Agency Information Collection Activities: Proposed Request and Comment Request, 59336-59338 [E9-27510]
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59336
Federal Register / Vol. 74, No. 220 / Tuesday, November 17, 2009 / Notices
affiliations). In addition, SSA will use
the information to meet any requirement
to issue a Form 1099–MISC to law firms
or other business entities pursuant to
sections 6041 and 6045(f) of the Internal
Revenue Code. The respondents are law
firms or other business entities that
wish to serve as appointed
representatives and receive direct
payment of fees.
Type of Request: Revision to an OMBapproved information collection.
Number of Respondents: 8,000.
Frequency of Response: 1.
Average Burden Per Response: 20
minutes.
to do business with us; (2) allows them
access to our records for the claimants
they represent; (3) facilitates direct
payment of authorized fees to appointed
representatives; and (4) collects
information needed to meet Internal
Revenue Service (IRS) requirements to
issue specific IRS forms, if we pay these
representatives in excess of a specific
amount.
This ICR is for changes we will
implement to the collection in 2010.
The respondents are appointed claimant
representatives.
Type of Request: Revision to an OMBapproved information collection.
Estimated Annual Burden: 2,667
hours.
3. Appointed Representative
Services—0960–0732. SSA uses Form
SSA–1699 to register:
• Individuals appointed as
representatives;
• Individuals who will perform
advocacy services on behalf of an
appointed representative;
• Individuals who will act on behalf
of an appointed representative and want
access to our electronic services; and
• Individuals who will serve as
administrators for an entity appointed
as a representative.
By registering these individuals, SSA:
(1) Authenticates and authorizes them
Number of
respondents
Modality of completion
Average
burden per
response
(minutes)
Frequency of
response
Estimated
annual burden
(hours)
SSA–1699 (paper form) ...................................................................................
Internet-based SSA–1699 ...............................................................................
52,800
13,200
1
1
30
22
26,400
4,840
Totals ........................................................................................................
66,000
........................
........................
31,240
Dated: November 10, 2009,
Elizabeth A. Davidson,
Director, Center for Reports Clearance Social
Security Administration.
[FR Doc. E9–27509 Filed 11–16–09; 8:45 am]
(OMB)
Office of Management and Budget,
Attn: Desk Officer for SSA, Fax: 202–
395–6974, E-mail address:
OIRA_Submion@omb.eop.gov.
BILLING CODE 4191–02–P
(SSA)
Social Security Administration,
DCBFM, Attn: Director, Center for
Reports Clearance, 1333 Annex
Building, 6401 Security Blvd.,
Baltimore, MD 21235, Fax: 410–965–
0454, 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. To be sure we consider your
comments, we must receive them no
later than January 19, 2010. Individuals
can obtain copies of the collection
instrument by calling the SSA Director
for Reports Clearance at 410–965–0454
or by writing to the above email address.
1. Important Information about Your
Appeal, Waiver Rights and Repayment
Options—20 CFR 404.502–521–0960–
NEW. SSA uses Form SSA–3105 in an
overpayment situation to explain the
claimant’s rights to reconsideration,
waiver, or a different repayment rate.
Claimants use Form SSA–3105 to
inform SSA they do not agree with
SSA’s initial overpayment
determination, they are unable to repay
the overpayment, or to request a waiver
for repayment to SSA. The respondents
are individuals who are overpaid
claimants who are requesting a waiver
of recovery for the overpayment,
SOCIAL SECURITY ADMINISTRATION
mstockstill on DSKH9S0YB1PROD with NOTICES
Agency Information Collection
Activities: Proposed Request and
Comment Request
The Social Security Administration
(SSA) publishes a list of information
collection packages requiring clearance
by the Office of Management and
Budget (OMB) in compliance with
Public Law (Pub. L.) 104–13, the
Paperwork Reduction Act of 1995,
effective October 1, 1995. This notice
includes revisions and extensions of
OMB-approved information collections.
SSA is soliciting comments on the
accuracy of the agency’s burden
estimate; the need for the information;
its practical utility; ways to enhance its
quality, utility, and clarity; and 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 Director for Reports
Clearance to the addresses or fax
numbers shown below.
VerDate Nov<24>2008
20:50 Nov 16, 2009
Jkt 220001
PO 00000
Frm 00224
Fmt 4703
Sfmt 4703
reconsideration of the fact of the
overpayment, or a lesser rate of
withholding of the overpayment.
Type of Request: New information
collection.
Number of Respondents: 800,000.
Frequency of Response: 1.
Average Burden per Response: 15
minutes.
Estimated Annual Burden: 200,000
hours.
2. Notification of a Social Security
Number (SSN) to an Employer for Wage
Reporting—20 CFR 422.103–0960–
NEW. Individuals applying for
employment must provide an SSN or
indicate they have applied for one. The
information SSA collects on Form SSA–
112 allows SSA to send, at the
individual’s request, the individual’s
SSN to his or her employer. Mailing this
information to the employer ensures the
employer has the correct SSN for the
individual, allows SSA to receive
correct earnings information for wage
reporting purposes for the individual,
and reduces the delay between the
initial SSN assignment and delivery of
the SSN information to the employer.
The respondents are individuals who
are applying for an initial SSN and
request to have the information mailed
to their employer.
Type of Request: New information
collection.
Number of Respondents: 375,000.
Frequency of Response: 1.
Average Burden per Response: 2
minutes.
E:\FR\FM\17NON1.SGM
17NON1
59337
Federal Register / Vol. 74, No. 220 / Tuesday, November 17, 2009 / Notices
Estimated Annual Burden: 12,500
hours.
3. Statement for Determining
Continuing Eligibility, Supplemental
Security Income Payment(s)—416.204–
0960–0416. SSA uses the information
from the SSA–8203–BK for high-errorprofile redeterminations of disability to
determine whether Supplemental
Security Income (SSI) recipients have
met and continue to meet all statutory
and regulatory requirements for SSI
eligibility and whether they have been,
and are still receiving, the correct
payment amount. Periodic collection of
this information is the only way SSA
can make these determinations, and
collection of this information is
mandatory under the law. The
Number of
respondents
Collection method
information is normally completed in
field offices by personal contact (face-toface or telephone interview) using the
automated Modernized SSI Claim
System (MSSICS). The respondents are
SSI recipients or their representative
payees.
Type of Request: Revision of an OMBapproved information collection.
Average
burden per
response
(minutes)
Frequency of
response
Estimated
annual burden
(hours)
94,568
31,522
31,522
1
1
1
20
19
20
31,523
9,982
10,507
Totals ........................................................................................................
mstockstill on DSKH9S0YB1PROD with NOTICES
MSSICS ...........................................................................................................
MSSICS/Signature Proxy ................................................................................
Paper ...............................................................................................................
157,612
........................
........................
52,012
4. Pain Report Child—20 CFR 416.912
and 416.512—0960–0540. Disability
interviewers and applicants/claimants
in self-help situations use Form SSA–
3371–BK to record information about
pain or other symptoms of a child who
is claiming disability. The State
Disability Determination Services
adjudicators and administrative law
judges use this information to assess the
effects of symptoms on functionality to
help make a disability determination.
The respondents are applicants for SSI
payments.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 250,000.
Frequency of Response: 1.
Average Burden per Response: 15
minutes.
Estimated Annual Burden: 62,500
hours.
5. Internet Direct Deposit
Application—31 CFR 210—0960–0634.
SSA uses Direct Deposit/Electronic
Funds Transfer (DD/EFT) enrollment
information received from beneficiaries
to facilitate DD/EFT of their Social
Security benefits with a financial
institution. Respondents are Social
Security beneficiaries who use the
Internet to enroll in DD/EFT.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 90,000.
Frequency of Response: 1.
Average Burden per Response: 10
minutes.
Estimated Annual Burden: 15,000
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 OMB and SSA receive them
within 30 days from the date of this
VerDate Nov<24>2008
20:50 Nov 16, 2009
Jkt 220001
publication. To be sure we consider
your comments, we must receive them
no later than December 17, 2009. You
can obtain a copy of the OMB clearance
packages by calling the SSA Director for
Reports Clearance at 410–965–0454 or
by writing to the above e-mail address.
1. Blood Donor Locator Service
(BDLS)—20 CFR 401.200—0960–0501.
This regulation stipulates when blood
donor facilities identify blood donations
as Human Immunodeficiency Virus
(HIV)-positive, the overseeing state
agency must provide the names and
SSNs of the affected donors to SSA’s
BDLS. SSA uses this information to
furnish the state agencies with the blood
donors’ address information to notify
the blood donors. Respondents are state
agencies acting on behalf of blood donor
facilities.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 10.
Frequency of Response: 5.
Average Burden per Response: 15
minutes.
Estimated Annual Burden: 13 hours.
2. Representative Payee Report of
Benefits and Dedicated Account—20
CFR 416.546, 416.635, 416.640,
416.665—0960–0576. SSA requires
representative payees (RP) to submit a
written report accounting for their use
of money paid to Social Security and/
or SSI recipients and to establish and
maintain a dedicated account for these
payments. SSA uses Form SSA–6233 to
ensure RPs are using the benefits
received for the recipient’s current
maintenance and personal needs, and
the expenditures of funds from the
dedicated account comply with the law.
Respondents are RPs for SSI recipients.
Note: This is a correction notice. SSA
published this information collection as an
PO 00000
Frm 00225
Fmt 4703
Sfmt 4703
extension on September 2, 2009, at 74 FR
4408. Since we are revising the Privacy Act
Statement, this is now 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: 20
minutes.
Estimated Annual Burden: 10,000
hours.
3. Medical Consultant’s Review of
Psychiatric Review Technique Form—
20 CFR 404.1520a, 404.1640, 404.1643,
404.1645, 416.920a—0960–0677. Form
SSA–3023 is a program evaluation form
SSA’s regional review component uses
to facilitate the contract medical/
psychological consultant’s review of the
Psychiatric Review Technique Form
(PRTF). SSA–3023 records the
reviewing medical/psychological
consultant’s assessment of the PRTF.
The medical/psychological consultant
only completes Form SSA–3023 when
an adjudicating component’s PRTF is in
the file. Form SSA–3023 is required for
each PRTF completed. The respondents
are medical/psychological consultants
who review the PRTF for quality
purposes.
Note: This is a correction notice. SSA
published this information collection as an
extension on September 2, 2009, at 74 FR
45508. Since we are revising the Privacy Act
Statement, this is now a revision of an OMBapproved information collection.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 344.
Frequency of Response: 165.
Average Burden per Response: 12
minutes.
Estimated Annual Burden: 11,352
hours.
E:\FR\FM\17NON1.SGM
17NON1
59338
Federal Register / Vol. 74, No. 220 / Tuesday, November 17, 2009 / Notices
Dated: November 10, 2009.
Elizabeth A. Davidson,
Director, Center for Reports Clearance, Social
Security Administration.
[FR Doc. E9–27510 Filed 11–16–09; 8:45 am]
BILLING CODE 4191–02–P
SOCIAL SECURITY ADMINISTRATION
Agency Information Collection
Activities: 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 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, email, or
fax your comments and
recommendations on the information
collection(s) to the OMB Desk Officer
and the SSA Director for Clearance to
the addresses or fax numbers shown
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: Director, Center
Clearance Officer, 1333 Annex
Building, 6401 Security Blvd.,
Baltimore, MD 21235, Fax: 410–965–
6400, E-mail address:
OPLM.RCO@ssa.gov.
I. SSA has submitted the information
collection we list below to OMB for
clearance. Your comments on the
information collection would be most
useful if OMB and SSA receive them
within 30 days from the date of this
publication. To be sure we consider
your comments, we must receive them
no later than December 17, 2009. You
can obtain a copy of the OMB clearance
package by calling the SSA Director for
Reports Clearance at 410–965–0454 or
by writing to the above email address.
1. Social Security Benefits
Application—20 CFR 404.310–.311,
.315–.322, .330–.333, 601–.603, and
.1501–.1512—0960–0618. This
collection comprises the various
application modalities for retirement,
survivors, and disability benefits. These
modalities include paper forms (SSA
Forms SSA–1, SSA–2, and SSA–16),
Modernized Claims System (MCS)
screens for in-person field office
interview applications, and the Internet
based iClaim application. This
information collection request (ICR) will
expand the potential user base for
iClaim.
Type of Collection: Revision to an
existing Office of Management and
Budget-approved information
collection.
Paper Forms/Accompanying MCS
Screens/Burden Information:
FORM SSA–1
Frequency of
response
Average burden per response (min)
172,200
1,549,800
21,000
299,000
1,000
2,043,000
1
1
1
1
1
........................
11
10
11
7
7
........................
31,570
258,300
3,850
34,883
117
328,720
36,860
331,740
3,800
372,400
1
1
1
........................
15
14
15
........................
9,215
77,406
950
87,571
218,657
1,967,913
24,161
2,210,731
1
1
1
........................
20
19
20
........................
72,886
623,172
8,054
704,112
1
1
1
1
........................
15
5
15
10
........................
7,030
2,343
135,463
33,333
178,169
Number of
respondents
Collection method
MCS .................................................................................................................
MCS/Signature Proxy ......................................................................................
Paper ...............................................................................................................
Medicare-only MCS .........................................................................................
Medicare-only Paper ........................................................................................
Totals ........................................................................................................
Estimated annual burden
(hours)
Form SSA–2:
MCS .................................................................................................................
MCS/Signature Proxy ......................................................................................
Paper ...............................................................................................................
Totals ........................................................................................................
Form SSA–16:
MCS .................................................................................................................
MCS/Signature Proxy ......................................................................................
Paper ...............................................................................................................
Totals ........................................................................................................
iClaim Burden Information:
mstockstill on DSKH9S0YB1PROD with NOTICES
iClaim 3rd Party ...............................................................................................
iClaim Applicant after 3rd Party Completion ...................................................
First Party iClaim .............................................................................................
Medicare-only iClaim (new to this ICR) ...........................................................
Totals ........................................................................................................
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20:50 Nov 16, 2009
Jkt 220001
PO 00000
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Fmt 4703
Sfmt 4703
28,118
28,118
541,851
200,000
798,087
E:\FR\FM\17NON1.SGM
17NON1
]]>Agencies
[Federal Register Volume 74, Number 220 (Tuesday, November 17, 2009)]
[Notices]
[Pages 59336-59338]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E9-27510]
-----------------------------------------------------------------------
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.
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 Director for Reports Clearance to
the addresses or fax numbers shown below.
(OMB)
Office of Management and Budget,
Attn: Desk Officer for SSA, Fax: 202-395-6974, E-mail address: OIRA_Submion@omb.eop.gov.
(SSA)
Social Security Administration, DCBFM, Attn: Director, Center for
Reports Clearance, 1333 Annex Building, 6401 Security Blvd., Baltimore,
MD 21235, Fax: 410-965-0454, 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. To be
sure we consider your comments, we must receive them no later than
January 19, 2010. Individuals can obtain copies of the collection
instrument by calling the SSA Director for Reports Clearance at 410-
965-0454 or by writing to the above email address.
1. Important Information about Your Appeal, Waiver Rights and
Repayment Options--20 CFR 404.502-521-0960-NEW. SSA uses Form SSA-3105
in an overpayment situation to explain the claimant's rights to
reconsideration, waiver, or a different repayment rate. Claimants use
Form SSA-3105 to inform SSA they do not agree with SSA's initial
overpayment determination, they are unable to repay the overpayment, or
to request a waiver for repayment to SSA. The respondents are
individuals who are overpaid claimants who are requesting a waiver of
recovery for the overpayment, reconsideration of the fact of the
overpayment, or a lesser rate of withholding of the overpayment.
Type of Request: New information collection.
Number of Respondents: 800,000.
Frequency of Response: 1.
Average Burden per Response: 15 minutes.
Estimated Annual Burden: 200,000 hours.
2. Notification of a Social Security Number (SSN) to an Employer
for Wage Reporting--20 CFR 422.103-0960-NEW. Individuals applying for
employment must provide an SSN or indicate they have applied for one.
The information SSA collects on Form SSA-112 allows SSA to send, at the
individual's request, the individual's SSN to his or her employer.
Mailing this information to the employer ensures the employer has the
correct SSN for the individual, allows SSA to receive correct earnings
information for wage reporting purposes for the individual, and reduces
the delay between the initial SSN assignment and delivery of the SSN
information to the employer. The respondents are individuals who are
applying for an initial SSN and request to have the information mailed
to their employer.
Type of Request: New information collection.
Number of Respondents: 375,000.
Frequency of Response: 1.
Average Burden per Response: 2 minutes.
[[Page 59337]]
Estimated Annual Burden: 12,500 hours.
3. Statement for Determining Continuing Eligibility, Supplemental
Security Income Payment(s)--416.204-0960-0416. SSA uses the information
from the SSA-8203-BK for high-error-profile redeterminations of
disability to determine whether Supplemental Security Income (SSI)
recipients have met and continue to meet all statutory and regulatory
requirements for SSI eligibility and whether they have been, and are
still receiving, the correct payment amount. Periodic collection of
this information is the only way SSA can make these determinations, and
collection of this information is mandatory under the law. The
information is normally completed in field offices by personal contact
(face-to-face or telephone interview) using the automated Modernized
SSI Claim System (MSSICS). The respondents are SSI recipients or their
representative payees.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average
Number of Frequency of burden per Estimated
Collection method respondents response response annual burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
MSSICS.......................................... 94,568 1 20 31,523
MSSICS/Signature Proxy.......................... 31,522 1 19 9,982
Paper........................................... 31,522 1 20 10,507
---------------------------------------------------------------
Totals...................................... 157,612 .............. .............. 52,012
�������������������������������������������������
----------------------------------------------------------------------------------------------------------------
4. Pain Report Child--20 CFR 416.912 and 416.512--0960-0540.
Disability interviewers and applicants/claimants in self-help
situations use Form SSA-3371-BK to record information about pain or
other symptoms of a child who is claiming disability. The State
Disability Determination Services adjudicators and administrative law
judges use this information to assess the effects of symptoms on
functionality to help make a disability determination. The respondents
are applicants for SSI payments.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 250,000.
Frequency of Response: 1.
Average Burden per Response: 15 minutes.
Estimated Annual Burden: 62,500 hours.
5. Internet Direct Deposit Application--31 CFR 210--0960-0634. SSA
uses Direct Deposit/Electronic Funds Transfer (DD/EFT) enrollment
information received from beneficiaries to facilitate DD/EFT of their
Social Security benefits with a financial institution. Respondents are
Social Security beneficiaries who use the Internet to enroll in DD/EFT.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 90,000.
Frequency of Response: 1.
Average Burden per Response: 10 minutes.
Estimated Annual Burden: 15,000 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 OMB and SSA receive them within 30 days from the date
of this publication. To be sure we consider your comments, we must
receive them no later than December 17, 2009. You can obtain a copy of
the OMB clearance packages by calling the SSA Director for Reports
Clearance at 410-965-0454 or by writing to the above e-mail address.
1. Blood Donor Locator Service (BDLS)--20 CFR 401.200--0960-0501.
This regulation stipulates when blood donor facilities identify blood
donations as Human Immunodeficiency Virus (HIV)-positive, the
overseeing state agency must provide the names and SSNs of the affected
donors to SSA's BDLS. SSA uses this information to furnish the state
agencies with the blood donors' address information to notify the blood
donors. Respondents are state agencies acting on behalf of blood donor
facilities.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 10.
Frequency of Response: 5.
Average Burden per Response: 15 minutes.
Estimated Annual Burden: 13 hours.
2. Representative Payee Report of Benefits and Dedicated Account--
20 CFR 416.546, 416.635, 416.640, 416.665--0960-0576. SSA requires
representative payees (RP) to submit a written report accounting for
their use of money paid to Social Security and/or SSI recipients and to
establish and maintain a dedicated account for these payments. SSA uses
Form SSA-6233 to ensure RPs are using the benefits received for the
recipient's current maintenance and personal needs, and the
expenditures of funds from the dedicated account comply with the law.
Respondents are RPs for SSI recipients.
Note: This is a correction notice. SSA published this
information collection as an extension on September 2, 2009, at 74
FR 4408. Since we are revising the Privacy Act Statement, this is
now 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: 20 minutes.
Estimated Annual Burden: 10,000 hours.
3. Medical Consultant's Review of Psychiatric Review Technique
Form--20 CFR 404.1520a, 404.1640, 404.1643, 404.1645, 416.920a--0960-
0677. Form SSA-3023 is a program evaluation form SSA's regional review
component uses to facilitate the contract medical/psychological
consultant's review of the Psychiatric Review Technique Form (PRTF).
SSA-3023 records the reviewing medical/psychological consultant's
assessment of the PRTF. The medical/psychological consultant only
completes Form SSA-3023 when an adjudicating component's PRTF is in the
file. Form SSA-3023 is required for each PRTF completed. The
respondents are medical/psychological consultants who review the PRTF
for quality purposes.
Note: This is a correction notice. SSA published this
information collection as an extension on September 2, 2009, at 74
FR 45508. Since we are revising the Privacy Act Statement, this is
now a revision of an OMB-approved information collection.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 344.
Frequency of Response: 165.
Average Burden per Response: 12 minutes.
Estimated Annual Burden: 11,352 hours.
[[Page 59338]]
Dated: November 10, 2009.
Elizabeth A. Davidson,
Director, Center for Reports Clearance, Social Security Administration.
[FR Doc. E9-27510 Filed 11-16-09; 8:45 am]
BILLING CODE 4191-02-P
