Agency Information Collection Activities: Proposed Request and Comment Request, 10623-10627 [2017-02941]

Download as PDF Federal Register / Vol. 82, No. 29 / Tuesday, February 14, 2017 / Notices For the Commission, by the Division of Trading and Markets, pursuant to delegated authority.27 Eduardo A. Aleman, Assistant Secretary. [FR Doc. 2017–02910 Filed 2–13–17; 8:45 am] Percent Non-Profit Organizations Without Credit Available Elsewhere ..................................... 2.500 The number assigned to this disaster for physical damage is 15041C and for economic injury is 15042C. BILLING CODE 8011–01–P SMALL BUSINESS ADMINISTRATION [Disaster Declaration #15041 and #15042] (Catalog of Federal Domestic Assistance Number 59008) James E. Rivera, Associate Administrator for Disaster Assistance. Mississippi Disaster #MS–00098 U.S. Small Business Administration. ACTION: Notice. [FR Doc. 2017–02908 Filed 2–13–17; 8:45 am] This is a Notice of the Presidential declaration of a major disaster for Public Assistance Only for the State of Mississippi (FEMA–4295– DR), dated 02/06/2017. Incident: Severe Storms, Tornadoes, Straight-line Winds, and Flooding. Incident Period: 01/20/2017 through 01/21/2017. Effective Date: 02/06/2017. Physical Loan Application Deadline Date: 04/07/2017. Economic Injury (EIDL) Loan Application Deadline Date: 11/06/2017. 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, Washington, DC 20416. SUPPLEMENTARY INFORMATION: Notice is hereby given that as a result of the President’s major disaster declaration on 02/06/2017, Private Non-Profit organizations that provide essential services of governmental nature may file disaster loan applications 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: Forrest, Lamar, Perry. The Interest Rates are: SMALL BUSINESS ADMINISTRATION AGENCY: sradovich on DSK3GMQ082PROD with NOTICES Percent For Physical Damage: Non-Profit Organizations With Credit Available Elsewhere ... Non-Profit Organizations Without Credit Available Elsewhere ..................................... For Economic Injury: 27 17 2.500 2.500 CFR 200.30–3(a)(12). VerDate Sep<11>2014 16:48 Feb 13, 2017 Jkt 241001 Percent For Physical Damage: Non-Profit Organizations with Credit Available Elsewhere ... Non-Profit Organizations without Credit Available Elsewhere ..................................... For Economic Injury: Non-Profit Organizations without Credit Available Elsewhere ..................................... 2.500 2.500 2.500 The number assigned to this disaster for physical damage is 15043C and for economic injury is 15044C. (Catalog of Federal Domestic Assistance Number 59008) BILLING CODE 8025–01–P SUMMARY: 10623 [Disaster Declaration #15043 and #15044] James E. Rivera, Associate Administrator for Disaster Assistance. [FR Doc. 2017–02907 Filed 2–13–17; 8:45 am] Georgia Disaster #GA–00092 BILLING CODE 8025–01–P U.S. Small Business Administration. ACTION: Notice. AGENCY: SOCIAL SECURITY ADMINISTRATION This is a Notice of the Presidential declaration of a major disaster for Public Assistance Only for the State of Georgia (FEMA–4297–DR), dated 02/07/2017. Incident: Severe Storms, Tornadoes, Straight-line Winds, and Flooding. Incident Period: 01/21/2017 through 01/22/2017. Effective Date: 02/07/2017. Physical Loan Application Deadline Date: 04/10/2017. Economic Injury (EIDL) Loan Application Deadline Date: 11/07/2017. 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, Washington, DC 20416. SUPPLEMENTARY INFORMATION: Notice is hereby given that as a result of the President’s major disaster declaration on 02/07/2017, Private Non-Profit organizations that provide essential services of governmental nature may file disaster loan applications 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: Baker, Brooks, Calhoun, Clay, Cook, Crisp, Dougherty, Thomas, Turner, Wilcox, Worth. The Interest Rates are: SUMMARY: PO 00000 Frm 00062 Fmt 4703 Sfmt 4703 [Docket No: SSA–2017–0003] 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 a new information collection and 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, OLCA, Attn: Reports Clearance Director, 3100 West High Rise, 6401 Security Blvd., Baltimore, MD 21235, Fax: 410–966–2830, Email address: OR.Reports.Clearance@ssa.gov Or you may submit your comments online through www.regulations.gov, E:\FR\FM\14FEN1.SGM 14FEN1 10624 Federal Register / Vol. 82, No. 29 / Tuesday, February 14, 2017 / Notices referencing Docket ID Number [SSA– 2017–0003]. 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 17, 2017. Individuals can obtain copies of the collection instruments by writing to the above email address. 1. Supported Employment Demonstration (SED) Project—0960– NEW. Sponsored by SSA, the SED project builds on the success of the intervention designed for the Mental Health Treatment Study (MHTS) previously funded by SSA. The MHTS provides integrated mental health and vocational services to disability beneficiaries with mental illness. The SED will offer these same services to individuals with mental illness for whom SSA denied Social Security disability benefits. SSA seeks to determine whether offering this evidence-based package of integrated vocational and mental health services to denied disability applicants fosters employment that leads to selfsufficiency; improved mental health and quality of life; and reduced demand for disability benefits. The SED will use a randomized controlled trial to compare the outcomes of two treatment groups and a control group. Study participation spans 36 months beginning on the day following the date of randomization to one of the three study groups. The SED study population consists of individuals aged 18 to 50 who apply for disability benefits alleging a mental illness, and the initial decision is a denial of benefits in the past 60 days. The SED will enroll up to 1,000 participants in each of the three study arms for a total of 3,000 participants: 40 participants in each of three study arms for the 20 urban sites equaling an n of 2,400 urban site participants, and 20 participants in each of three arms for the 10 rural sites equaling an n of 600 rural site participants. We randomly select and assign each enrolled participant to one of three study arms: • Full-Service Treatment (n = 1,000). The multi-component service model from the MHTS comprises the FullService Treatment. At its core, it includes an Individual Placement and Support (IPS) supported employment specialist and behavioral health specialist providing IPS supported employment services integrated with behavioral health care. Participants in the full-service treatment group will also receive the services of a Nurse Care Coordinator who coordinates Systematic Medication Management services, as well assistance with: Out-of-pocket expenses associated with prescription behavioral health medications; workrelated expenses; and services and treatment not covered by the participant’s health insurance. • Basic-Service Treatment (n = 1,000). The Basic-Service Treatment model leaves intact IPS supported employment integrated with behavioral health services as the centerpiece of the intervention arm. The Basic-Service Treatment is essentially the Full-Service model without the services of the Nurse Care Coordinator; Systematic Medication Management; and the funds associated with out-of-pocket expenses for prescription behavioral health medications. • Usual Services (n = 1,000). This study arm represents a control group against which we can compare the two treatment groups. Participants assigned to this group seek services as they normally would (or would not) in their community. However, at the time of randomization, each Usual Service participant will receive a comprehensive manual describing Number of respondents sradovich on DSK3GMQ082PROD with NOTICES Modality of completion mental health and vocational services in their locale, along with state and national resources. This study will test the two treatment conditions against each other and against the control group on multiple outcomes of policy interest to SSA. The key outcomes of interest include: (1) Employment; (2) earnings; (3) income; (4) mental status; (5) quality of life; (6) health services utilization; and (7) SSA disability benefit receipt and amount. SSA is also interested in the study take up rate (participation); knowing who enrolls (and who does not); and fidelity to evidence-based treatments; among other aspects of implementation. Data collection for the evaluation of the SED will consist of the following activities: Baseline in-person participant interviews; quarterly participant telephone interviews; receipt of SSA administrative record data; and collection of site-level program data. Evaluation team members will also conduct site visits involving: (1) Previsit environmental scans to understand the local context in which we embed SED services; (2) independent fidelity assessments in conjunction with those carried out by state Mental Health or Vocational Rehabilitation staff; (3) key informant interviews with the IPS specialist, the nurse care coordinator, the case manager, and facility director; (4) focus groups with participants in the Full-Service and Basic-Service Treatment groups; and (5) ethnographic data collection consisting of observations in the natural environment, and person-centered interviews with participants and nonparticipants. The respondents are study participants and non-participants; family members; IPS specialists; nurse care coordinators; case managers; and facility directors. Type of Request: Request for a new information collection. Average burden per response (minutes) Frequency of response Estimated total annual burden (hours) Competency and CIDI Screener ...................................................................... Baseline Interview ............................................................................................ Quarterly Interview (Quarters 1, 2, 3, 5, 6, 7, 9, 10, and 11) ......................... Annual Interview (Quarters 4, 8, and 11) ........................................................ Fidelity Assessment Participant Interview ....................................................... Fidelity Assessment Family Member Interview ............................................... Key Informant Interview ................................................................................... Participant Focus Groups ................................................................................ Person-Centered Interview .............................................................................. 3,000 3,000 3,000 3,000 180 90 120 600 180 1 1 9 3 4 4 4 2 4 40 45 20 30 60 60 60 60 60 2,000 2,250 9,000 4,500 720 360 480 1,200 720 Totals ........................................................................................................ 13,170 ........................ ........................ 21,230 VerDate Sep<11>2014 16:48 Feb 13, 2017 Jkt 241001 PO 00000 Frm 00063 Fmt 4703 Sfmt 4703 E:\FR\FM\14FEN1.SGM 14FEN1 10625 Federal Register / Vol. 82, No. 29 / Tuesday, February 14, 2017 / Notices 2. Student Reporting Form—20 CFR 404.352(b)(2); 404.367; 404.368; 404.415; 404.434; 422.135—0960–0088. To qualify for Social Security Title II student benefits, student beneficiaries must be in full-time attendance status at an educational institution. In addition, SSA requires these beneficiaries to report events that may cause a reduction, termination, or suspension of their benefits. SSA collects this information on Forms SSA–1383 and SSA–1383–FC to determine if the changes or events the student beneficiaries report will affect their continuing entitlement to SSA benefits. SSA also uses the SSA–1383 and SSA– 1383–FC to calculate the correct benefit amounts for student beneficiaries. The respondents are Social Security Title II student beneficiaries. Type of Request: Revision of an OMBapproved information collection. Number of respondents Modality of completion Average burden per response (minutes) Frequency of response Estimated total annual burden (hours) SSA–1383 ........................................................................................................ SSA–1383–FC ................................................................................................. 74,887 1,247 1 1 6 6 7,489 125 Totals ........................................................................................................ 76,134 ........................ ........................ 7,614 3. Advanced Notice of Termination of Child’s Benefits & Student’s Statement Regarding School Attendance—20 CFR 404.350–404.352, 404.367–404.368— 0960–0105. SSA collects information on Forms SSA–1372–BK and SSA–1372– student claimants for Social Security benefits; their respective schools; and in some cases; their representative payees. Type of Request: Revision of an OMBapproved information collection. BK–FC to determine whether children of an insured worker meet the eligibility requirements for student benefits. The data we collect allows SSA to determine student entitlement and thether to terminate benefits. The respondents are SSA–1372–BK Number of respondents Type of respondent Average burden per response (minutes) Frequency of response Estimated total annual burden (hours) Individuals/Households .................................................................................... State/Local/Tribal Government ........................................................................ 99,850 99,850 1 1 8 3 13,313 4,993 Totals ........................................................................................................ 199,700 ........................ ........................ 18,306 Frequency of response Average burden per response (minutes) SSA–1372–BK–FC Number of respondents Type of respondent Estimated total annual burden (hours) 1,198 1,198 1 1 8 3 160 60 Totals ........................................................................................................ 2,396 ........................ ........................ 220 Grand Total ............................................................................................... sradovich on DSK3GMQ082PROD with NOTICES Individuals/Households .................................................................................... State/Local/Tribal Government ........................................................................ 200,096 ........................ ........................ 18,526 4. Request for Review of Hearing Decision/Order—20 CFR 404.967– 404.981, 416.1467–416.1481—0960– 0277. Claimants have a statutory right under the Social Security Act and current regulations to request review of an administrative law judge’s (ALJ) hearing decision or dismissal of a hearing request on Title II and Title XVI claims. Claimants may request Appeals Council review by filing a written request using Form HA–520. SSA uses the information to establish the claimant filed the request for review within the prescribed time and to ensure the claimant completed the requisite steps permitting the Appeals Council review. The Appeals Council uses the information to: (1) Document the claimant’s reason(s) for disagreeing with the ALJ’s decision or dismissal; (2) determine whether the claimant has additional evidence to submit; and (3) determine whether the claimant has a representative or wants to appoint one. The respondents are claimants requesting review of an ALJ’s decision or dismissal of hearing. 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) HA–520 ............................................................................................................ 175,000 1 10 29,167 VerDate Sep<11>2014 16:48 Feb 13, 2017 Jkt 241001 PO 00000 Frm 00064 Fmt 4703 Sfmt 4703 E:\FR\FM\14FEN1.SGM 14FEN1 10626 Federal Register / Vol. 82, No. 29 / Tuesday, February 14, 2017 / Notices 5. Disability Update Report—20 CFR 404.1589–404.1595 and 416.988– 416.996—0960–0511. As part of our statutory requirements, SSA periodically uses Form SSA–455, the Disability Update Report, to evaluate current Title II disability beneficiaries’ and Title XVI disability payment recipients’ continued eligibility for Social Security disability payments. Specifically, SSA uses the form to determine if: (1) There is enough evidence to warrant referring the respondent for a full medical Continuing Disability Review (CDR); (2) the respondent’s impairments are still present and indicative of no medical improvement, precluding the need for a CDR; or (3) the respondent has unresolved work-related issues. SSA mails Form SSA–455 to specific disability recipients, whom we select as possibly qualifying for the CDR process. SSA pre-fills the form with data specific to the disability recipient, except for the sections we ask the recipients to complete. When SSA receives the completed form, we scan it into SSA’s system. This allows us to gather the information electronically, and enables SSA to process the returned forms through automated decision logic to decide the proper course of action to take. The respondents are recipients of Title II and Title XVI Social Security disability payments. 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–455 .......................................................................................................... 1,500,000 1 15 375,000 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 March 16, 2017. Individuals can obtain copies of the OMB clearance package by writing to OR.Reports.Clearance@ ssa.gov. 1. Agreement to Sell Property—20 CFR 416.1240–1245—0960–0127. Individuals or couples who are otherwise eligible for Supplemental Security Income (SSI) payments, but whose resources exceed the allowable limit may receive conditional payments if they agree to dispose of the excess non-liquid resources and make repayments. SSA uses Form SSA–8060– U3 to document this agreement, and to ensure the individuals understand their obligations. Respondents are applicants for and recipients of SSI payments who will be disposing of excess non-liquid resources. 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–8060–U3 ................................................................................................. 20,000 1 10 3,333 2. Development of Participation in a Vocational Rehabilitation or Similar Program—20 CFR 404.316(c), 404.337(c), 404.352(d), 404.1586(g), 404.1596, 404.1597(a), 404.327, 404.328, 416.1321(d), 416.1331(a)–(b), and 416.1338, 416.1402—0960–0282. State Disability Determination Services (DDS) must determine if Social Security disability payment recipients whose disability ceased and who participate in vocational rehabilitation programs may continue to receive disability payments. To do this, DDSs need information about the recipients; the types of program participation; and the services they receive under the rehabilitation program. SSA uses Form SSA–4290 to collect this information. The respondents are State employment networks; vocational rehabilitation agencies; or other providers of educational or job training services. Type of Request: Revision of an OMBapproved information collection. Number of respondents Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) SSA–4290 ........................................................................................................ sradovich on DSK3GMQ082PROD with NOTICES Modality of completion 3,000 1 15 750 3. Appointment of Representative—20 CFR 404.1707, 404.1720, 408.1101, 416.1507, and 416.1520—0960–0527. Individuals claiming rights or benefits under the Social Security Act (Act) must notify SSA in writing when they appoint an individual to represent them in dealing with SSA. SSA collects the VerDate Sep<11>2014 16:48 Feb 13, 2017 Jkt 241001 information on Form SSA–1696–U4 to verify the appointment of these representatives. The SSA–1696–U4 allows SSA to inform representatives of items that affect the recipient’s claim, and allows claimants to give permission to their appointed representatives to designate a person to receive their PO 00000 Frm 00065 Fmt 4703 Sfmt 4703 claims files. Respondents are applicants for, or recipients of, Social Security disability benefits (SSDI) or SSI payments who are notifying SSA they have appointed a person to represent them in their dealings with SSA. Type of Request: Revision of an OMBapproved information collection. E:\FR\FM\14FEN1.SGM 14FEN1 Federal Register / Vol. 82, No. 29 / Tuesday, February 14, 2017 / Notices 10627 Modality of completion Number of respondents Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) SSA–1696–U4 ................................................................................................. 800,000 1 10 133,333 4. Work Activity Report (SelfEmployment)—20 CFR 404.1520(b), 20 CFR 404.1571–404.1576, 20 CFR 404.1584–404.1593, and 20 CFR 416.971–416.976—0960–0598. SSA uses Form SSA–820–U4 to determine initial or continuing eligibility for (1) Title II SSDI, or (2) Title XVI SSI payments. Under Titles II and XVI of the Act, recipients receive disability benefits and SSI payments based on their inability to engage in substantial gainful activity (SGA) due to a physical or mental condition. Therefore, when the recipients resume work, they must report their work so SSA can evaluate and determine by law whether they continue to meet the disability requirements. SSA uses Form SSA–820– U4 to obtain information on selfemployment activities of Social Security Title II and XVI disability applicants and recipients. We use the data we obtain to evaluate disability claims, and to help us determine if the claimant meets current disability provisions under Titles II and XVI. Since applicants for disability benefits or payments must prove an inability to perform any kind of SGA generally available in the national economy for which we expect them to qualify based on age, education, and work experience, any work an applicant performed until, or subsequent to, the date the disability allegedly began, affects our disability determination. The respondents are applicants and claimants for SSI payments or SSDI benefits. 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–820–BK ................................................................................................... 100,000 1 30 50,000 Dated: February 9, 2017. Naomi R. Sipple, Reports Clearance Officer, Social Security Administration. [FR Doc. 2017–02941 Filed 2–13–17; 8:45 am] BILLING CODE 4191–02–P DEPARTMENT OF TRANSPORTATION Federal Highway Administration Notice of Final Federal Agency Actions on Proposed Highway in California Federal Highway Administration (FHWA), DOT. ACTION: Notice of limitation on claims for Judicial Review of Actions by the California Department of Transportation (Caltrans), pursuant to 23 U.S.C. 327, and other federal agencies. AGENCY: The FHWA, on behalf of Caltrans, is issuing this notice to announce actions taken by Caltrans, that are final within the meaning of 23 U.S.C. 139(l)(1). The actions relate to a proposed highway project, on State Route 29, in the County of Lake, State of California. Those actions grant licenses, permits, and approvals for the project. DATES: By this notice, the FHWA, on behalf of Caltrans, is advising the public of final agency actions subject to 23 U.S.C. 139(l)(1). A claim seeking judicial review of the Federal agency actions on the highway project will be sradovich on DSK3GMQ082PROD with NOTICES SUMMARY: VerDate Sep<11>2014 16:48 Feb 13, 2017 Jkt 241001 barred unless the claim is filed on or before July 14, 2017. If the Federal law that authorizes judicial review of a claim provides a time period of less than 150 days for filing such claim, then that shorter time period still applies. FOR FURTHER INFORMATION CONTACT: For Caltrans: Chris Quiney, Branch Chief R– 1, Caltrans Environmental Planning Office—District 2, 1657 Riverside Drive, Redding, CA 96001, regular office hours 7:30 a.m.–4:15 p.m. Monday–Friday, telephone: (530) 225–3174, email: chris.quiney@dot.ca.gov. SUPPLEMENTARY INFORMATION: Effective July 1, 2007, the Federal Highway Administration (FHWA) assigned, and the California Department of Transportation (Caltrans) assumed, environmental responsibilities for this project pursuant to 23 U.S.C. 327. Notice is hereby given that the Caltrans has taken final agency actions subject to 23 U.S.C. 139(l)(1) by issuing licenses, permits, and approvals for the following highway project in the State of California: Widening and improvement of an eight-mile segment of State Route (SR) 29, beginning 0.2 miles east of Diener Drive and ending 0.6 miles west of the SR 175 intersection, in Lake County. The project will widen and improve the existing two-lane highway to a four-lane divided expressway with access control to provide a modern transportation facility that will provide adequate capacity to accommodate anticipated traffic growth and improve PO 00000 Frm 00066 Fmt 4703 Sfmt 4703 safety and operation of SR 29. The actions by the Federal agencies, and the laws under which such actions were taken, are described in the Environmental Assessment (EA) for the project, approved on November 23, 2016, in the FHWA Finding of No Significant Impact (FONSI) issued on November 23, 2016, and in other documents in the FHWA project records. The EA, FONSI, and other project records are available by contacting Caltrans at the addresses provided above. The Caltrans EA and FONSI can be viewed and downloaded from the project Web site at http:// www.dot.ca.gov/dist1/d1projects/ lake29/. This notice applies to all Federal agency decisions as of the issuance date of this notice and all laws under which such actions were taken, including but not limited to: 1. General: National Environmental Policy Act (NEPA) [42 U.S.C. 4321– 4351]; Federal Aid Highway Act [23 U.S.C. 109 and 23 U.S.C. 128] 2. Air: Clean Air Act [42 U.S.C. 7401– 7671(q)] 3. Land: Section 4(f) of the Department of Transportation Act of 1966 [49 U.S.C. 303] 4. Wildlife: Endangered Species Act [16 U.S.C. 1531–1544 and Section 1536]; Migratory Bird Treaty Act [16 U.S.C. 703–712] 5. Historic and Cultural Resources: Section 106 of the National Historic E:\FR\FM\14FEN1.SGM 14FEN1

Agencies

[Federal Register Volume 82, Number 29 (Tuesday, February 14, 2017)]
[Notices]
[Pages 10623-10627]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-02941]


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SOCIAL SECURITY ADMINISTRATION

[Docket No: SSA-2017-0003]


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 a new information collection and 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, OLCA, Attn: Reports Clearance 
Director, 3100 West High Rise, 6401 Security Blvd., Baltimore, MD 
21235, Fax: 410-966-2830, Email address: OR.Reports.Clearance@ssa.gov

    Or you may submit your comments online through www.regulations.gov,

[[Page 10624]]

referencing Docket ID Number [SSA-2017-0003].
    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 17, 2017. Individuals can obtain copies of the collection 
instruments by writing to the above email address.
    1. Supported Employment Demonstration (SED) Project--0960-NEW. 
Sponsored by SSA, the SED project builds on the success of the 
intervention designed for the Mental Health Treatment Study (MHTS) 
previously funded by SSA. The MHTS provides integrated mental health 
and vocational services to disability beneficiaries with mental 
illness. The SED will offer these same services to individuals with 
mental illness for whom SSA denied Social Security disability benefits. 
SSA seeks to determine whether offering this evidence-based package of 
integrated vocational and mental health services to denied disability 
applicants fosters employment that leads to self-sufficiency; improved 
mental health and quality of life; and reduced demand for disability 
benefits. The SED will use a randomized controlled trial to compare the 
outcomes of two treatment groups and a control group. Study 
participation spans 36 months beginning on the day following the date 
of randomization to one of the three study groups. The SED study 
population consists of individuals aged 18 to 50 who apply for 
disability benefits alleging a mental illness, and the initial decision 
is a denial of benefits in the past 60 days. The SED will enroll up to 
1,000 participants in each of the three study arms for a total of 3,000 
participants: 40 participants in each of three study arms for the 20 
urban sites equaling an n of 2,400 urban site participants, and 20 
participants in each of three arms for the 10 rural sites equaling an n 
of 600 rural site participants.
    We randomly select and assign each enrolled participant to one of 
three study arms:
     Full-Service Treatment (n = 1,000). The multi-component 
service model from the MHTS comprises the Full-Service Treatment. At 
its core, it includes an Individual Placement and Support (IPS) 
supported employment specialist and behavioral health specialist 
providing IPS supported employment services integrated with behavioral 
health care. Participants in the full-service treatment group will also 
receive the services of a Nurse Care Coordinator who coordinates 
Systematic Medication Management services, as well assistance with: 
Out-of-pocket expenses associated with prescription behavioral health 
medications; work-related expenses; and services and treatment not 
covered by the participant's health insurance.
     Basic-Service Treatment (n = 1,000). The Basic-Service 
Treatment model leaves intact IPS supported employment integrated with 
behavioral health services as the centerpiece of the intervention arm. 
The Basic-Service Treatment is essentially the Full-Service model 
without the services of the Nurse Care Coordinator; Systematic 
Medication Management; and the funds associated with out-of-pocket 
expenses for prescription behavioral health medications.
     Usual Services (n = 1,000). This study arm represents a 
control group against which we can compare the two treatment groups. 
Participants assigned to this group seek services as they normally 
would (or would not) in their community. However, at the time of 
randomization, each Usual Service participant will receive a 
comprehensive manual describing mental health and vocational services 
in their locale, along with state and national resources.
    This study will test the two treatment conditions against each 
other and against the control group on multiple outcomes of policy 
interest to SSA. The key outcomes of interest include: (1) Employment; 
(2) earnings; (3) income; (4) mental status; (5) quality of life; (6) 
health services utilization; and (7) SSA disability benefit receipt and 
amount. SSA is also interested in the study take up rate 
(participation); knowing who enrolls (and who does not); and fidelity 
to evidence-based treatments; among other aspects of implementation. 
Data collection for the evaluation of the SED will consist of the 
following activities: Baseline in-person participant interviews; 
quarterly participant telephone interviews; receipt of SSA 
administrative record data; and collection of site-level program data. 
Evaluation team members will also conduct site visits involving: (1) 
Pre-visit environmental scans to understand the local context in which 
we embed SED services; (2) independent fidelity assessments in 
conjunction with those carried out by state Mental Health or Vocational 
Rehabilitation staff; (3) key informant interviews with the IPS 
specialist, the nurse care coordinator, the case manager, and facility 
director; (4) focus groups with participants in the Full-Service and 
Basic-Service Treatment groups; and (5) ethnographic data collection 
consisting of observations in the natural environment, and person-
centered interviews with participants and non-participants. The 
respondents are study participants and non-participants; family 
members; IPS specialists; nurse care coordinators; case managers; and 
facility directors.
    Type of Request: Request for a new information collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency  of    burden per     total annual
             Modality of completion                 respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
Competency and CIDI Screener....................           3,000               1              40           2,000
Baseline Interview..............................           3,000               1              45           2,250
Quarterly Interview (Quarters 1, 2, 3, 5, 6, 7,            3,000               9              20           9,000
 9, 10, and 11).................................
Annual Interview (Quarters 4, 8, and 11)........           3,000               3              30           4,500
Fidelity Assessment Participant Interview.......             180               4              60             720
Fidelity Assessment Family Member Interview.....              90               4              60             360
Key Informant Interview.........................             120               4              60             480
Participant Focus Groups........................             600               2              60           1,200
Person-Centered Interview.......................             180               4              60             720
                                                 ---------------------------------------------------------------
    Totals......................................          13,170  ..............  ..............          21,230
----------------------------------------------------------------------------------------------------------------


[[Page 10625]]

    2. Student Reporting Form--20 CFR 404.352(b)(2); 404.367; 404.368; 
404.415; 404.434; 422.135--0960-0088. To qualify for Social Security 
Title II student benefits, student beneficiaries must be in full-time 
attendance status at an educational institution. In addition, SSA 
requires these beneficiaries to report events that may cause a 
reduction, termination, or suspension of their benefits. SSA collects 
this information on Forms SSA-1383 and SSA-1383-FC to determine if the 
changes or events the student beneficiaries report will affect their 
continuing entitlement to SSA benefits. SSA also uses the SSA-1383 and 
SSA-1383-FC to calculate the correct benefit amounts for student 
beneficiaries. The respondents are Social Security Title II student 
beneficiaries.
    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-1383........................................          74,887               1               6           7,489
SSA-1383-FC.....................................           1,247               1               6             125
                                                 ---------------------------------------------------------------
    Totals......................................          76,134  ..............  ..............           7,614
----------------------------------------------------------------------------------------------------------------

    3. Advanced Notice of Termination of Child's Benefits & Student's 
Statement Regarding School Attendance--20 CFR 404.350-404.352, 404.367-
404.368--0960-0105. SSA collects information on Forms SSA-1372-BK and 
SSA-1372-BK-FC to determine whether children of an insured worker meet 
the eligibility requirements for student benefits. The data we collect 
allows SSA to determine student entitlement and thether to terminate 
benefits. The respondents are student claimants for Social Security 
benefits; their respective schools; and in some cases; their 
representative payees.
    Type of Request: Revision of an OMB-approved information 
collection.

                                                   SSA-1372-BK
----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency  of    burden per     total annual
               Type of respondent                   respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
Individuals/Households..........................          99,850               1               8          13,313
State/Local/Tribal Government...................          99,850               1               3           4,993
                                                 ---------------------------------------------------------------
    Totals......................................         199,700  ..............  ..............          18,306
----------------------------------------------------------------------------------------------------------------


                                                 SSA-1372-BK-FC
----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency  of    burden per     total annual
               Type of respondent                   respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
Individuals/Households..........................           1,198               1               8             160
State/Local/Tribal Government...................           1,198               1               3              60
                                                 ---------------------------------------------------------------
    Totals......................................           2,396  ..............  ..............             220
                                                 ---------------------------------------------------------------
    Grand Total.................................         200,096  ..............  ..............          18,526
----------------------------------------------------------------------------------------------------------------

    4. Request for Review of Hearing Decision/Order--20 CFR 404.967-
404.981, 416.1467-416.1481--0960-0277. Claimants have a statutory right 
under the Social Security Act and current regulations to request review 
of an administrative law judge's (ALJ) hearing decision or dismissal of 
a hearing request on Title II and Title XVI claims. Claimants may 
request Appeals Council review by filing a written request using Form 
HA-520. SSA uses the information to establish the claimant filed the 
request for review within the prescribed time and to ensure the 
claimant completed the requisite steps permitting the Appeals Council 
review. The Appeals Council uses the information to: (1) Document the 
claimant's reason(s) for disagreeing with the ALJ's decision or 
dismissal; (2) determine whether the claimant has additional evidence 
to submit; and (3) determine whether the claimant has a representative 
or wants to appoint one. The respondents are claimants requesting 
review of an ALJ's decision or dismissal of hearing.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden     Estimated
           Modality of completion                Number of      Frequency  of    per  response     total annual
                                                respondents        response        (minutes)     burden  (hours)
----------------------------------------------------------------------------------------------------------------
HA-520......................................         175,000                1               10           29,167
----------------------------------------------------------------------------------------------------------------


[[Page 10626]]

    5. Disability Update Report--20 CFR 404.1589-404.1595 and 416.988-
416.996--0960-0511. As part of our statutory requirements, SSA 
periodically uses Form SSA-455, the Disability Update Report, to 
evaluate current Title II disability beneficiaries' and Title XVI 
disability payment recipients' continued eligibility for Social 
Security disability payments. Specifically, SSA uses the form to 
determine if: (1) There is enough evidence to warrant referring the 
respondent for a full medical Continuing Disability Review (CDR); (2) 
the respondent's impairments are still present and indicative of no 
medical improvement, precluding the need for a CDR; or (3) the 
respondent has unresolved work-related issues. SSA mails Form SSA-455 
to specific disability recipients, whom we select as possibly 
qualifying for the CDR process. SSA pre-fills the form with data 
specific to the disability recipient, except for the sections we ask 
the recipients to complete. When SSA receives the completed form, we 
scan it into SSA's system. This allows us to gather the information 
electronically, and enables SSA to process the returned forms through 
automated decision logic to decide the proper course of action to take. 
The respondents are recipients of Title II and Title XVI Social 
Security disability 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
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-455.....................................       1,500,000                1               15          375,000
----------------------------------------------------------------------------------------------------------------

    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 March 16, 2017. Individuals can obtain copies of the OMB 
clearance package by writing to OR.Reports.Clearance@ssa.gov.
    1. Agreement to Sell Property--20 CFR 416.1240-1245--0960-0127. 
Individuals or couples who are otherwise eligible for Supplemental 
Security Income (SSI) payments, but whose resources exceed the 
allowable limit may receive conditional payments if they agree to 
dispose of the excess non-liquid resources and make repayments. SSA 
uses Form SSA-8060-U3 to document this agreement, and to ensure the 
individuals understand their obligations. Respondents are applicants 
for and recipients of SSI payments who will be disposing of excess non-
liquid resources.
    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-8060-U3.................................          20,000                1               10            3,333
----------------------------------------------------------------------------------------------------------------

    2. Development of Participation in a Vocational Rehabilitation or 
Similar Program--20 CFR 404.316(c), 404.337(c), 404.352(d), 
404.1586(g), 404.1596, 404.1597(a), 404.327, 404.328, 416.1321(d), 
416.1331(a)-(b), and 416.1338, 416.1402--0960-0282. State Disability 
Determination Services (DDS) must determine if Social Security 
disability payment recipients whose disability ceased and who 
participate in vocational rehabilitation programs may continue to 
receive disability payments. To do this, DDSs need information about 
the recipients; the types of program participation; and the services 
they receive under the rehabilitation program. SSA uses Form SSA-4290 
to collect this information. The respondents are State employment 
networks; vocational rehabilitation agencies; or other providers of 
educational or job training services.
    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-4290....................................           3,000                1               15              750
----------------------------------------------------------------------------------------------------------------

    3. Appointment of Representative--20 CFR 404.1707, 404.1720, 
408.1101, 416.1507, and 416.1520--0960-0527. Individuals claiming 
rights or benefits under the Social Security Act (Act) must notify SSA 
in writing when they appoint an individual to represent them in dealing 
with SSA. SSA collects the information on Form SSA-1696-U4 to verify 
the appointment of these representatives. The SSA-1696-U4 allows SSA to 
inform representatives of items that affect the recipient's claim, and 
allows claimants to give permission to their appointed representatives 
to designate a person to receive their claims files. Respondents are 
applicants for, or recipients of, Social Security disability benefits 
(SSDI) or SSI payments who are notifying SSA they have appointed a 
person to represent them in their dealings with SSA.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 10627]]



----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden  Estimated total
           Modality of completion                Number of       Frequency of     per response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1696-U4.................................         800,000                1               10          133,333
----------------------------------------------------------------------------------------------------------------

    4. Work Activity Report (Self-Employment)--20 CFR 404.1520(b), 20 
CFR 404.1571-404.1576, 20 CFR 404.1584-404.1593, and 20 CFR 416.971-
416.976--0960-0598. SSA uses Form SSA-820-U4 to determine initial or 
continuing eligibility for (1) Title II SSDI, or (2) Title XVI SSI 
payments. Under Titles II and XVI of the Act, recipients receive 
disability benefits and SSI payments based on their inability to engage 
in substantial gainful activity (SGA) due to a physical or mental 
condition. Therefore, when the recipients resume work, they must report 
their work so SSA can evaluate and determine by law whether they 
continue to meet the disability requirements. SSA uses Form SSA-820-U4 
to obtain information on self-employment activities of Social Security 
Title II and XVI disability applicants and recipients. We use the data 
we obtain to evaluate disability claims, and to help us determine if 
the claimant meets current disability provisions under Titles II and 
XVI. Since applicants for disability benefits or payments must prove an 
inability to perform any kind of SGA generally available in the 
national economy for which we expect them to qualify based on age, 
education, and work experience, any work an applicant performed until, 
or subsequent to, the date the disability allegedly began, affects our 
disability determination. The respondents are applicants and claimants 
for SSI payments or SSDI benefits.
    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-820-BK..................................         100,000                1               30           50,000
----------------------------------------------------------------------------------------------------------------


    Dated: February 9, 2017.
Naomi R. Sipple,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2017-02941 Filed 2-13-17; 8:45 am]
 BILLING CODE 4191-02-P