Agency Information Collection Activities: Proposed Request and Comment Request, 4854-4857 [2012-1947]
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Federal Register / Vol. 77, No. 20 / Tuesday, January 31, 2012 / Notices
Submit completed loan
applications to: U.S. Small Business
Administration, Processing and
Disbursement Center, 14925 Kingsport
Road, Fort Worth, TX 76155.
FOR FURTHER INFORMATION CONTACT: A.
Escobar, Office of Disaster Assistance,
U.S. Small Business Administration,
409 3rd Street, SW., Suite 6050,
Washington, DC 20416.
SUPPLEMENTARY INFORMATION: Notice is
hereby given that as a result of the
Administrator’s disaster declaration,
applications for disaster loans may be
filed at the address listed above or other
locally announced locations.
The following areas have been
determined to be adversely affected by
the disaster:
Primary Counties: Burke.
Contiguous Counties:
North Carolina: Avery, Caldwell,
Catawba, Cleveland, Lincoln,
Mcdowell, Rutherford.
The Interest Rates are:
ADDRESSES:
ACTION:
Amendment 1.
SOCIAL SECURITY ADMINISTRATION
wreier-aviles on DSK5TPTVN1PROD with NOTICES
This is an amendment of the
Presidential declaration of a major
disaster for Public Assistance Only for
the State of ALASKA (FEMA–4050–DR),
dated 12/22/2011.
Incident: Severe Winter Storms and
Flooding.
Incident Period: 11/08/2011 through
11/13/2011.
Effective Date: 01/24/2012.
Physical Loan Application Deadline
Date: 02/21/2012.
Economic Injury (EIDL) Loan
Application Deadline Date: 09/24/2012.
ADDRESSES: Submit completed loan
applications to: U.S. Small Business
Administration, Processing and
Disbursement Center, 14925 Kingsport
Road, Fort Worth, TX 76155.
FOR FURTHER INFORMATION CONTACT: A.
Escobar, Office of Disaster Assistance,
U.S. Small Business Administration,
409 3rd Street SW., Suite 6050,
Percent
Washington, DC 20416.
SUPPLEMENTARY INFORMATION: The notice
of the President’s major disaster
4.125 declaration for Private Non-Profit
organizations in the State of ALASKA,
2.063 dated 12/22/2011, is hereby amended to
establish the incident period for this
6.000 disaster as beginning 11/08/2011 and
4.000 continuing through 11/13/2011.
All other information in the original
3.125 declaration remains unchanged.
SUMMARY:
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 104–13, the Paperwork
Reduction Act (PRA) of 1995, effective
October 1, 1995. This notice includes
revisions and extensions of OMBapproved information collections, and a
new 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 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
For Physical Damage:
collection(s) to the OMB Desk Officer
Homeowners with Credit Availand SSA Reports Clearance Officer at
able Elsewhere ......................
the following addresses or fax numbers.
Homeowners without Credit
(OMB)
Available Elsewhere ..............
Office of Management and Budget, Attn:
Businesses with Credit AvailDesk Officer for SSA. Fax: (202) 395–
able Elsewhere ......................
6974. Email address:
Businesses
without
Credit
OIRA_Submission@omb.eop.gov.
Available Elsewhere ..............
(SSA)
Non-Profit Organizations with
Credit Available Elsewhere ...
Social Security Administration, DCRDP,
Non-Profit Organizations withAttn: Reports Clearance Officer, 107
(Catalog of Federal Domestic Assistance
out Credit Available ElseAltmeyer Building, 6401 Security
Numbers 59002 and 59008)
where .....................................
3.000
Blvd., Baltimore, MD 21235. Fax:
For Economic Injury:
James E. Rivera,
(410) 966–2830. Email address:
Businesses & Small Agricultural
Associate Administrator for Disaster
OPLM.RCO@ssa.gov.
Cooperatives without Credit
Assistance.
I. The information collections below
Available Elsewhere ..............
4.000
[FR Doc. 2012–2019 Filed 1–30–12; 8:45 am]
Non-Profit Organizations withare pending at SSA. SSA will submit
BILLING CODE 8025–01–P
out Credit Available Elsethem to OMB within 60 days from the
where .....................................
3.000
date of this notice. To be sure we
consider your comments, we must
SMALL BUSINESS ADMINISTRATION
The number assigned to this disaster
receive them no later than April 2, 2012.
for physical damage is 12990 C and for
Individuals can obtain copies of the
Military Reservist Economic Injury
economic injury is 12991 O.
collection instruments by calling the
Disaster Loans; Interest Rate for
The States which received an EIDL
SSA Reports Clearance Officer at (410)
Second Quarter FY 2012
Declaration # are NORTH CAROLINA.
965–8783 or by writing to the above
(Catalog of Federal Domestic Assistance
In accordance with the Code of
email address.
Numbers 59002 and 59008.)
1. Electronic Health Records
Federal Regulations 13—Business Credit
Partnering Program Evaluation Form—
and Assistance § 123.512, the following
Dated: January 19, 2012.
24 CFR 495.300–495.370—0960–New.
interest rate is effective for Military
Karen G. Mills,
The Health Information Technology for
Reservist Economic Injury Disaster
Administrator.
Economic and Clinical Health (HITECH)
Loans approved on or after January 23,
[FR Doc. 2012–2018 Filed 1–30–12; 8:45 am]
Act promotes the adoption and
2012.
BILLING CODE 8025–01–P
meaningful use of health information
Military Reservist Loan Program
4.000% technology (IT), particularly in the
context of working with government
SMALL BUSINESS ADMINISTRATION
January 23, 2012.
agencies. Similarly, Section 3004 of the
[Disaster Declaration #12976 and #12977]
James E. Rivera,
Public Health Service Act requires
Associate Administrator for Disaster
health care providers or health
Alaska Disaster Number AK–00022
Assistance.
insurance issuers with government
[FR Doc. 2012–2023 Filed 1–30–12; 8:45 am]
AGENCY: U.S. Small Business
contracts to implement, acquire, or
Administration.
upgrade their health IT systems and
BILLING CODE P
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Federal Register / Vol. 77, No. 20 / Tuesday, January 31, 2012 / Notices
products to meet adopted standards and
implementation specifications. To
support expansion of SSA’s health IT
initiative as defined under HITECH,
SSA developed Form SSA–680, the
Partnering Program Evaluation Form.
The SSA–680 allows healthcare
providers to provide the information
SSA needs to determine their ability to
completeness of organizations’ SSA–680
responses as one part of our careful
analysis of their readiness to enter into
a health IT partnership with us. The
respondents are healthcare providers
and organizations exchanging
information with the agency.
Type of Request: This is a new
information collection request.
exchange health information with us
electronically. We intend to evaluate
potential partners (i.e., healthcare
providers and organizations) on (1) the
accessibility of the health information
they possess and (2) the content value
of their electronic health records’
systems for our disability adjudication
processes. SSA reviews the
Collection instrument
Number of
responses
Frequency of
response
Average
burden per
response
(hours)
Estimated total
annual burden
(hours)
SSA–680 ..........................................................................................................
30
1
5
150
2. Third Party Liability Information
Statement—42 CFR 433.136–433.139—
0960–0323. To reduce Medicaid costs,
Medicaid state agencies must identify
third party insurers liable for medical
care or services for Medicaid
beneficiaries. Regulations at 42 CFR
433.136–433.139 require Medicaid state
agencies to obtain this information on
Medicaid applications and
redeterminations as a condition of
Medicaid eligibility. States may enter
into agreements with the Commissioner
of Social Security to make Medicaid
eligibility determinations for aged,
blind, and disabled beneficiaries in
those states. Applications for and
redeterminations of Supplemental
Security Income (SSI) eligibility in
jurisdictions with such agreements are
applications and redeterminations of
Medicaid eligibility. Under these
agreements, SSA obtains third party
liability information using Form SSA–
8019, and provides that information to
the Medicaid state agencies. The
Medicaid state agencies use the
information to bill third parties liable
for medical care, support, or services for
a beneficiary to guarantee that Medicaid
remains the payer of last resort. The
respondents are SSI claimants and
recipients.
Type of Request: Extension of an
OMB-approved information collection.
Number of
responses
Collection instrument
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–8012 Paper form .....................................................................................
SSA Intranet Modernized SSI Claims System (MSSICS) ...............................
130
66,904
1
1
5
5
11
5,575
Totals ........................................................................................................
67,034
........................
........................
5,586
3. Prohibition of Payment of SSI
Benefits to Fugitive Felons and Parole/
Probation Violators—20 CFR
416.708(o)—0960–0617. Section
1611(e)(4) of the Social Security Act
(Act) precludes eligibility for SSI
payments for certain fugitives and
probation/parole violators. Regulations
at 20 CFR 416.708(o) require individuals
applying for or receiving SSI benefits to
report to SSA that (1) they are fleeing to
avoid prosecution for a crime; (2) they
are fleeing to avoid custody or
confinement after conviction of a crime;
or (3) they are violating a condition of
probation or parole. SSA will use the
information we receive to deny
eligibility, or suspend recipients SSI
payments. The respondents are SSI
applicants and recipients, or
representative payees of SSI applicants
and recipients, who are reporting their
status as a fugitive felon or probation/
parole violator.
Type of Request: Extension of an
OMB-approved information collection.
Number of
responses
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
MSSICS ...........................................................................................................
wreier-aviles on DSK5TPTVN1PROD with NOTICES
Collection instrument
1,000
1
1
17
II. SSA submitted the information
collections below to OMB for clearance.
Your comments regarding 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 March 1, 2012. Individuals
can obtain copies of the OMB clearance
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packages by calling the SSA Reports
Clearance Officer at (410) 965–8783 or
by writing to the above email address.
1. Statement of Marital Relationship
(By one of the parties)—20 CFR
404.726—0960–0038. SSA must obtain a
signed statement from a spousal
applicant if the applicant claims a
common-law marriage to the insured in
a state in which such marriages are
PO 00000
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recognized, and no formal marriage
documentation exists. SSA uses
information we collect on Form SSA–
754–F4 to determine if 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.
E:\FR\FM\31JAN1.SGM
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Federal Register / Vol. 77, No. 20 / Tuesday, January 31, 2012 / Notices
This is a correction notice. SSA
published this information collection as
an extension on November 16, 2011 at
76 FR 71105. Since we are revising the
Privacy Act Statement, this is actually a
revision of an OMB-approved
information collection.
Type of Request: Revision of an OMBapproved information collection.
Collection instrument
Number of
responses
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–754–F4 ....................................................................................................
30,000
1
30
15,000
2. Medicaid Use Report—20 CFR
416.268—0960–0267. Section 20 CFR
416.268 of the Code of Federal
Regulations requires SSA to determine
eligibility for (1) special SSI cash
payments and (2) special SSI eligibility
status for a person who works despite a
disabling condition. It also explains
how, in order to qualify for special SSI
eligibility status, an individual must
establish that termination of eligibility
for benefits under title XIX of the Act
would seriously inhibit the ability to
continue employment. SSA uses the
information required by this regulation
to determine if an individual is entitled
to special title XVI SSI payments and,
consequently, to Medicaid. The
respondents are SSI recipients for whom
SSA has stopped payments based on
earnings.
Type of Request: Extension of an
OMB-approved information collection.
Regulation section
Number of
responses
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
20 CFR 416.268 ..............................................................................................
60,000
1
3
3,000
3. Supplemental Security Income
(SSI) Claim Information Notice—20 CFR
416.210—0960–0324. Section 1611(e)(2)
of the Act requires individuals to file for
and obtain all payments (annuities,
pensions, disability benefits, veteran’s
compensation, etc.) for which they are
eligible before qualifying for SSI
payments. Individuals do not qualify for
SSI if they do not first apply for all other
benefits. SSA uses the information on
Form SSA–L8050–U3 to verify and
establish a claimant’s or recipient’s
eligibility under the SSI program.
Respondents are SSI applicants or
recipients who may be eligible for other
payments from public or private
programs.
Type of Request: Revision of an OMBapproved information collection.
Collection instrument
Number of
responses
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–L–8050–U3 .............................................................................................
7,500
1
10
1,250
4. Filing Claims Under the Federal
Tort Claims Act—20 CFR 429.101–
429.110—0960–0667. The Federal Tort
Claims Act is the legal mechanism for
compensating persons injured by
negligent or wrongful acts that occur
during the performance of official duties
by Federal employees. In accordance
with the law, SSA accepts monetary
claims filed under the Federal Tort
Claims Act for damages against the
United States, loss of property, personal
injury, or death resulting from an SSA
employee’s wrongful act or omission.
The regulation sections this information
collection comprises require claimants
to provide information SSA can use to
investigate and determine whether to
Number of
responses
wreier-aviles on DSK5TPTVN1PROD with NOTICES
Regulation section
make an award, compromise, or
settlement under the Federal Tort
Claims Act. The respondents are
individuals or entities making a claim
under the Federal Tort Claims Act.
Type of Request: Extension of an
OMB-approved information collection.
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
429.102; 20 CFR 492.103 1 ...............................................................
429.104(a) ..........................................................................................
429.104(b) ..........................................................................................
429.104(c) ..........................................................................................
429.106(b) ..........................................................................................
—
31
25
2
10
—
1
1
1
1
—
5
5
5
10
1
3
2
.17
2
Totals ........................................................................................................
20
20
20
20
20
68
........................
........................
8
CFR
CFR
CFR
CFR
CFR
1 The
1 hour represents a placeholder burden. We are not reporting a burden for this collection because respondents complete OMB-approved
Form SF–95 (OMB Control #1105–0008).
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Federal Register / Vol. 77, No. 20 / Tuesday, January 31, 2012 / Notices
Dated: January 25, 2012.
Faye Lipsky,
Reports Clearance Officer, Office of
Regulations and Reports Clearance, Social
Security Administration.
[FR Doc. 2012–1947 Filed 1–30–12; 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 revisions 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 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 SSA Reports Clearance Officer at
the following addresses or fax numbers.
(OMB), Office of Management and
Budget, Attn: Desk Officer for SSA,
Fax: (202) 395–6974, Email address:
OIRA_Submission@omb.eop.gov.
(SSA), Social Security Administration,
DCRDP, Attn: Reports Clearance
Officer, 107 Altmeyer Building, 6401
Security Blvd., Baltimore, MD 21235,
Fax: (410) 966–2830, Email address:
OPLM.RCO@ssa.gov.
SSA submitted the information
collection below to OMB for clearance.
Your comments regarding 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 March 1, 2012. Individuals
can obtain copies of the OMB clearance
package by calling the SSA Reports
Clearance Officer at (410) 965–8783 or
by writing to the above email address.
1. Disability Report-Appeal—20 CFR
404.1512, 416.912, 404.916(c),
Number of
respondents
Collection method
416.1416(c), 405 Subpart C, 422.140—
0960–0144. SSA requires disability
claimants who are appealing an
unfavorable disability determination to
complete the SSA–3441–BK, the
associated Electronic Disability Collect
System (EDCS) interview, or the Internet
application, i3441. This allows
claimants to disclose any changes to
their disability or resources that might
influence SSA’s unfavorable
determination. We may use the
information to: (1) Reconsider and
review an initial disability
determination; (2) review a continuing
disability; and (3) evaluate a request for
a hearing. This information assists the
State Disability Determination Services
and administrative law judges (ALJ) in
preparing for the appeals and hearings,
and issuing a determination or decision
on an individual’s entitlement (initial or
continuing) to disability benefits.
Respondents are individuals who
appeal denial, reduction, or cessation of
Social Security disability income
Supplemental Security Income (SSI)
payments, or who are requesting a
hearing before an ALJ.
Type of Request: Revision of an OMBapproved information collection.
Frequency of
response
Average
burden per response (minutes)
Estimated total
annual burden
(hours)
SSA–3441–BK .................................................................................................
EDCS Interview ...............................................................................................
i3441 (Internet) ................................................................................................
5,604
662,090
605,268
1
1
1
45
45
28
4,203
496,568
282,458
Totals ........................................................................................................
1,272,962
........................
........................
783,229
2. Request for Hearing by
Administrative Law Judge—20 CFR
404.929, 404.933, 416.1429, 404.1433,
418.1350, and 42 CFR 405.722—0960–
0269. When SSA denies applicants’ or
beneficiaries’ requests for new or
continuing benefits, those applicants or
beneficiaries are entitled to request a
hearing to appeal the decision. To
request a hearing, individuals use Form
HA–501, the associated Modernized
Claims System (MCS) or Modernized
Supplemental Security Income Claims
System (MSSICS) interview, or the
Internet application (i501). SSA uses the
information to determine if the
individual filed the request within the
prescribed time; is the proper party; and
has taken the steps necessary to obtain
the right to a hearing. SSA also uses the
information to determine the
individual’s reason(s) for disagreeing
with SSA’s prior determinations in the
case; if the individual has additional
evidence to submit; if the individual
wants an oral hearing or a decision onNumber of
respondents
wreier-aviles on DSK5TPTVN1PROD with NOTICES
Collection method
the-record; and whether the individual
has (or wants to appoint) a
representative. The respondents are
Social Security benefit applicants and
recipients who want to appeal SSA’s
denial of their request for new or
continued benefits and Medicare Part B
recipients who must pay the Medicare
Part B Income-Related Monthly
Adjustment Amount.
Type of Request: Revision of an OMBapproved information collection.
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
HA–501; MCS or MSSICS Interview ...............................................................
i501 (Internet iAppeals) ...................................................................................
25,953
643,516
1
1
10
5
4,326
53,626
Totals ........................................................................................................
669,469
........................
........................
57,952
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31JAN1
]]>Agencies
[Federal Register Volume 77, Number 20 (Tuesday, January 31, 2012)]
[Notices]
[Pages 4854-4857]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-1947]
=======================================================================
-----------------------------------------------------------------------
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 104-13, the
Paperwork Reduction Act (PRA) of 1995, effective October 1, 1995. This
notice includes revisions and extensions of OMB-approved information
collections, and a new 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 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 SSA Reports Clearance Officer at the following
addresses or fax numbers.
(OMB)
Office of Management and Budget, Attn: Desk Officer for SSA. Fax: (202)
395-6974. Email address: OIRA_Submission@omb.eop.gov.
(SSA)
Social Security Administration, DCRDP, Attn: Reports Clearance Officer,
107 Altmeyer Building, 6401 Security Blvd., Baltimore, MD 21235. Fax:
(410) 966-2830. Email address: OPLM.RCO@ssa.gov.
I. The information collections below are pending at SSA. SSA will
submit them 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
April 2, 2012. Individuals can obtain copies of the collection
instruments by calling the SSA Reports Clearance Officer at (410) 965-
8783 or by writing to the above email address.
1. Electronic Health Records Partnering Program Evaluation Form--24
CFR 495.300-495.370--0960-New. The Health Information Technology for
Economic and Clinical Health (HITECH) Act promotes the adoption and
meaningful use of health information technology (IT), particularly in
the context of working with government agencies. Similarly, Section
3004 of the Public Health Service Act requires health care providers or
health insurance issuers with government contracts to implement,
acquire, or upgrade their health IT systems and
[[Page 4855]]
products to meet adopted standards and implementation specifications.
To support expansion of SSA's health IT initiative as defined under
HITECH, SSA developed Form SSA-680, the Partnering Program Evaluation
Form. The SSA-680 allows healthcare providers to provide the
information SSA needs to determine their ability to exchange health
information with us electronically. We intend to evaluate potential
partners (i.e., healthcare providers and organizations) on (1) the
accessibility of the health information they possess and (2) the
content value of their electronic health records' systems for our
disability adjudication processes. SSA reviews the completeness of
organizations' SSA-680 responses as one part of our careful analysis of
their readiness to enter into a health IT partnership with us. The
respondents are healthcare providers and organizations exchanging
information with the agency.
Type of Request: This is a new information collection request.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Collection instrument Number of Frequency of per response annual burden
responses response (hours) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-680..................................... 30 1 5 150
----------------------------------------------------------------------------------------------------------------
2. Third Party Liability Information Statement--42 CFR 433.136-
433.139--0960-0323. To reduce Medicaid costs, Medicaid state agencies
must identify third party insurers liable for medical care or services
for Medicaid beneficiaries. Regulations at 42 CFR 433.136-433.139
require Medicaid state agencies to obtain this information on Medicaid
applications and redeterminations as a condition of Medicaid
eligibility. States may enter into agreements with the Commissioner of
Social Security to make Medicaid eligibility determinations for aged,
blind, and disabled beneficiaries in those states. Applications for and
redeterminations of Supplemental Security Income (SSI) eligibility in
jurisdictions with such agreements are applications and
redeterminations of Medicaid eligibility. Under these agreements, SSA
obtains third party liability information using Form SSA-8019, and
provides that information to the Medicaid state agencies. The Medicaid
state agencies use the information to bill third parties liable for
medical care, support, or services for a beneficiary to guarantee that
Medicaid remains the payer of last resort. The respondents are SSI
claimants and recipients.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Estimated
Number of Frequency of Average burden total annual
Collection instrument responses response per response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-8012 Paper form............................. 130 1 5 11
SSA Intranet Modernized SSI Claims System 66,904 1 5 5,575
(MSSICS).......................................
---------------------------------------------------------------
Totals...................................... 67,034 .............. .............. 5,586
----------------------------------------------------------------------------------------------------------------
3. Prohibition of Payment of SSI Benefits to Fugitive Felons and
Parole/Probation Violators--20 CFR 416.708(o)--0960-0617. Section
1611(e)(4) of the Social Security Act (Act) precludes eligibility for
SSI payments for certain fugitives and probation/parole violators.
Regulations at 20 CFR 416.708(o) require individuals applying for or
receiving SSI benefits to report to SSA that (1) they are fleeing to
avoid prosecution for a crime; (2) they are fleeing to avoid custody or
confinement after conviction of a crime; or (3) they are violating a
condition of probation or parole. SSA will use the information we
receive to deny eligibility, or suspend recipients SSI payments. The
respondents are SSI applicants and recipients, or representative payees
of SSI applicants and recipients, who are reporting their status as a
fugitive felon or probation/parole violator.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Collection instrument Number of Frequency of per response annual burden
responses response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
MSSICS...................................... 1,000 1 1 17
----------------------------------------------------------------------------------------------------------------
II. SSA submitted the information collections below to OMB for
clearance. Your comments regarding 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 March 1, 2012. Individuals can obtain copies of the
OMB clearance packages by calling the SSA Reports Clearance Officer at
(410) 965-8783 or by writing to the above email address.
1. Statement of Marital Relationship (By one of the parties)--20
CFR 404.726--0960-0038. SSA must obtain a signed statement from a
spousal applicant if the applicant claims a common-law marriage to the
insured in a state in which such marriages are recognized, and no
formal marriage documentation exists. SSA uses information we collect
on Form SSA-754-F4 to determine if 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.
[[Page 4856]]
This is a correction notice. SSA published this information
collection as an extension on November 16, 2011 at 76 FR 71105. Since
we are revising the Privacy Act Statement, this is actually a revision
of an OMB-approved information collection.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Collection instrument Number of Frequency of per response annual burden
responses response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-754-F4.................................. 30,000 1 30 15,000
----------------------------------------------------------------------------------------------------------------
2. Medicaid Use Report--20 CFR 416.268--0960-0267. Section 20 CFR
416.268 of the Code of Federal Regulations requires SSA to determine
eligibility for (1) special SSI cash payments and (2) special SSI
eligibility status for a person who works despite a disabling
condition. It also explains how, in order to qualify for special SSI
eligibility status, an individual must establish that termination of
eligibility for benefits under title XIX of the Act would seriously
inhibit the ability to continue employment. SSA uses the information
required by this regulation to determine if an individual is entitled
to special title XVI SSI payments and, consequently, to Medicaid. The
respondents are SSI recipients for whom SSA has stopped payments based
on earnings.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Regulation section Number of Frequency of per response annual burden
responses response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
20 CFR 416.268.............................. 60,000 1 3 3,000
----------------------------------------------------------------------------------------------------------------
3. Supplemental Security Income (SSI) Claim Information Notice--20
CFR 416.210--0960-0324. Section 1611(e)(2) of the Act requires
individuals to file for and obtain all payments (annuities, pensions,
disability benefits, veteran's compensation, etc.) for which they are
eligible before qualifying for SSI payments. Individuals do not qualify
for SSI if they do not first apply for all other benefits. SSA uses the
information on Form SSA-L8050-U3 to verify and establish a claimant's
or recipient's eligibility under the SSI program. Respondents are SSI
applicants or recipients who may be eligible for other payments from
public or private programs.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Collection instrument Number of Frequency of per response annual burden
responses response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L-8050-U3............................... 7,500 1 10 1,250
----------------------------------------------------------------------------------------------------------------
4. Filing Claims Under the Federal Tort Claims Act--20 CFR 429.101-
429.110--0960-0667. The Federal Tort Claims Act is the legal mechanism
for compensating persons injured by negligent or wrongful acts that
occur during the performance of official duties by Federal employees.
In accordance with the law, SSA accepts monetary claims filed under the
Federal Tort Claims Act for damages against the United States, loss of
property, personal injury, or death resulting from an SSA employee's
wrongful act or omission. The regulation sections this information
collection comprises require claimants to provide information SSA can
use to investigate and determine whether to make an award, compromise,
or settlement under the Federal Tort Claims Act. The respondents are
individuals or entities making a claim under the Federal Tort Claims
Act.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Estimated
Number of Frequency of Average burden total annual
Regulation section responses response per response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
20 CFR 429.102; 20 CFR 492.103 \1\.............. -- -- -- 1
20 CFR 429.104(a)............................... 31 1 5 3
20 CFR 429.104(b)............................... 25 1 5 2
20 CFR 429.104(c)............................... 2 1 5 .17
20 CFR 429.106(b)............................... 10 1 10 2
---------------------------------------------------------------
Totals...................................... 68 .............. .............. 8
----------------------------------------------------------------------------------------------------------------
\1\ The 1 hour represents a placeholder burden. We are not reporting a burden for this collection because
respondents complete OMB-approved Form SF-95 (OMB Control 1105-0008).
[[Page 4857]]
Dated: January 25, 2012.
Faye Lipsky,
Reports Clearance Officer, Office of Regulations and Reports Clearance,
Social Security Administration.
[FR Doc. 2012-1947 Filed 1-30-12; 8:45 am]
BILLING CODE 4191-02-P
