD) project is to help
young people with disabilities make the
transition from school to work. While
participating in the project, youth can
continue to work and/or continue their
education because SSA waives certain
disability program rules and offers
services to youth who are receiving
disability benefits or have a high
probability of receiving them. We are
currently implementing YTD projects in
eight sites across the country. The
evaluation will produce empirical
evidence on the effects of the waivers
and project services including
educational attainment, employment,
earnings, and receipt of benefits by
youth with disabilities, but also on the
Social Security Trust Fund and federal
income tax revenues. This project is
authorized by Sections 1110 and 234 of
the Social Security Act.
Project Description
Given the importance of estimating
YTD effects as accurately as possible,
we will evaluate the project using
Collection
2009 .............................................
Average burden
per response
(hours)
Total response
burden
(hours)
1,895
1,895
1,518
120
150
80
364
1
1
1
1
1
1
1
0.55
0.083
0.83
0.42
1.5
1
0.83
1,042
157
1,260
50
225
80
302
..........................
..........................
............................
3,116
Baseline .......................................
Informed Consent ........................
12 Month Follow-up ....................
In-depth Interviews ......................
Focus Group ...............................
Program Staff/Service Provider ...
36 Month Follow-up ....................
Total 2009 .............................
sroberts on PROD1PC70 with NOTICES
Responses per
respondent
Number of respondents
Data collection year
......................................................
3. Workers’ Compensation/Public
Disability Questionnaire—20 CFR
404.408—0960–0247. Section 224 of the
Social Security Act provides for the
reduction of disability insurance
benefits (DIB) when the combination of
DIB and any workers’ compensation
(WC) and/or certain federal, state or
local public disability benefits (PDB)
exceeds 80% of the worker’s predisability earnings. SSA uses Form
SSA–546 to collect the data necessary to
determine if the worker’s receipt of WC/
PDB payments will cause a reduction of
DIB. The respondents are applicants for
the Title II DIB.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 100,000.
Frequency of Response: 1.
Average Burden per Response: 15
minutes.
Estimated Annual Burden: 25,000
hours.
4. Statement of Funds You Provided
to Another and Statement of Funds You
Received—20 CFR 416.1103(f)—0960–
0481. Forms SSA–2854 and SSA–2855
collect information on an SSI
beneficiary’s allegations that he or she
borrowed funds informally from noncommercial lender, e.g. a relative or
friend. The borrower/beneficiary and
VerDate Nov<24>2008
19:45 Feb 13, 2009
Jkt 217001
the lender of the funds complete these
statements. Forms SSA–2854 and SSA–
2855 are required to determine whether
the proceeds from the transaction are
income to the borrower. If the
transaction constitutes a bona fide loan,
then the proceeds are not income to the
borrower. Form SSA–2855 (Statement of
Funds You Received) requests
information from the SSI applicant/
recipient by personal interview. Form
SSA–2854 (Statement of Funds You
Provided to Another) requests
information by mail from the other party
to the transaction. The respondents are
SSI recipients who informally borrow
money and those persons who lend the
funds.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 40,000.
Frequency of Response: 1.
Average Burden per Response: 10
minutes.
Estimated Annual Burden: 6,667
hours.
5. The Mental Health Treatment
Study (MHTS)—0960–0726.
Background
Because of advances in medical
treatment, assistive devices, changes in
the way we view those with disabilities,
and legislation designed to assure access
PO 00000
Frm 00118
Fmt 4703
rigorous analytic methods based on
randomly assigning youth to a treatment
or control group. We will conduct
several data collections. These include
(1) baseline interviews with youth and
their parents or guardians prior to
random assignment; (2) follow-up
interviews at 12 and 36 months after
random assignment; (3) interviews and/
or roundtable discussions with local
program administrators, program
supervisors, and service delivery staff;
and (4) focus groups of youths, their
parents, and service providers. The
respondents are youths with disabilities
enrolled in the project; their parents or
guardians; program staff; and service
providers.
Type of Request: Revision of an
existing OMB Clearance.
Sfmt 4703
to employment, SSA is taking on an
increasingly active role in assisting
Social Security disability beneficiaries
who want to return to work. As a result,
SSA developed the MHTS under
Section 234 of the Social Security Act
(42 U.S.C. 434), which gives the
Commissioner of Social Security the
authority to carry out experiments and
demonstration projects designed to
determine the relative advantages and
disadvantages of interventions that
facilitate a beneficiary’s return to work.
Part of the agency’s role involves
finding ways to promote work and
increase independence among disability
beneficiaries.
SSA received additional support for
this study in February 2001, through
President Bush’s New Freedom
Initiative—a comprehensive program
whose primary goal is to promote the
full participation of individuals with
disabilities in all areas of society. The
aim of the Initiative is to help
Americans with disabilities by
increasing their access to effective
technologies, expanding educational
opportunities, increasing the ability of
Americans with disabilities to integrate
into the workforce, and promoting
increased access into daily community
life. This initiative provided SSA with
E:\FR\FM\17FEN1.SGM
17FEN1
7508
Federal Register / Vol. 74, No. 30 / Tuesday, February 17, 2009 / Notices
the support that will enable
beneficiaries to maximize their selfsufficiency and potentially enter or
reenter the workforce.
MHTS Collection
The MHTS implemented a
randomized trial study designed to
evaluate the effect of the intervention on
employment and functional outcomes
for SSDI beneficiaries with a primary
mental impairment of schizophrenia or
affective disorder. SSA is currently
implementing the MHTS in 22
demonstration sites across the United
States, with one site having two
locations. The study participants are
SSDI beneficiaries with varying clinical
and demographic characteristics,
mechanisms and adherence to treatment
guidelines, with subsequent training to
improve deficiencies as identified.
The comprehensive assessment of the
MHTS outcomes will identify which, if
any, of the interventions resulted in
successful employment and functioning
outcomes, and identify the
characteristics of the interventions that
contributed to the success. This
information enables SSA to develop
better ways to improve services to
current and future recipients. SSA also
uses this information to guide any
potential changes to program rules to
allow for better coordination among
other federal and state programs.
Type of Request: Extension of an
OMB-approved information collection.
employment histories, and, sometimes,
additional medical impairments. The
study design has two arms: treatment
(special services), and control (regular
services) groups. SSA randomly
assigned study participants to the
treatment or control group. Each
treatment or control recipient will
participate for a total of 24 months
following enrollment. The treatment
intervention activities include the
following: diagnostic psychiatric
assessment, comprehensive medical
assessment, systematic medication
management, supporting employment,
individualized clinical treatment,
supplemental health insurance,
coordination and payment of recipients’
claims, as well as quality assurance
SCREENER ESTIMATED BURDEN
Questionnaire
Frequency of
response
Number of respondents
Burden per responses
(minutes)
Total burden
hours
Screener Survey ......................................................................................
1
2,265
4
151
Hours per response
(minutes)
Total burden
hours
ESTIMATED BURDEN FOR TREATMENT GROUP
Frequency of
response
Questionnaire
Total number of
respondents1
Baseline ...................................................................................................
Quarterly ..................................................................................................
Follow-up .................................................................................................
1
7
1
1,121
1,121
1,121
47
18
30
878
2,354
561
Total ..................................................................................................
..........................
..........................
..........................
3,793
1 The
number of respondents may reduce over time due to study withdrawals.
ESTIMATED BURDEN FOR CONTROL GROUP
Frequency of
response
Questionnaire
Total number of
respondents
Hours per response
(minutes)
Total burden
hours
Baseline ...................................................................................................
Quarterly ..................................................................................................
Follow-up .................................................................................................
1
7
1
1,117
1,117
1,117
47 minutes
7 minutes
30 minutes
875
912
559
Total ..................................................................................................
..........................
..........................
..........................
2,346
TOTAL ESTIMATED BURDEN FOR ALL STUDY ACTIVITIES
Frequency of
response
Questionnaire
Total number of
respondents
Total burden
hours
1
9
9
2,265
1,121
1,117
151
3,792
2,345
Total ................................................................................................................................
sroberts on PROD1PC70 with NOTICES
Screener Survey ....................................................................................................................
Treatment Group ...................................................................................................................
Control Group ........................................................................................................................
..........................
4,503
6,288
6. Application for SSA Employee
Testimony—20 CFR 403.100–155—
0960–0619. SSA regulations at 20 CFR
403.100–155 establish policies and
procedures whereby an individual,
VerDate Nov<24>2008
19:45 Feb 13, 2009
Jkt 217001
organization, or governmental entity
may request official agency information,
records, or testimony of an agency
employee in a legal proceeding where
the agency is not a party. The request,
PO 00000
Frm 00119
Fmt 4703
Sfmt 4703
which must be in writing to the
Commissioner, must fully set out the
nature and relevance of the sought
testimony. Respondents are individuals
E:\FR\FM\17FEN1.SGM
17FEN1
7509
Federal Register / Vol. 74, No. 30 / Tuesday, February 17, 2009 / Notices
or entities who request testimony from
SSA employees in a legal proceeding.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 100.
Frequency of Response: 1.
Average Burden Per Response: 60
minutes.
Estimated Annual Burden: 100 hours.
7. Self-Employment/Corporate Officer
Questionnaire—20 CFR 404.435(e),
404.446—0960–0487. SSA uses Form
SSA–4184 to develop earnings and
corroborate the claimant’s allegations of
retirement when the claimant is selfemployed or a corporate officer. SSA
uses the information to determine an
individual’s Old Age, Survivors, and
Disability Insurance (OASDI) benefit
amount. The respondents are selfemployed individuals or corporate
officers who apply for OASDI benefits.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden Per Response: 20
minutes.
Estimated Annual Burden: 16,667
hours.
8. Claimant’s Medication—20 CFR
404.1512, 416.912—0960–0289. In cases
where a claimant is requesting a hearing
after denial of his or her claim for Social
Security benefits, SSA uses Form HA–
4632 to request information from the
claimant regarding the medications they
are using. This information helps the
Administrative Law Judge (ALJ) hearing
the case to inquire fully into the medical
treatment the claimant is receiving and
the effect of medications on the
claimant’s medical impairments and
functional capacity. Respondents are
applicants for OASDI benefits and/or
Supplemental Security Income (SSI)
payments.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 200,000.
Frequency of Response: 1.
Average Burden Per Response: 15
minutes.
Estimated Annual Burden: 50,000
hours.
9. Request for Withdrawal of
Application—20 CFR 404.640—0960–
0015. Individuals complete Form SSA–
521 to request withdrawal of an
application for benefits. Individuals
who wish to withdraw their
applications for benefits complete this
form. SSA uses the information from
Form SSA–521 to process the request
for withdrawal. The respondents are
applicants for OASDI benefits.
Number of respondents
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 100,000.
Frequency of Response: 1.
Average Burden Per Response: 5
minutes.
Estimated Annual Burden: 8,333
hours.
10. Authorization for the Social
Security Administration to Obtain
Account Records from a Financial
Institution and Request for Records
(Medicare Low-Income Subsidy)—
0960–0729. Under the aegis of the
Medicare Modernization Act of 2003,
Medicare beneficiaries can apply for a
subsidy for the Medicare Prescription
Drug Plan (Part D) program. In some
cases, SSA will need to verify the
details of applicants’ accounts at
financial institutions to determine if
they are eligible for the subsidy. Form
SSA–4640 will give SSA the authority
to contact financial institutions about
applicants’ accounts. Financial
institutions will also use the form to
verify the information requested by
SSA. The respondents are applicants for
the Medicare Part D program subsidy
and financial institutions where
applicants have accounts.
Type of Request: Extension of an
OMB-approved information collection.
Average burden
per response
(minutes)
Frequency of
response
Estimated annual burden
(hours)
5,000
5,000
1
1
1
5
84
333
Totals ................................................................................................
sroberts on PROD1PC70 with NOTICES
Medicare Part D Subsidy Applicants .......................................................
Financial Institutions ................................................................................
10,000
..........................
..........................
417
11. Request to Pay Civil Monetary
Penalty by Installment Agreement—20
CFR 498—0960–NEW. SSA uses Form
SSA–640 to obtain the information
necessary to determine a repayment rate
for individuals who have a civil
monetary penalty imposed on them for
various fraudulent conduct related to
SSA-administered programs. SSA needs
this financial information to ensure the
repayment rate is in the best interest of
both the individual and the agency. The
respondents are recipients of Social
Security benefits and non-entitled
individuals who must pay a civil
monetary penalty.
Type of Request: New information
collection.
Number of Respondents: 400.
Frequency of Response: 1.
Average Burden Per Response: 120
minutes.
Estimated Annual Burden: 800 hours.
II. SSA has submitted the information
collections listed below to OMB for
VerDate Nov<24>2008
19:45 Feb 13, 2009
Jkt 217001
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. Report of New Information in
Disability Cases—20 CFR 404.1588—
0960–0071. SSA uses the information it
collects on Form SSA–612 to ensure
federal Old Age, Survivors, and
Disability Insurance (OASDI) payments
are correct. It is essential beneficiaries
notify SSA of any information that may
affect their continuing entitlement to
disability benefits. To facilitate and
encourage timely reporting of such
events, SSA furnishes beneficiaries a
Form SSA–612. The beneficiary
completes and returns the form to SSA
when there is a change in his/her
circumstances. When a beneficiary
PO 00000
Frm 00120
Fmt 4703
Sfmt 4703
reports a change, SSA investigates any
reported work activity or improvement
in the beneficiary’s condition, updates
its records, and makes necessary
payment changes. The respondents are
recipients of federal OASDI benefits.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 27,000.
Frequency of Response: 1.
Average Burden Per Response: 5
minutes.
Estimated Annual Burden: 2,250
hours.
Note: This is a correction notice: SSA
inadvertently published the incorrect burden
information for this collection on December
02, 2008. We are correcting this error here.
Previously, SSA published this collection as
an extension; however, as we are revising the
Privacy Act Statement, this is now a revision.
2. Statement of Marital Relationship
(By one of the parties)—20 CFR
404.726—0960–0038. Where no formal
marriage documentation exists, SSA
E:\FR\FM\17FEN1.SGM
17FEN1
7510
Federal Register / Vol. 74, No. 30 / Tuesday, February 17, 2009 / Notices
uses the information it collects on Form
SSA–754–F4 to determine whether an
individual applying for spousal benefits
meets the criteria of common-law
marriage under state law. The
respondents are applicants for spouse’s
Social Security benefits or SSI
payments. Note: SSA listed this
information collection as an extension
of an OMB-approved information
collection in the 60-Day Federal
Register Notice published on October
27, 2008; it is a revision of an OMBapproved information collection.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 30,000.
Frequency of Response: 1.
Average Burden Per Response: 30
minutes.
Estimated Annual Burden: 15,000
hours.
3. Application for Parent’s Insurance
Benefits—20 CFR 404.370–404.374, 20
CFR 404.601–404.603—0960–0012. SSA
uses Form SSA–7 to collect information
used to entitle an individual to his or
her parent’s OASDI benefits. The
respondents are claimants who wish to
apply to receive their parent’s OASDI
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. 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. An individual
may request waiver of recovery of an
overpayment or a different repayment
Number of respondents
Type of request
rate of OASDI benefits and SSI
payments. To make this request, the
overpaid individual uses the SSA–632–
BK. The individual explains why he/she
is 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, he/she can use
the SSA–632–BK to request a monthly
rate or to request a different rate of
recovery. In those cases, the individual
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.
Frequency of
response
Average burden
per response
Total annual
burden
Waiver of Overpayment (Completes Whole Form) ................................
Change in Repayment (Completes Partial Form) ..................................
Internet Instructions ................................................................................
400,000
100,000
500,000
1
1
1
2 hours .............
45 minutes ........
5 minutes ..........
800,000
75,000
41,667
Totals ...............................................................................................
1,000,000
..........................
...........................
916,667
5. You Can Make Your Payment by
Credit Card—0960–0462. SSA uses the
information on Forms SSA–4588 and
SSA–4589 to update an individual’s
Social Security record to reflect
payments made on their overpayment
and to effect payment through the
appropriate credit card company. SSA is
modifying the Form SSA–4588 to
include a recurring credit card payment
option to allow individuals to authorize
automatic monthly payments. SSA
sends out the SSA–4588 with initial
overpayment notices informing
individuals SSA has detected an
overpayment. Individuals may choose to
make a one-time payment or recurring
monthly payments by completing and
submitting the SSA–4588.
SSA uses the Form SSA—4589 only
when individuals choose to call the
program service centers to make
payments in lieu of completing the
Form SSA–4588. An SSA debtor contact
Number of respondents
Form #
representative completes Form SSA–
4589 when a debtor calls to make a
payment by telephone. The debtor
contact representative also uses the
information from Form SSA–4589 to
make recurring monthly payments via
telephone call with the debtor.
Respondents are OASDI beneficiaries
and SSI recipients who have
outstanding overpayments.
Type of Request: Revision of an OMBapproved information collection.
Average burden
per response
(minutes)
Frequency of
response
Total burden
hours
3,500
36,500
1
1
10
5
583
3,042
Totals ................................................................................................
sroberts on PROD1PC70 with NOTICES
SSA–4588 ................................................................................................
SSA–4589 ................................................................................................
40,000
..........................
..........................
3,625
6. Medical Source Statement of
Ability To Do Work Related Activities
(Physical and Mental)—20 CFR
404.1512–404.1514, 404.912–404.914,
404.1517, 416.917, 404.1519–404.1520,
416.919–416.920, 404.946, 416.946,
404–1546—0960–0662. SSA uses the
Forms HA–1151 and HA–1152 to collect
data SSA needs to determine the
residual functional capacity (RFC) of
individuals who are appealing denied
claims for benefits based on disability.
VerDate Nov<24>2008
19:45 Feb 13, 2009
Jkt 217001
SSA uses the RFC when the agency
cannot make a determination on a claim
for benefits based on current work
activity or on medical facts alone. The
respondents are medical sources paid by
SSA to provide reports either based on
existing medical evidence or on
consultative examinations conducted
for the purposes of the report. Note: SSA
listed this as an extension of an OMBapproved information collection in the
60-Day Federal Register Notice
PO 00000
Frm 00121
Fmt 4703
Sfmt 4703
published on October 27, 2008; it is a
revision of an OMB-approved
collection.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 10,000.
Frequency of Response: 20.
Average Burden Per Response: 15
minutes.
Estimated Annual Burden: 50,000
hours.
7. Statement of Funds You Provided
to Another and Statement of Funds You
E:\FR\FM\17FEN1.SGM
17FEN1
7511
Federal Register / Vol. 74, No. 30 / Tuesday, February 17, 2009 / Notices
Received—20 CFR 404.1520(b),
404.1571–.1576, 404.1584–.1593 and
416.971–.976 —0960–0059. SSA’s field
offices use Form SSA–821–BK to obtain
work information from recipients during
the continuing disability review
process, and whenever a work issue
arises in SSI claims. SSA’s processing
centers and 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 substantial gainful
activity. SSA will review and evaluate
the data to determine if the recipient
continues to meet the disability
requirements of the law. The
respondents are Social Security
disability applicants, beneficiaries, and
SSI applicants. Note: SSA listed this
information collection as an extension
of an OMB-approved information
collection in the 60-Day Federal
Register Notice published on December
11, 2008; it is a revision of an OMBapproved information collection.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 300,000.
Frequency of Response: 1.
Average Burden Per Response: 10
minutes.
Estimated Annual Burden: 50,000
hours.
8. 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
payments. SSA employees secure this
information during interviews
conducted with members of the public
who wish to file for SSI payments. SSA
uses this form for two purposes: (1) To
establish a disability claim, but defer the
complete development of non-medical
issues until SSA approves the disability,
or (2) to formally deny SSI payments for
non-medical reasons when information
provided by the applicant results in
ineligibility. The respondents are
applicants for SSI payments.
Note: SSA listed this information
collection as an extension of an OMBapproved information collection in the 60Day Federal Register Notice published on
December 11, 2008; it is a revision of an
OMB-approved information collection.
Type of Request: Revision of an OMBapproved information collection.
Number of minutes to complete form
Number of respondents
Form type
Burden hours
711,135
237,045
19,351
15
14
18
177,784
55,311
5,805
Totals ..............................................................................................................................
sroberts on PROD1PC70 with NOTICES
MSSIC ....................................................................................................................................
MSSIC/Signature Proxy .........................................................................................................
Paper .....................................................................................................................................
967,531
..........................
238,900
9. 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 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.
10. Claimant’s Recent Medical
Treatment— 20 CFR 404.1512 and
416.912—0960–0292. Each claimant
who requests a hearing before an ALJ
has a right to such a hearing once the
Disability Determination Service (DDS),
at the reconsideration level, has denied
the claim. For the hearing, SSA requests
the claimant complete and return the
HA–4631 if the claimant’s file does not
reflect a current, complete medical
history as the claimant proceeds
through the appeals process. ALJs must
obtain the information to update and
complete the record and to verify the
accuracy of the information. It is by this
process ALJs can ascertain whether the
claimant’s situation has changed. The
VerDate Nov<24>2008
19:45 Feb 13, 2009
Jkt 217001
ALJ and hearing office staff use the
response to make arrangements for
consultative examination(s) and the
attendance of an expert witness(es) at
the hearing, if appropriate. During 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 claimants
requesting hearings on entitlement to
OASDI benefits or SSI payments.
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.
Dated: February 9, 2009.
John Biles,
Reports Clearance Officer, Center for Reports
Clearance, Social Security Administration.
[FR Doc. E9–3171 Filed 2–13–09; 8:45 am]
BILLING CODE 4191–02–P
PO 00000
Frm 00122
Fmt 4703
Sfmt 4703
SOCIAL SECURITY ADMINISTRATION
[Docket No. SSA–2008–0062]
Social Security Ruling, SSR 09–3p.;
Title XVI: Determining Childhood
Disability—The Functional Equivalence
Domain of ‘‘Acquiring and Using
Information’’
Social Security Administration.
Notice of Social Security Ruling
AGENCY:
ACTION:
(SSR).
SUMMARY: We are giving notice of SSR
09–3p. This SSR consolidates
information from our regulations,
training materials, and question-andanswer documents about the functional
equivalence domain of ‘‘Acquiring and
using information.’’ It also explains our
policy about that domain.
DATES: Effective Date: March 19, 2009.
FOR FURTHER INFORMATION CONTACT:
Janet Truhe, Office of Disability
Programs, Social Security
Administration, 6401 Security
Boulevard, Baltimore, MD 21235–6401,
(410) 965–1020.
SUPPLEMENTARY INFORMATION: Although
5 U.S.C. 552(a)(1) and (a)(2) do not
require us to publish this SSR, we are
doing so under 20 CFR 402.35(b)(1).
SSRs make available to the public
precedential decisions relating to the
Federal old-age, survivors, disability,
E:\FR\FM\17FEN1.SGM
17FEN1
]]>Agencies
[Federal Register Volume 74, Number 30 (Tuesday, February 17, 2009)]
[Notices]
[Pages 7506-7511]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E9-3171]
=======================================================================
-----------------------------------------------------------------------
SOCIAL SECURITY ADMINISTRATION
Agency Information Collection Activities: Proposed Request and
Comment Request
The Social Security Administration (SSA) publishes a list of
information collection packages requiring clearance by the Office of
Management and Budget (OMB) in compliance with Public Law (Pub. L.)
104-13, the Paperwork Reduction Act of 1995, effective October 1, 1995.
This notice includes revisions and extensions of OMB-approved
Information Collections and a new 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, email, or
fax your comments and recommendations on the information collection(s)
to the OMB Desk Officer and the SSA Reports Clearance Officer to the
addresses or fax numbers listed below.
(OMB), Office of Management and Budget, Attn: Desk Officer for SSA,Fax:
202-395-6974,E-mail address: OIRA_Submission@omb.eop.gov.
(SSA), Social Security Administration, DCBFM,Attn: Reports Clearance
Officer,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. Application for Search of Census Records for Proof of Age--20
CFR 404.716-0960--0097. SSA uses the information collected by the SSA-
1535-U3 to provide the Census Bureau with sufficient identification
information for an accurate search of census records for proof of age
of an individual applying for Social Security benefits. When preferred
evidence of age is not available and the available evidence is not
convincing, SSA may request the U.S. Department of Commerce, Bureau of
the Census, to search its records in order to establish a claimant's
date of birth. The Census Bureau uses the information from a completed,
signed SSA-1535-U3 to bill SSA for the search. The respondents are
applicants for Social Security benefits who need to establish their
date of birth as a factor of entitlement.
[[Page 7507]]
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 18,030.
Frequency of Response: 1.
Average Burden Per Response: 12 minutes.
Estimated Annual Burden: 3,606 hours.
2. Youth Transition Process Demonstration Evaluation Data
Collection--0960-0687.
Background
The purpose of the Youth Transition Demonstration (YTD) project is
to help young people with disabilities make the transition from school
to work. While participating in the project, youth can continue to work
and/or continue their education because SSA waives certain disability
program rules and offers services to youth who are receiving disability
benefits or have a high probability of receiving them. We are currently
implementing YTD projects in eight sites across the country. The
evaluation will produce empirical evidence on the effects of the
waivers and project services including educational attainment,
employment, earnings, and receipt of benefits by youth with
disabilities, but also on the Social Security Trust Fund and federal
income tax revenues. This project is authorized by Sections 1110 and
234 of the Social Security Act.
Project Description
Given the importance of estimating YTD effects as accurately as
possible, we will evaluate the project using rigorous analytic methods
based on randomly assigning youth to a treatment or control group. We
will conduct several data collections. These include (1) baseline
interviews with youth and their parents or guardians prior to random
assignment; (2) follow-up interviews at 12 and 36 months after random
assignment; (3) interviews and/or roundtable discussions with local
program administrators, program supervisors, and service delivery
staff; and (4) focus groups of youths, their parents, and service
providers. The respondents are youths with disabilities enrolled in the
project; their parents or guardians; program staff; and service
providers.
Type of Request: Revision of an existing OMB Clearance.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Average burden
Data collection year Collection Number of Responses per per response Total response
respondents respondent (hours) burden (hours)
--------------------------------------------------------------------------------------------------------------------------------------------------------
2009............................................ Baseline.......................... 1,895 1 0.55 1,042
Informed Consent.................. 1,895 1 0.083 157
12 Month Follow-up................ 1,518 1 0.83 1,260
In-depth Interviews............... 120 1 0.42 50
Focus Group....................... 150 1 1.5 225
Program Staff/Service Provider.... 80 1 1 80
36 Month Follow-up................ 364 1 0.83 302
-------------------------------------------------------------------------------------------------------
Total 2009.................................. .................................. ............... ............... ............... 3,116
--------------------------------------------------------------------------------------------------------------------------------------------------------
3. Workers' Compensation/Public Disability Questionnaire--20 CFR
404.408--0960-0247. Section 224 of the Social Security Act provides for
the reduction of disability insurance benefits (DIB) when the
combination of DIB and any workers' compensation (WC) and/or certain
federal, state or local public disability benefits (PDB) exceeds 80% of
the worker's pre-disability earnings. SSA uses Form SSA-546 to collect
the data necessary to determine if the worker's receipt of WC/PDB
payments will cause a reduction of DIB. The respondents are applicants
for the Title II DIB.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 100,000.
Frequency of Response: 1.
Average Burden per Response: 15 minutes.
Estimated Annual Burden: 25,000 hours.
4. Statement of Funds You Provided to Another and Statement of
Funds You Received--20 CFR 416.1103(f)--0960-0481. Forms SSA-2854 and
SSA-2855 collect information on an SSI beneficiary's allegations that
he or she borrowed funds informally from non-commercial lender, e.g. a
relative or friend. The borrower/beneficiary and the lender of the
funds complete these statements. Forms SSA-2854 and SSA-2855 are
required to determine whether the proceeds from the transaction are
income to the borrower. If the transaction constitutes a bona fide
loan, then the proceeds are not income to the borrower. Form SSA-2855
(Statement of Funds You Received) requests information from the SSI
applicant/recipient by personal interview. Form SSA-2854 (Statement of
Funds You Provided to Another) requests information by mail from the
other party to the transaction. The respondents are SSI recipients who
informally borrow money and those persons who lend the funds.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 40,000.
Frequency of Response: 1.
Average Burden per Response: 10 minutes.
Estimated Annual Burden: 6,667 hours.
5. The Mental Health Treatment Study (MHTS)--0960-0726.
Background
Because of advances in medical treatment, assistive devices,
changes in the way we view those with disabilities, and legislation
designed to assure access to employment, SSA is taking on an
increasingly active role in assisting Social Security disability
beneficiaries who want to return to work. As a result, SSA developed
the MHTS under Section 234 of the Social Security Act (42 U.S.C. 434),
which gives the Commissioner of Social Security the authority to carry
out experiments and demonstration projects designed to determine the
relative advantages and disadvantages of interventions that facilitate
a beneficiary's return to work. Part of the agency's role involves
finding ways to promote work and increase independence among disability
beneficiaries.
SSA received additional support for this study in February 2001,
through President Bush's New Freedom Initiative--a comprehensive
program whose primary goal is to promote the full participation of
individuals with disabilities in all areas of society. The aim of the
Initiative is to help Americans with disabilities by increasing their
access to effective technologies, expanding educational opportunities,
increasing the ability of Americans with disabilities to integrate into
the workforce, and promoting increased access into daily community
life. This initiative provided SSA with
[[Page 7508]]
the support that will enable beneficiaries to maximize their self-
sufficiency and potentially enter or reenter the workforce.
MHTS Collection
The MHTS implemented a randomized trial study designed to evaluate
the effect of the intervention on employment and functional outcomes
for SSDI beneficiaries with a primary mental impairment of
schizophrenia or affective disorder. SSA is currently implementing the
MHTS in 22 demonstration sites across the United States, with one site
having two locations. The study participants are SSDI beneficiaries
with varying clinical and demographic characteristics, employment
histories, and, sometimes, additional medical impairments. The study
design has two arms: treatment (special services), and control (regular
services) groups. SSA randomly assigned study participants to the
treatment or control group. Each treatment or control recipient will
participate for a total of 24 months following enrollment. The
treatment intervention activities include the following: diagnostic
psychiatric assessment, comprehensive medical assessment, systematic
medication management, supporting employment, individualized clinical
treatment, supplemental health insurance, coordination and payment of
recipients' claims, as well as quality assurance mechanisms and
adherence to treatment guidelines, with subsequent training to improve
deficiencies as identified.
The comprehensive assessment of the MHTS outcomes will identify
which, if any, of the interventions resulted in successful employment
and functioning outcomes, and identify the characteristics of the
interventions that contributed to the success. This information enables
SSA to develop better ways to improve services to current and future
recipients. SSA also uses this information to guide any potential
changes to program rules to allow for better coordination among other
federal and state programs.
Type of Request: Extension of an OMB-approved information
collection.
Screener Estimated Burden
----------------------------------------------------------------------------------------------------------------
Burden per
Questionnaire Frequency of Number of responses Total burden
response respondents (minutes) hours
----------------------------------------------------------------------------------------------------------------
Screener Survey......................... 1 2,265 4 151
----------------------------------------------------------------------------------------------------------------
Estimated Burden for Treatment Group
----------------------------------------------------------------------------------------------------------------
Hours per
Questionnaire Frequency of Total number of response Total burden
response respondents\1\ (minutes) hours
----------------------------------------------------------------------------------------------------------------
Baseline.................................... 1 1,121 47 878
Quarterly................................... 7 1,121 18 2,354
Follow-up................................... 1 1,121 30 561
-------------------------------------------------------------------
Total................................... ............... ............... ............... 3,793
----------------------------------------------------------------------------------------------------------------
\1\ The number of respondents may reduce over time due to study withdrawals.
Estimated Burden for Control Group
----------------------------------------------------------------------------------------------------------------
Hours per
Questionnaire Frequency of Total number of response Total burden
response respondents (minutes) hours
----------------------------------------------------------------------------------------------------------------
Baseline.................................... 1 1,117 47 minutes 875
Quarterly................................... 7 1,117 7 minutes 912
Follow-up................................... 1 1,117 30 minutes 559
-------------------------------------------------------------------
Total................................... ............... ............... ............... 2,346
----------------------------------------------------------------------------------------------------------------
Total Estimated Burden for All Study Activities
----------------------------------------------------------------------------------------------------------------
Frequency of Total number of Total burden
Questionnaire response respondents hours
----------------------------------------------------------------------------------------------------------------
Screener Survey.............................................. 1 2,265 151
Treatment Group.............................................. 9 1,121 3,792
Control Group................................................ 9 1,117 2,345
--------------------------------------------------
Total.................................................... ............... 4,503 6,288
----------------------------------------------------------------------------------------------------------------
6. Application for SSA Employee Testimony--20 CFR 403.100-155--
0960-0619. SSA regulations at 20 CFR 403.100-155 establish policies and
procedures whereby an individual, organization, or governmental entity
may request official agency information, records, or testimony of an
agency employee in a legal proceeding where the agency is not a party.
The request, which must be in writing to the Commissioner, must fully
set out the nature and relevance of the sought testimony. Respondents
are individuals
[[Page 7509]]
or entities who request testimony from SSA employees in a legal
proceeding.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 100.
Frequency of Response: 1.
Average Burden Per Response: 60 minutes.
Estimated Annual Burden: 100 hours.
7. Self-Employment/Corporate Officer Questionnaire--20 CFR
404.435(e), 404.446--0960-0487. SSA uses Form SSA-4184 to develop
earnings and corroborate the claimant's allegations of retirement when
the claimant is self-employed or a corporate officer. SSA uses the
information to determine an individual's Old Age, Survivors, and
Disability Insurance (OASDI) benefit amount. The respondents are self-
employed individuals or corporate officers who apply for OASDI
benefits.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden Per Response: 20 minutes.
Estimated Annual Burden: 16,667 hours.
8. Claimant's Medication--20 CFR 404.1512, 416.912--0960-0289. In
cases where a claimant is requesting a hearing after denial of his or
her claim for Social Security benefits, SSA uses Form HA-4632 to
request information from the claimant regarding the medications they
are using. This information helps the Administrative Law Judge (ALJ)
hearing the case to inquire fully into the medical treatment the
claimant is receiving and the effect of medications on the claimant's
medical impairments and functional capacity. Respondents are applicants
for OASDI benefits and/or Supplemental Security Income (SSI) payments.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 200,000.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 50,000 hours.
9. Request for Withdrawal of Application--20 CFR 404.640--0960-
0015. Individuals complete Form SSA-521 to request withdrawal of an
application for benefits. Individuals who wish to withdraw their
applications for benefits complete this form. SSA uses the information
from Form SSA-521 to process the request for withdrawal. The
respondents are applicants for OASDI benefits.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 100,000.
Frequency of Response: 1.
Average Burden Per Response: 5 minutes.
Estimated Annual Burden: 8,333 hours.
10. Authorization for the Social Security Administration to Obtain
Account Records from a Financial Institution and Request for Records
(Medicare Low-Income Subsidy)--0960-0729. Under the aegis of the
Medicare Modernization Act of 2003, Medicare beneficiaries can apply
for a subsidy for the Medicare Prescription Drug Plan (Part D) program.
In some cases, SSA will need to verify the details of applicants'
accounts at financial institutions to determine if they are eligible
for the subsidy. Form SSA-4640 will give SSA the authority to contact
financial institutions about applicants' accounts. Financial
institutions will also use the form to verify the information requested
by SSA. The respondents are applicants for the Medicare Part D program
subsidy and financial institutions where applicants have accounts.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
Medicare Part D Subsidy Applicants.......... 5,000 1 1 84
Financial Institutions...................... 5,000 1 5 333
-------------------------------------------------------------------
Totals.................................. 10,000 ............... ............... 417
----------------------------------------------------------------------------------------------------------------
11. Request to Pay Civil Monetary Penalty by Installment
Agreement--20 CFR 498--0960-NEW. SSA uses Form SSA-640 to obtain the
information necessary to determine a repayment rate for individuals who
have a civil monetary penalty imposed on them for various fraudulent
conduct related to SSA-administered programs. SSA needs this financial
information to ensure the repayment rate is in the best interest of
both the individual and the agency. The respondents are recipients of
Social Security benefits and non-entitled individuals who must pay a
civil monetary penalty.
Type of Request: New information collection.
Number of Respondents: 400.
Frequency of Response: 1.
Average Burden Per Response: 120 minutes.
Estimated Annual Burden: 800 hours.
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. Report of New Information in Disability Cases--20 CFR 404.1588--
0960-0071. SSA uses the information it collects on Form SSA-612 to
ensure federal Old Age, Survivors, and Disability Insurance (OASDI)
payments are correct. It is essential beneficiaries notify SSA of any
information that may affect their continuing entitlement to disability
benefits. To facilitate and encourage timely reporting of such events,
SSA furnishes beneficiaries a Form SSA-612. The beneficiary completes
and returns the form to SSA when there is a change in his/her
circumstances. When a beneficiary reports a change, SSA investigates
any reported work activity or improvement in the beneficiary's
condition, updates its records, and makes necessary payment changes.
The respondents are recipients of federal OASDI benefits.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 27,000.
Frequency of Response: 1.
Average Burden Per Response: 5 minutes.
Estimated Annual Burden: 2,250 hours.
Note: This is a correction notice: SSA inadvertently published
the incorrect burden information for this collection on December 02,
2008. We are correcting this error here. Previously, SSA published
this collection as an extension; however, as we are revising the
Privacy Act Statement, this is now a revision.
2. Statement of Marital Relationship (By one of the parties)--20
CFR 404.726--0960-0038. Where no formal marriage documentation exists,
SSA
[[Page 7510]]
uses the information it collects on Form SSA-754-F4 to determine
whether an individual applying for spousal benefits meets the criteria
of common-law marriage under state law. The respondents are applicants
for spouse's Social Security benefits or SSI payments. Note: SSA listed
this information collection as an extension of an OMB-approved
information collection in the 60-Day Federal Register Notice published
on October 27, 2008; it is a revision of an OMB-approved information
collection.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 30,000.
Frequency of Response: 1.
Average Burden Per Response: 30 minutes.
Estimated Annual Burden: 15,000 hours.
3. Application for Parent's Insurance Benefits--20 CFR 404.370-
404.374, 20 CFR 404.601-404.603--0960-0012. SSA uses Form SSA-7 to
collect information used to entitle an individual to his or her
parent's OASDI benefits. The respondents are claimants who wish to
apply to receive their parent's OASDI 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. 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. An individual may request waiver of
recovery of an overpayment or a different repayment rate of OASDI
benefits and SSI payments. To make this request, the overpaid
individual uses the SSA-632-BK. The individual explains why he/she is
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,
he/she can use the SSA-632-BK to request a monthly rate or to request a
different rate of recovery. In those cases, the individual 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.
----------------------------------------------------------------------------------------------------------------
Number of Frequency of Average burden per Total annual
Type of request respondents response response burden
----------------------------------------------------------------------------------------------------------------
Waiver of Overpayment (Completes 400,000 1 2 hours.................. 800,000
Whole Form).
Change in Repayment (Completes 100,000 1 45 minutes............... 75,000
Partial Form).
Internet Instructions............. 500,000 1 5 minutes................ 41,667
-----------------------------------------------------------------------------
Totals........................ 1,000,000 ............... ......................... 916,667
----------------------------------------------------------------------------------------------------------------
5. You Can Make Your Payment by Credit Card--0960-0462. SSA uses
the information on Forms SSA-4588 and SSA-4589 to update an
individual's Social Security record to reflect payments made on their
overpayment and to effect payment through the appropriate credit card
company. SSA is modifying the Form SSA-4588 to include a recurring
credit card payment option to allow individuals to authorize automatic
monthly payments. SSA sends out the SSA-4588 with initial overpayment
notices informing individuals SSA has detected an overpayment.
Individuals may choose to make a one-time payment or recurring monthly
payments by completing and submitting the SSA-4588.
SSA uses the Form SSA--4589 only when individuals choose to call
the program service centers to make payments in lieu of completing the
Form SSA-4588. An SSA debtor contact representative completes Form SSA-
4589 when a debtor calls to make a payment by telephone. The debtor
contact representative also uses the information from Form SSA-4589 to
make recurring monthly payments via telephone call with the debtor.
Respondents are OASDI beneficiaries and SSI recipients who have
outstanding overpayments.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden
Form Number of Frequency of per response Total burden
respondents response (minutes) hours
----------------------------------------------------------------------------------------------------------------
SSA-4588.................................... 3,500 1 10 583
SSA-4589.................................... 36,500 1 5 3,042
-------------------------------------------------------------------
Totals.................................. 40,000 ............... ............... 3,625
----------------------------------------------------------------------------------------------------------------
6. Medical Source Statement of Ability To Do Work Related
Activities (Physical and Mental)--20 CFR 404.1512-404.1514, 404.912-
404.914, 404.1517, 416.917, 404.1519-404.1520, 416.919-416.920,
404.946, 416.946, 404-1546--0960-0662. SSA uses the Forms HA-1151 and
HA-1152 to collect data SSA needs to determine the residual functional
capacity (RFC) of individuals who are appealing denied claims for
benefits based on disability. SSA uses the RFC when the agency cannot
make a determination on a claim for benefits based on current work
activity or on medical facts alone. The respondents are medical sources
paid by SSA to provide reports either based on existing medical
evidence or on consultative examinations conducted for the purposes of
the report. Note: SSA listed this as an extension of an OMB-approved
information collection in the 60-Day Federal Register Notice published
on October 27, 2008; it is a revision of an OMB-approved collection.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 10,000.
Frequency of Response: 20.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 50,000 hours.
7. Statement of Funds You Provided to Another and Statement of
Funds You
[[Page 7511]]
Received--20 CFR 404.1520(b), 404.1571-.1576, 404.1584-.1593 and
416.971-.976 --0960-0059. SSA's field offices use Form SSA-821-BK to
obtain work information from recipients during the continuing
disability review process, and whenever a work issue arises in SSI
claims. SSA's processing centers and 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 substantial gainful activity. SSA will
review and evaluate the data to determine if the recipient continues to
meet the disability requirements of the law. The respondents are Social
Security disability applicants, beneficiaries, and SSI applicants.
Note: SSA listed this information collection as an extension of an OMB-
approved information collection in the 60-Day Federal Register Notice
published on December 11, 2008; it is a revision of an OMB-approved
information collection.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 300,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 50,000 hours.
8. 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 payments. SSA employees secure this information during
interviews conducted with members of the public who wish to file for
SSI payments. SSA uses this form for two purposes: (1) To establish a
disability claim, but defer the complete development of non-medical
issues until SSA approves the disability, or (2) to formally deny SSI
payments for non-medical reasons when information provided by the
applicant results in ineligibility. The respondents are applicants for
SSI payments.
Note: SSA listed this information collection as an extension of
an OMB-approved information collection in the 60-Day Federal
Register Notice published on December 11, 2008; it is a revision of
an OMB-approved information collection.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Number of
Form type Number of minutes to Burden hours
respondents complete 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
----------------------------------------------------------------------------------------------------------------
9. 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 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.
10. Claimant's Recent Medical Treatment-- 20 CFR 404.1512 and
416.912--0960-0292. Each claimant who requests a hearing before an ALJ
has a right to such a hearing once the Disability Determination Service
(DDS), at the reconsideration level, has denied the claim. For the
hearing, SSA requests the claimant complete and return the HA-4631 if
the claimant's file does not reflect a current, complete medical
history as the claimant proceeds through the appeals process. ALJs must
obtain the information to update and complete the record and to verify
the accuracy of the information. It is by this process ALJs can
ascertain whether the claimant's situation has changed. The ALJ and
hearing office staff use the response to make arrangements for
consultative examination(s) and the attendance of an expert witness(es)
at the hearing, if appropriate. During 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 claimants requesting hearings on entitlement to OASDI
benefits or SSI payments.
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.
Dated: February 9, 2009.
John Biles,
Reports Clearance Officer, Center for Reports Clearance, Social
Security Administration.
[FR Doc. E9-3171 Filed 2-13-09; 8:45 am]
BILLING CODE 4191-02-P
