Agency Information Collection Activities: Proposed Request and Comment Request, 71204-71207 [2012-28891]
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71204
Federal Register / Vol. 77, No. 230 / Thursday, November 29, 2012 / Notices
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 of 1995, effective October
1, 1995. This notice includes revisions
to 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 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
Director, 107 Altmeyer Building, 6401
Security Blvd., Baltimore, MD 21235,
Fax: 410–966–2830, Email address:
OR.Reports.Clearance@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
Number of
respondents
Modality of completion
receive them no later than January 28,
2013. Individuals can obtain copies of
the collection instruments by writing to
the above email address.
1. Application for Widow’s or
Widower’s Insurance Benefits—20 CFR
404.335–404.338, & 404.603—0960–
0004. Since SSA needs information to
make a formal determination for
entitlement to widow(er)’s benefits, we
use Form SSA–10–BK to determine
whether an applicant meets the
statutory and regulatory conditions for
entitlement to widow(er)’s title II
benefits. SSA employees interview
individuals applying for benefits either
face-to-face or via telephone and enter
the information on the paper form or
into the Modernized Claims System
(MCS). The respondents are applicants
for widow(er)’s benefits.
Type of Request: Revision of an OMBapproved information collection.
Average
burden per
response
(minutes)
Frequency of
response
Estimated total
annual burden
(hours)
SSA–10–BK—paper version ...........................................................................
SSA–10–BK—MCS version .............................................................................
5,000
449,000
1
1
15
14
1,250
104,767
Total ..........................................................................................................
454,000
........................
........................
106,017
2. Statement for Determining
Continuing Eligibility Supplemental
Security Income Payment—20 CFR
416.204—0960–0145. SSA uses Form
SSA–8202–BK to conduct low and
middle error profile telephone or faceto-face redetermination interviews with
Supplemental Security Income (SSI)
recipients and representative payees
(RP). The information SSA collects
during the interview is necessary to
determine whether SSI recipients met
and continue to meet all statutory and
regulatory requirements for SSI
Number of
responses
Modality of completion
eligibility and whether they received,
and are still receiving, the correct
payment amount.
Type of Request: Revision of an OMBapproved information collection.
Average
burden per
response
(minutes)
Frequency of
response
Estimated total
annual burden
(hours)
SSA–8202–BK .................................................................................................
Modernized SSI Claims System ......................................................................
6,633
71,444
1
1
21
20
2,322
23,815
Total ..........................................................................................................
78,077
........................
........................
26,137
pmangrum on DSK3VPTVN1PROD with NOTICES
3. Notice Regarding Substitution of
Party Upon Death of Claimant—
Reconsideration of Disability
Cessation—20 CFR 404.917–404.921
and 416.1407–416.1421—0960–0351.
When a claimant dies before we make
a determination on that person’s request
for reconsideration of a disability
cessation, SSA seeks a qualified
substitute party to pursue the appeal. If
SSA locates a qualified substitute party,
the agency uses Form SSA–770 to
collect information about whether to
pursue or withdraw the reconsideration
request. We use this information as the
basis for the decision to continue or
discontinue with the appeals process.
Respondents are substitute applicants
who are pursuing a reconsideration
request for a deceased claimant.
Type of Request: Revision of an OMBapproved information collection.
Modality of completion
Number of
responses
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–770 ..........................................................................................................
1,200
1
5
100
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Federal Register / Vol. 77, No. 230 / Thursday, November 29, 2012 / Notices
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 30
days from the date of this publication.
To be sure we consider your comments,
we must receive them no later than
December 31, 2012. Individuals can
obtain copies of the OMB clearance
information to SSA; the agency then
determines if the respondents continue
to be entitled to benefits, and if so, the
proper amount of these benefits. The
respondents are Social Security
beneficiaries receiving title II SSA
retirement, disability, or survivor’s
auxiliary benefits who need to report an
event that could affect their payments.
Type of Request: Revision of an OMBapproved information collection.
packages by writing to
OR.Reports.Clearance@ssa.gov.
1. Reporting Changes that Affect Your
Social Security Payment—20 CFR
404.301–305, 404.310–311, 404.330–
.333, 404.335–.341, 404.350–.352, and
404.468—0960–0073. When Social
Security beneficiaries experience a
change that could affect their payments,
they must report these changes to SSA.
Title II beneficiaries in this category use
Form SSA–1425 to report the relevant
Modality of completion
Number of
responses
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–1425 ........................................................................................................
70,000
1
5
5,833
2. State Supplementation Provisions:
Agreement; Payments—20 CFR
416.2095–416.2098, 416.2099—0960–
0240. Section 1618 of the Social
Security Act (Act) contains pass-along
provisions of the Social Security
amendments. These provisions require
states that supplement Federal SSI
determine a state’s eligibility for
Medicaid reimbursement. Respondents
are state agencies administering
supplemental programs.
Type of Request: Extension of an
OMB-approved information collection.
payments to pass along Federal cost-ofliving increases to individuals who are
eligible for state supplemental
payments. If a state fails to keep
payments at the required level, it
becomes ineligible for Medicaid
reimbursement under title XIX of the
Act. SSA uses the information to
Number of
respondents
State reporting method
Average
burden per
response
(minutes)
Frequency of
response
Estimated
total annual
burden
(hours)
Total Expenditures ...........................................................................................
Maintenance of Payment Levels .....................................................................
7
24
4
1
60
60
28
24
Total ..........................................................................................................
31
........................
........................
52
3. Substitution of Party Upon Death of
Claimant—20 CFR 404.957(c)(4) and
416.1457(c)(4)—0960–0288. An
administrative law judge (ALJ) may
dismiss a request for a hearing on a
pending claim of a deceased individual
for Social Security benefits or SSI
payments. Individuals who believe they
may be adversely affected by the
dismissal may ask to be a substitute
party for the deceased claimant by
completing Form HA–539. The ALJs
and the hearing office support staff use
this information to (1) maintain a
written record of the request; (2)
establish the relationship of the
requester to the deceased claimant; (3)
determine the substituted individual’s
wishes regarding an oral hearing or
decision on the record; and (4) admit
the data into the claimant’s official
record as an exhibit. The respondents
are individuals requesting to be a
substitute party for a deceased claimant.
Type of Request: Revision of an OMBapproved information collection.
Number of
responses
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
hours)
HA–539 ............................................................................................................
pmangrum on DSK3VPTVN1PROD with NOTICES
Modality of completion
4,000
1
5
333
4. Continuation of SSI Benefits for the
Temporarily Institutionalized—
Certification of Period and Need to
Maintain Home—20 CFR
416.212(b)(1)—0960–0516. When SSI
recipients (1) enter a public institution
or (2) enter a private medical treatment
facility with Medicaid paying more than
50 percent of expenses, SSA must
reduce recipients’ SSI payments to a
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Jkt 229001
nominal sum. However, if this
institutionalization is temporary
(defined as a maximum of three
months), SSA may waive the reduction.
Before SSA can waive the SSI
payment reduction, the agency must
receive the following documentation: (1)
A physician’s certification stating the
SSI recipient will only be
institutionalized for a maximum of three
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Frm 00039
Fmt 4703
Sfmt 4703
months and (2) certification from the
recipient, the recipient’s family, or
friends confirming SSI payments are
needed to maintain the living
arrangements to which the individual
will return post-institutionalization. The
respondents are SSI recipients, their
family or friends, and doctors.
Type of Request: Extension of an
OMB-approved information collection.
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Federal Register / Vol. 77, No. 230 / Thursday, November 29, 2012 / Notices
Modality of completion
Number of
responsdents
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
hours)
Certifications from physicians and other respondents ....................................
60,000
1
5
5,000
5. Privacy and Disclosure of Official
Records and Information; Availability of
Information and Records to the Public—
20 CFR 401.40(b)&(c), 401.55(b),
401.100(a), 402.130, 402.185—0960–
0566. SSA established methods for the
public to: (1) Access their SSA records;
(2) allow SSA to disclose records; (3)
with the exception of the consent for
release of records, for which there is
Form SSA–3288. The respondents are
individuals requesting access to,
correction of, or disclosure of SSA
records.
Type of Request: Revision of an OMBapproved information collection.
correct or amend their SSA records; (4)
consent to release of their records; (5)
request records under the Freedom of
Information Act (FOIA); and (6) request
SSA waive or reduce fees normally
charged for release of FOIA. SSA often
collects the necessary information for
these requests through a written letter,
Number of
responses
Modality of completion
Average
burden per
response
(minutes)
Frequency of
response
Estimated total
annual burden
hours)
Access to Records ...........................................................................................
Designating a Representative for Disclosure of Records ...............................
Amendment of Records ...................................................................................
Consent of Release of Records ......................................................................
FOIA Requests for Records ............................................................................
Waiver/Reduction of Fees ...............................................................................
10,000
3,000
100
3,000,000
15,000
400
1
1
1
1
1
1
11
120
10
3
5
5
1,833
6,000
17
150,000
1,250
33
Total ..........................................................................................................
3,028,500
........................
........................
159,133
6. Representative Payee Report of
Benefits and Dedicated Account—20
CFR 416.546, 416.635, 416.640,
416.665—0960–0576. SSA requires
representative payees (RPs) to submit a
written report accounting for the use of
money paid to Social Security
beneficiaries or SSI recipients, and to
establish and maintain a dedicated
account for these payments. SSA uses
Form SSA–6233 to ensure the RPs are
use the benefits for the beneficiary’s or
recipient’s current maintenance and
personal needs, and the expenditures of
funds from the dedicated account are in
compliance with the law. Respondents
are RPs for SSI recipients and Social
Security beneficiaries.
Type of Request: Revision of an OMBapproved information collection.
Modality of completion
Number of
respondents
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
hours)
SSA–6233 ........................................................................................................
30,000
1
20
10,000
7. Application for Circuit Court Law—
20 CFR 404.985 & 416.1458—0960–
0581. Persons claiming an acquiescence
ruling (AR) would change SSA’s prior
determination or decision must submit
a written readjudication request with
specific information. SSA reviews the
information in the requests to determine
if the issues stated in the AR pertain to
the claimant’s case, and if the claimant
is entitled to readjudication. If
readjudication is appropriate, SSA
considers the issues the AR covers. Any
new determination or decision is subject
to administrative or judicial review as
specified in the regulations.
Number of
respondents
Modality of completion
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AR-based Readjudication Requests ................................................................
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Respondents are claimants for Social
Security benefits and SSI payments who
request readjudication. This information
collection request is for the information
claimants must provide to request
readjudication.
Type of Request: Extension of an
OMB-approved information collection.
Frequency of
response
10,000
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Average
burden per
response
(minutes)
17
Estimated total
annual burden
hours)
2,833
Federal Register / Vol. 77, No. 230 / Thursday, November 29, 2012 / Notices
Dated: November 26, 2012.
Faye Lipsky,
Reports Clearance Director, Social Security
Administration.
[FR Doc. 2012–28891 Filed 11–28–12; 8:45 am]
BILLING CODE 4191–02–P
DEPARTMENT OF TRANSPORTATION
Federal Highway Administration
Notice of Final Federal Agency Actions
on Proposed Highway and Bridge in
the Cities of Cincinnati, Ohio, and
Covington, Kentucky
Federal Highway
Administration (FHWA), DOT.
ACTION: Notice; correction.
AGENCY:
claim is filed 150 days after publication
of a notice in the Federal Register. As
such, any claim seeking judicial review
of the above referenced highway project
will be barred unless the claim is filed
on or before April 1, 2013. Also, if the
Federal law that authorizes judicial
review of a claim provides a time period
of less than 150 days for filing such a
claim, then that shorter time period still
applies.
Authority: 23 U.S.C. 139(l); Sec. 1308, Pub.
L. 112–141, 126 Stat. 405.
Issued on: November 21, 2012.
Robert L. Griffith,
Assistant Division Administrator, Columbus,
Ohio.
[FR Doc. 2012–28912 Filed 11–28–12; 8:45 am]
BILLING CODE 4910–22–P
This notice corrects an error
in the FHWA notice published on
November 2, 2012, at 77 FR 66215. That
notice provided an incorrect reference
to a statute of limitations timeframe, and
an incorrect date.
DATES: This notice is effective
November 29, 2012.
FOR FURTHER INFORMATION CONTACT: Noel
F. Mehlo Jr., Environmental Program
Manager, Federal Highway
Administration, 200 North High Street,
Room 328, Columbus, Ohio 43215,
Telephone: (614) 280–6896; or Stefan
Spinosa, PE, Ohio Department of
Transportation (ODOT), 505 South State
Route 741, Lebanon, Ohio 45036,
Telephone: (513) 933–6639.
SUPPLEMENTARY INFORMATION: On
November 2, 2012, at 77 FR 66215, the
FHWA published a notice regarding
actions taken by the FHWA, United
States Army Corps of Engineers
(USACE), and other Federal agencies
that are final within the meaning of 23
U.S.C. 139(l)(1). The actions relate to a
proposed highway project to improve
Interstate 71 and Interstate 75, including
interchanges and a new bridge over the
Ohio River in the City of Cincinnati,
Hamilton County, State of Ohio and the
City of Covington, Kenton County,
Commonwealth of Kentucky.
The original notice indicated that
claims seeking judicial review of the
Federal agency actions on the highway
project will be barred unless the claim
is filed on or before May 1, 2013, which
represents 180 days after publication in
the Federal Register. However, the
recently enacted ‘‘Moving Ahead for
Progress in the 21st Century Act’’
(MAP–21) (Sec. 1308, Pub. L. 112–141,
126 STAT. 405), amended 23 U.S.C.
139(l)(1) as of October 1, 2012, to
provide that any claim seeking judicial
review of the Federal agency actions on
a highway project is barred unless the
pmangrum on DSK3VPTVN1PROD with NOTICES
SUMMARY:
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Jkt 229001
DEPARTMENT OF THE TREASURY
Submission for OMB Review;
Comment Request
November 26, 2012.
The Department of the Treasury will
submit the following information
collection request to the Office of
Management and Budget (OMB) for
review and clearance in accordance
with the Paperwork Reduction Act of
1995, Public Law 104–13, on or after the
date of publication of this notice.
DATES: Comments should be received on
or before December 31, 2012 to be
assured of consideration.
ADDRESSES: Send comments regarding
the burden estimate, or any other aspect
of the information collection, including
suggestion for reducing the burden, to
(1) Office of Information and Regulatory
Affairs, Office of Management and
Budget, Attention: Desk Officer for
Treasury, New Executive Office
Building, Room 10235, Washington, DC
20503, or email at
OIRA_Submission@OMB.EOP.GOV and
(2) Treasury PRA Clearance Officer,
1750 Pennsylvania Ave. NW., Suite
8140, Washington, DC 20220, or email
at PRA@treasury.gov.
FOR FURTHER INFORMATION CONTACT:
Copies of the submission(s) may be
obtained by calling (202) 927–5331,
email at PRA@treasury.gov, or the entire
information collection request maybe
found at www.reginfo.gov.
Alcohol and Tobacco Tax and Trade
Bureau (TTB)
OMB Number: 1513–0010.
Type of Review: Extension without
change of a currently approved
collection.
Title: Formula and Process for Wine.
Form: TTB F 5120.29.
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71207
Abstract: TTB F 5120.29 is used to
determine the classification of wines for
labeling and consumer protection. The
form is used to describe the person
filing, the type of product to be made,
and the process by which the product is
made. The form is also used to audit a
product.
Affected Public: Private Sector:
Businesses or other for-profits.
Estimated Total Burden Hours: 1,200.
OMB Number: 1513–0028.
Type of Review: Revision of a
currently approved collection.
Title: Application for an Industrial
Alcohol User Permit.
Form: TTB F 5150.22.
Abstract: TTB F 5150.22 is used to
determine the eligibility of the applicant
to engage in certain operations and the
extent of the operations for the
production and distribution of specially
denatured spirits (alcohol/rum) and the
use of tax-free alcohol under 27 CFR
22.41. This form identifies the location
of the premises and establishes whether
the premises will be in conformity with
Federal laws and regulations.
Affected Public: Private Sector:
Businesses or other for-profits.
Estimated Total Burden Hours: 419.
OMB Number: 1513–0047.
Type of Review: Extension without
change of a currently approved
collection.
Title: Distilled Spirits Records (TTB
REC 5110/01) and Monthly Report of
Production Operations.
Form: TTB F 5110.40.
Abstract: The information collected is
used to account for proprietor’s tax
liability and adequacy of bond coverage,
for protection of the revenue. The
information also provides data to
analyze trends in the industry, plan
efficient allocation of field resources,
and compile statistics for government
economic analysis.
Affected Public: Private Sector:
Businesses or other for-profits.
Estimated Total Burden Hours: 3,600.
OMB Number: 1513–0048.
Type of Review: Revision of a
currently approved collection.
Title: Registration of Distilled Spirits
Plants and Miscellaneous Requests and
Notices and Distilled Spirits Plans.
Form: TTB F 5110.41.
Abstract: The information provided
by the applicants assists TTB in
determining eligibility and providing for
registration. These eligibility
requirements are for persons who wish
to establish distilled spirits plant
operations. In addition, both statutes
and regulations allow variances from
regulations, and the information
collected enables TTB to determine
whether a variance can be approved.
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]]>Agencies
[Federal Register Volume 77, Number 230 (Thursday, November 29, 2012)]
[Notices]
[Pages 71204-71207]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-28891]
[[Page 71204]]
=======================================================================
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SOCIAL SECURITY ADMINISTRATION
Agency Information Collection Activities: Proposed Request and
Comment Request
The Social Security Administration (SSA) publishes a list of
information collection packages requiring clearance by the Office of
Management and Budget (OMB) in compliance with Public Law 104-13, the
Paperwork Reduction Act of 1995, effective October 1, 1995. This notice
includes revisions to 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 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
Director, 107 Altmeyer Building, 6401 Security Blvd., Baltimore, MD
21235, Fax: 410-966-2830, Email address: OR.Reports.Clearance@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
January 28, 2013. Individuals can obtain copies of the collection
instruments by writing to the above email address.
1. Application for Widow's or Widower's Insurance Benefits--20 CFR
404.335-404.338, & 404.603--0960-0004. Since SSA needs information to
make a formal determination for entitlement to widow(er)'s benefits, we
use Form SSA-10-BK to determine whether an applicant meets the
statutory and regulatory conditions for entitlement to widow(er)'s
title II benefits. SSA employees interview individuals applying for
benefits either face-to-face or via telephone and enter the information
on the paper form or into the Modernized Claims System (MCS). The
respondents are applicants for widow(er)'s benefits.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average Estimated
Number of Frequency of burden per total annual
Modality of completion respondents response response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-10-BK--paper version........................ 5,000 1 15 1,250
SSA-10-BK--MCS version.......................... 449,000 1 14 104,767
---------------------------------------------------------------
Total....................................... 454,000 .............. .............. 106,017
----------------------------------------------------------------------------------------------------------------
2. Statement for Determining Continuing Eligibility Supplemental
Security Income Payment--20 CFR 416.204--0960-0145. SSA uses Form SSA-
8202-BK to conduct low and middle error profile telephone or face-to-
face redetermination interviews with Supplemental Security Income (SSI)
recipients and representative payees (RP). The information SSA collects
during the interview is necessary to determine whether SSI recipients
met and continue to meet all statutory and regulatory requirements for
SSI eligibility and whether they received, and are still receiving, the
correct payment amount.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average Estimated
Number of Frequency of burden per total annual
Modality of completion responses response response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-8202-BK..................................... 6,633 1 21 2,322
Modernized SSI Claims System.................... 71,444 1 20 23,815
---------------------------------------------------------------
Total....................................... 78,077 .............. .............. 26,137
----------------------------------------------------------------------------------------------------------------
3. Notice Regarding Substitution of Party Upon Death of Claimant--
Reconsideration of Disability Cessation--20 CFR 404.917-404.921 and
416.1407-416.1421--0960-0351. When a claimant dies before we make a
determination on that person's request for reconsideration of a
disability cessation, SSA seeks a qualified substitute party to pursue
the appeal. If SSA locates a qualified substitute party, the agency
uses Form SSA-770 to collect information about whether to pursue or
withdraw the reconsideration request. We use this information as the
basis for the decision to continue or discontinue with the appeals
process. Respondents are substitute applicants who are pursuing a
reconsideration request for a deceased claimant.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
responses response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-770..................................... 1,200 1 5 100
----------------------------------------------------------------------------------------------------------------
[[Page 71205]]
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 30 days from the date of this
publication. To be sure we consider your comments, we must receive them
no later than December 31, 2012. Individuals can obtain copies of the
OMB clearance packages by writing to OR.Reports.Clearance@ssa.gov.
1. Reporting Changes that Affect Your Social Security Payment--20
CFR 404.301-305, 404.310-311, 404.330-.333, 404.335-.341, 404.350-.352,
and 404.468--0960-0073. When Social Security beneficiaries experience a
change that could affect their payments, they must report these changes
to SSA. Title II beneficiaries in this category use Form SSA-1425 to
report the relevant information to SSA; the agency then determines if
the respondents continue to be entitled to benefits, and if so, the
proper amount of these benefits. The respondents are Social Security
beneficiaries receiving title II SSA retirement, disability, or
survivor's auxiliary benefits who need to report an event that could
affect their payments.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
responses response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1425.................................... 70,000 1 5 5,833
----------------------------------------------------------------------------------------------------------------
2. State Supplementation Provisions: Agreement; Payments--20 CFR
416.2095-416.2098, 416.2099--0960-0240. Section 1618 of the Social
Security Act (Act) contains pass-along provisions of the Social
Security amendments. These provisions require states that supplement
Federal SSI payments to pass along Federal cost-of-living increases to
individuals who are eligible for state supplemental payments. If a
state fails to keep payments at the required level, it becomes
ineligible for Medicaid reimbursement under title XIX of the Act. SSA
uses the information to determine a state's eligibility for Medicaid
reimbursement. Respondents are state agencies administering
supplemental programs.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average
Number of Frequency of burden per Estimated
State reporting method respondents response response total annual
(minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
Total Expenditures.............................. 7 4 60 28
Maintenance of Payment Levels................... 24 1 60 24
---------------------------------------------------------------
Total....................................... 31 .............. .............. 52
----------------------------------------------------------------------------------------------------------------
3. Substitution of Party Upon Death of Claimant--20 CFR
404.957(c)(4) and 416.1457(c)(4)--0960-0288. An administrative law
judge (ALJ) may dismiss a request for a hearing on a pending claim of a
deceased individual for Social Security benefits or SSI payments.
Individuals who believe they may be adversely affected by the dismissal
may ask to be a substitute party for the deceased claimant by
completing Form HA-539. The ALJs and the hearing office support staff
use this information to (1) maintain a written record of the request;
(2) establish the relationship of the requester to the deceased
claimant; (3) determine the substituted individual's wishes regarding
an oral hearing or decision on the record; and (4) admit the data into
the claimant's official record as an exhibit. The respondents are
individuals requesting to be a substitute party for a deceased
claimant.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
responses response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
HA-539...................................... 4,000 1 5 333
----------------------------------------------------------------------------------------------------------------
4. Continuation of SSI Benefits for the Temporarily
Institutionalized--Certification of Period and Need to Maintain Home--
20 CFR 416.212(b)(1)--0960-0516. When SSI recipients (1) enter a public
institution or (2) enter a private medical treatment facility with
Medicaid paying more than 50 percent of expenses, SSA must reduce
recipients' SSI payments to a nominal sum. However, if this
institutionalization is temporary (defined as a maximum of three
months), SSA may waive the reduction.
Before SSA can waive the SSI payment reduction, the agency must
receive the following documentation: (1) A physician's certification
stating the SSI recipient will only be institutionalized for a maximum
of three months and (2) certification from the recipient, the
recipient's family, or friends confirming SSI payments are needed to
maintain the living arrangements to which the individual will return
post-institutionalization. The respondents are SSI recipients, their
family or friends, and doctors.
Type of Request: Extension of an OMB-approved information
collection.
[[Page 71206]]
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
responsdents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
Certifications from physicians and other 60,000 1 5 5,000
respondents................................
----------------------------------------------------------------------------------------------------------------
5. Privacy and Disclosure of Official Records and Information;
Availability of Information and Records to the Public--20 CFR
401.40(b)&(c), 401.55(b), 401.100(a), 402.130, 402.185--0960-0566. SSA
established methods for the public to: (1) Access their SSA records;
(2) allow SSA to disclose records; (3) correct or amend their SSA
records; (4) consent to release of their records; (5) request records
under the Freedom of Information Act (FOIA); and (6) request SSA waive
or reduce fees normally charged for release of FOIA. SSA often collects
the necessary information for these requests through a written letter,
with the exception of the consent for release of records, for which
there is Form SSA-3288. The respondents are individuals requesting
access to, correction of, or disclosure of SSA records.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average Estimated
Number of Frequency of burden per total annual
Modality of completion responses response response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
Access to Records............................... 10,000 1 11 1,833
Designating a Representative for Disclosure of 3,000 1 120 6,000
Records........................................
Amendment of Records............................ 100 1 10 17
Consent of Release of Records................... 3,000,000 1 3 150,000
FOIA Requests for Records....................... 15,000 1 5 1,250
Waiver/Reduction of Fees........................ 400 1 5 33
---------------------------------------------------------------
Total....................................... 3,028,500 .............. .............. 159,133
----------------------------------------------------------------------------------------------------------------
6. Representative Payee Report of Benefits and Dedicated Account--
20 CFR 416.546, 416.635, 416.640, 416.665--0960-0576. SSA requires
representative payees (RPs) to submit a written report accounting for
the use of money paid to Social Security beneficiaries or SSI
recipients, and to establish and maintain a dedicated account for these
payments. SSA uses Form SSA-6233 to ensure the RPs are use the benefits
for the beneficiary's or recipient's current maintenance and personal
needs, and the expenditures of funds from the dedicated account are in
compliance with the law. Respondents are RPs for SSI recipients and
Social Security beneficiaries.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-6233.................................... 30,000 1 20 10,000
----------------------------------------------------------------------------------------------------------------
7. Application for Circuit Court Law--20 CFR 404.985 & 416.1458--
0960-0581. Persons claiming an acquiescence ruling (AR) would change
SSA's prior determination or decision must submit a written
readjudication request with specific information. SSA reviews the
information in the requests to determine if the issues stated in the AR
pertain to the claimant's case, and if the claimant is entitled to
readjudication. If readjudication is appropriate, SSA considers the
issues the AR covers. Any new determination or decision is subject to
administrative or judicial review as specified in the regulations.
Respondents are claimants for Social Security benefits and SSI payments
who request readjudication. This information collection request is for
the information claimants must provide to request readjudication.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average Estimated
Number of Frequency of burden per total annual
Modality of completion respondents response response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
AR-based Readjudication Requests................ 10,000 1 17 2,833
----------------------------------------------------------------------------------------------------------------
[[Page 71207]]
Dated: November 26, 2012.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2012-28891 Filed 11-28-12; 8:45 am]
BILLING CODE 4191-02-P
