Agency Information Collection Activities: Proposed Request and Comment Request, 11293-11297 [2017-03308]

Download as PDF Federal Register / Vol. 82, No. 33 / Tuesday, February 21, 2017 / Notices subject line if email is used. To help the Commission process and review your comments more efficiently, please use only one method. The Commission will post all comments on the Commission’s Internet Web site (http://www.sec.gov/ rules/sro.shtml). Copies of the submission, all subsequent amendments, all written statements with respect to the proposed rule change that are filed with the Commission, and all written communications relating to the proposed rule change between the Commission and any person, other than those that may be withheld from the public in accordance with the provisions of 5 U.S.C. 552, will be available for Web site viewing and printing in the Commission’s Public Reference Room, 100 F Street NE., Washington, DC 20549, on official business days between the hours of 10:00 a.m. and 3:00 p.m. Copies of the filing also will be available for inspection and copying at the principal office of the Exchange. All comments received will be posted without change; the Commission does not edit personal identifying information from submissions. You should submit only information that you wish to make available publicly. All submissions should refer to File Number SR–CBOE– 2017–014, and should be submitted on or before March 14, 2017. For the Commission, by the Division of Trading and Markets, pursuant to delegated authority.17 Eduardo A. Aleman, Assistant Secretary. [FR Doc. 2017–03302 Filed 2–17–17; 8:45 am] BILLING CODE 8011–01–P SOCIAL SECURITY ADMINISTRATION [Docket No: SSA–2017–0006] 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 and one extension 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, referencing Docket ID Number [SSA– 2017–0006]. I. The information collections below are pending at SSA. SSA will submit 11293 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 24, 2017. Individuals can obtain copies of the collection instruments by writing to the above email address. 1. Government Pension Questionnaire—20 CFR 404.408a— 0960–0160. The basic Social Security benefits application (OMB No. 0960– 0618) contains a lead question asking if the applicants are qualified (or will qualify) to receive a government pension. If the respondent is qualified, or will qualify, to receive a government pension, the applicant completes Form SSA–3885 either on paper or through a personal interview with an SSA claims representative. If the applicants are not entitled to receive a government pension at the time they apply for Social Security benefits, SSA requires them to provide the government pension information as beneficiaries when they become eligible to receive their pensions. Regardless of the timing, at some point the applicants or beneficiaries must complete and sign Form SSA–3885 to report information about their government pensions before the pensions begin. SSA uses the information to: (1) Determine whether the Government Pension Offset provision applies; (2) identify exceptions as stated in 20 CFR 404.408a; and (3) determine the benefit reduction amount and effective date. If the applicants and beneficiaries do not respond using this questionnaire, SSA offsets their entire benefit amount. The respondents are applicants or recipients of spousal benefits who are eligible for or already receiving a Government pension. 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–3885 ........................................................................................................ sradovich on DSK3GMQ082PROD with NOTICES Modality of completion 76,000 1 13 16,467 2. Modified Benefit Formula Questionnaire—0960–0395. SSA collects information on Form SSA–150 to determine which formula to use in computing the Social Security benefit for someone who receives a pension from employment not covered by Social Security. The Windfall Elimination Provision (WEP) requires use of a benefit formula replacing a smaller percentage of a worker’s pre-retirement 17 17 earnings. However, the resulting amount cannot show a difference in the benefit computed using the modified and regular formulas greater than one-half the amount of the pension received in the first month an individual is entitled to both the pension and the Social Security benefit. The SSA–150 collects the information needed to make all the necessary benefit computations. SSA requires respondents to furnish the information on Form SSA–150 so we can calculate their benefits using the data they supply. SSA calculates the benefits of applicants who do not respond to this questionnaire using the full WEP reduction. SSA employees collect this information once from the applicant at the time they file their claim. The respondents are applicants for old age and disability benefits. CFR 200.30–3(a)(12). VerDate Sep<11>2014 17:15 Feb 17, 2017 Jkt 241001 PO 00000 Frm 00123 Fmt 4703 Sfmt 4703 E:\FR\FM\21FEN1.SGM 21FEN1 11294 Federal Register / Vol. 82, No. 33 / Tuesday, February 21, 2017 / Notices 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–150 .......................................................................................................... 90,000 1 8 12,000 3. Modified Benefit Formula Questionnaire-Employer—20 CFR 401 & 402—0960–0477. Sections 215(a)(7) and 215(d)(3) of the Social Security Act (Act) require SSA to use a modified benefit formula to compute Social Security retirement or disability benefits for persons first eligible (after 1985) for both a Social Security benefit and a pension or annuity, based on employment not covered by Social Security. This method is the Windfall Elimination Provision (WEP). SSA makes a determination regarding whether the WEP is applicable and when to apply it to a person’s benefit. SSA uses Form SSA–58 to verify the claimant’s allegations on Form SSA–150 (OMB #0906–0395, Modified Benefits Formula Questionnaire). SSA also uses Form SSA–58 to determine if the modified benefit formula is applicable and when to apply it to a person’s benefits. SSA sends Form SSA–58 to an employer for pension related information, if the claimant is unable to provide it. The respondents are employers of people who are eligible after 1985 for both Social Security benefits and a pension based on work not covered by SSA. 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–58 ............................................................................................................ 30,000 1 20 10,000 4. Questionnaire for Children Claiming Supplemental Security Income (SSI) Benefits—0960–0499. Section 1631(d)(2) of the Act allows SSA to determine the eligibility of an applicant’s claim for SSI payments. Parents or legal guardians seeking to obtain or retain SSI eligibility for their children use Form SSA–3881–BK to provide SSA with the addresses of nonmedical sources such as schools, counselors, agencies, organizations, or therapists who would have information about a child’s functioning. SSA uses this information to help determine a child’s claim or continuing eligibility Number of respondents Modality of completion for SSI. The respondents are applicants who appeal SSI childhood disability decisions or recipients undergoing a continuing disability review. Type of Request: Revision of an OMBapproved information collection. Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) SSA–3881–BK (Paper Version) ...................................................................... SSA–3881–BK (Electronic Disability Collect System) ..................................... 84,500 45,500 1 1 30 30 42,250 22,750 Totals ........................................................................................................ 130,000 ........................ ........................ 65,000 5. Work History Report—20 CFR 404.1515, 404.1560, 404.1565, 416.960 and 416.3965—0960–0578. Under certain circumstances, SSA asks individuals applying for disability about work they have performed in the past. Applicants use Form SSA–3369, Work History Report, to provide detailed information about jobs held prior to becoming unable to work. State Disability Determination Services evaluate the information, together with Number of respondents sradovich on DSK3GMQ082PROD with NOTICES Modality of completion medical evidence, to determine eligibility for disability payments. Respondents are disability applicants and third parties assisting applicants. Type of Request: Revision of an OMBapproved information collection. Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) SSA–3369 (Paper Version) ............................................................................. SSA–3369 (Electronic Disability Collect System) ............................................ 1,553,900 38,049 1 1 60 60 1,553,900 38,049 Totals ........................................................................................................ 1,591,949 ........................ ........................ 1,591,949 6. Authorization to Obtain Earnings Data From the Social Security VerDate Sep<11>2014 17:15 Feb 17, 2017 Jkt 241001 Administration—0960–0602. On occasion, public and private PO 00000 Frm 00124 Fmt 4703 Sfmt 4703 organizations and agencies need to obtain detailed earnings information E:\FR\FM\21FEN1.SGM 21FEN1 11295 Federal Register / Vol. 82, No. 33 / Tuesday, February 21, 2017 / Notices about specific Social Security number (SSN) holding wage earners for business purposes (e.g. pension funds, State agencies, etc.). Respondents use Form SSA–581 to identify the SSN holder whose information they are requesting, and provide authorization from the SSN holder, when applicable. SSA uses the information provided on Form SSA–581 to: (1) Identify the wage earner; (2) establish the period of earnings information requested; (3) verify the wage earner authorized SSA to release this information to the requesting party; and (4) produce the Itemized Statement of Earnings (SSA–1826). The respondents are private businesses, state or local agencies, and other federal agencies. 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–581 .......................................................................................................... 24,000 1 2 800 7. Appeal of Determination for Help with Medicare Prescription Drug Plan Costs—0960–0695. Public Law 108–173, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), established the Medicare Part D program for voluntary prescription drug coverage for certain low-income individuals. The MMA stipulates the provision of subsidies for individuals who are eligible for the program and who meet eligibility criteria for help with premium, deductible, and co-payment costs. SSA uses Form SSA–1021, Appeal of Determination for Help with Medicare Prescription Drug Plan Costs, to obtain information from individuals who appeal SSA’s decisions regarding eligibility or continuing eligibility for a Number of respondents Modality of completion Medicare Part D subsidy. The respondents are Medicare beneficiaries, or proper applicants acting on behalf of a Medicare beneficiary, who do not agree with the outcome of an SSA subsidy eligibility determination, and are filing an appeal. Type of Request: Revision of an OMBapproved information collection. Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) SSA–1021 (Paper Version) ............................................................................. SSA–1021 (Internet Version; Medicare Application Processing System) ....... 3,283 11,037 1 1 10 10 547 1,840 Totals ........................................................................................................ 14,320 ........................ ........................ 2,387 8. Social Security Administration Eligible Non-Attorney Representative— 20 CFR 404.1717, 404.1745–404.1799, 416.1517, and 416.1545–416.1599— 0960–0699. Section 3 of the Social Security Disability Applicants Access to Professional Representation Act (PRA) of 2010, Public Law 111–142, permanently extends the direct payment provision of Section 303 of the Social Security Protection Act (SSPA) of 2004, Public Law 108–203. The PRA permits SSA to extend direct payment of approved fees from claimants’ past-due benefits to certain non-attorney representatives. Prior to the enactment of the SSPA and PRA, only attorneys could receive direct payment of SSAapproved fees. Under the PRA, nonattorneys must meet certain prerequisites to be eligible for direct payment of fees. These prerequisites include: (1) A bachelor’s degree from an accredited institution of higher education, or four years of relevant professional experience and a high school diploma or General Education Development certificate; (2) passing a written examination administered by SSA testing the knowledge of relevant provisions of the Act under Titles II and XVI; (3) securing and maintaining continuous professional liability insurance, or equivalent, to protect claimants from malpractice; (4) passing a criminal background check; (5) demonstrating ongoing completion of continuing education courses. The PRA requires SSA to collect the information needed to determine if applicants have satisfied these prerequisites. SSA uses the information we collect on Form Number of respondents sradovich on DSK3GMQ082PROD with NOTICES Modality of completion New Respondents—Paper Application (complete and submit)—404.1717(b) & (c); 416.1517(b) & (c) ............................................................................... New Respondents Examination—404.1717(a)(5); 416.1517(a)(5) ................. New Respondents—Submission of proof of Bachelor’s Degree or Equivalent Qualifications—404.1717(a)(3); 416.1517(a)(3) .................................... VerDate Sep<11>2014 17:15 Feb 17, 2017 Jkt 241001 PO 00000 Frm 00125 Fmt 4703 Sfmt 4703 SSA–1691 to determine whether an applicant fulfilled the statutory prerequisites and regulatory requirements as listed above. To verify this information, we also request the five required items listed above from each new applicant, and we request items #3 and #5 from all non-attorney representatives (new and existing) on a yearly basis. Every year, SSA evaluates the applications; conducts verification investigations; and issues recommendations regarding applicants’ eligibility to sit for the examination and eligibility to receive direct payment. The respondents are non-attorneys who want to receive direct payment of their fees for representational services before SSA. Type of Request: Revision of an OMBapproved information collection. Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) 200 200 1 1 45 120 547 400 200 1 10 33 E:\FR\FM\21FEN1.SGM 21FEN1 11296 Federal Register / Vol. 82, No. 33 / Tuesday, February 21, 2017 / Notices Number of respondents Modality of completion New and Existing Respondents—CE Submission via email/mail/or FAX of training courses taken as prescribed by SSA—404.1717(a)(7); 416.1517(a)(7) .............................................................................................. New and Existing Respondents—Proof of Continuous Professional or Business Liability Insurance Coverage (Scan and Email)—404.1717(a)(6); 416.1517(a)(6) .............................................................................................. New and Existing Respondents—Proof of Continuous Professional or Business Liability Insurance Coverage (Copy and Mail)—404.1717(a)(6); 416.1517(a)(6) .............................................................................................. New and Existing Respondents—Written Protests—404.1717(d); 416.1517(d) .................................................................................................. Average burden per response (minutes) Estimated total annual burden (hours) 710 1 20 237 672 1 10 112 38 1 15 10 45 1 45 34 2,065 Totals ........................................................................................................ 9. Sheltered Workshop Wage Reporting—0960–0771. Sheltered workshops are non-profit organizations or institutions that implement a recognized program of rehabilitation for handicapped workers, or provide such workers with remunerative employment or other occupational rehabilitating activity of an educational or therapeutic Frequency of response ........................ ........................ 976 nature. Sheltered workshops perform a service for their clients by reporting monthly wages directly to SSA. SSA uses the information these workshops provide to verify and post monthly wages to the SSI recipient’s record. Most workshops report monthly wage totals to their local SSA office so we can adjust the client’s SSI payment amount in a timely manner and prevent overpayments. Sheltered workshops are motivated to report wages voluntarily as a service to their clients. Respondents are sheltered workshops that report monthly wages for services performed in the workshop. Type of Request: Extension of an OMB-approved information collection. Modality of completion Number of respondents Frequency of response (Number of responses) Average burden per response (minutes) Estimated total annual burden (hours) Sheltered Workshop Wage Reporting ................................. 800 12 (9,600) 15 2,400 10. Medicare Income-Related Monthly Adjustment Amount—Life-Changing Event Form—0960–0784. Federally mandated reductions in the Federal Medicare Part B and prescription drug coverage subsidies result in selected Medicare recipients paying higher premiums with income above a specific threshold. The amount of the premium subsidy reduction is an income-related monthly adjustment amount (IRMAA). The Internal Revenue Service (IRS) transmits income tax return data to SSA for SSA to determine the IRMAA. SSA uses the Form SSA–44 to determine if a recipient qualifies for a reduction in the IRMAA. If affected Medicare recipients believe SSA should use more recent tax data because of a lifechanging event that significantly reduces their income, they can report these changes to SSA and ask for a new Number of respondents Modality of completion initial determination of their IRMAA. The respondents are Medicare Part B and prescription drug coverage recipients and enrollees with modified adjusted gross income over a highincome threshold who experience one of eight significant life-changing events. Type of Request: Revision of an OMBapproved information collection. Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) 140,378 60,162 1 1 30 45 70,189 45,122 Totals ........................................................................................................ sradovich on DSK3GMQ082PROD with NOTICES SSA–44 (Personal Interview in SSA field office) ............................................. SSA–44 (Paper Version) ................................................................................. 200,540 ........................ ........................ 115,311 II. SSA submitted the information collection below to OMB for clearance. Your comments regarding the information collection would be most useful if OMB and SSA receive them 30 days from the date of this publication. To be sure we consider your comments, we must receive them no later than March 23, 2017. Individuals can obtain copies of the OMB clearance package by VerDate Sep<11>2014 17:15 Feb 17, 2017 Jkt 241001 writing to OR.Reports.Clearance@ ssa.gov. Statement of Agricultural Employer (Year Prior to 1988; and 1988 and later)—20 CFR 404.702, 404.802, 404.1056—0960–0036. If agricultural workers believe their employers (1) did not report their wages, or (2) reported incorrect wage amounts, SSA will assist them in resolving this issue. PO 00000 Frm 00126 Fmt 4703 Sfmt 4703 Specifically, SSA will send Forms SSA– 1002–F3 or SSA–1003–F3 to the agricultural employers to collect evidence of wages paid. The respondents are agricultural employers whose workers request wage verification or correction for their earnings records. Type of Request: Revision of an OMBapproved information collection. E:\FR\FM\21FEN1.SGM 21FEN1 11297 Federal Register / Vol. 82, No. 33 / Tuesday, February 21, 2017 / Notices Number of respondents Modality of completion Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) SSA–1002 ........................................................................................................ SSA–1003 ........................................................................................................ 7,500 25,000 1 1 30 30 3,750 12,500 Totals ........................................................................................................ 32,500 ........................ ........................ 16,250 Dated: February 15, 2017. Naomi R. Sipple, Reports Clearance Officer, Social Security Administration. [FR Doc. 2017–03308 Filed 2–17–17; 8:45 am] sradovich on DSK3GMQ082PROD with NOTICES BILLING CODE 4191–02–P VerDate Sep<11>2014 17:15 Feb 17, 2017 Jkt 241001 PO 00000 Frm 00127 Fmt 4703 Sfmt 9990 E:\FR\FM\21FEN1.SGM 21FEN1

Agencies

[Federal Register Volume 82, Number 33 (Tuesday, February 21, 2017)]
[Notices]
[Pages 11293-11297]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-03308]


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SOCIAL SECURITY ADMINISTRATION

[Docket No: SSA-2017-0006]


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 and one extension 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, 
referencing Docket ID Number [SSA-2017-0006].
    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 24, 2017. Individuals can obtain copies of the collection 
instruments by writing to the above email address.
    1. Government Pension Questionnaire--20 CFR 404.408a--0960-0160. 
The basic Social Security benefits application (OMB No. 0960-0618) 
contains a lead question asking if the applicants are qualified (or 
will qualify) to receive a government pension. If the respondent is 
qualified, or will qualify, to receive a government pension, the 
applicant completes Form SSA-3885 either on paper or through a personal 
interview with an SSA claims representative. If the applicants are not 
entitled to receive a government pension at the time they apply for 
Social Security benefits, SSA requires them to provide the government 
pension information as beneficiaries when they become eligible to 
receive their pensions. Regardless of the timing, at some point the 
applicants or beneficiaries must complete and sign Form SSA-3885 to 
report information about their government pensions before the pensions 
begin. SSA uses the information to: (1) Determine whether the 
Government Pension Offset provision applies; (2) identify exceptions as 
stated in 20 CFR 404.408a; and (3) determine the benefit reduction 
amount and effective date. If the applicants and beneficiaries do not 
respond using this questionnaire, SSA offsets their entire benefit 
amount. The respondents are applicants or recipients of spousal 
benefits who are eligible for or already receiving a Government 
pension.
    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-3885....................................          76,000                1               13           16,467
----------------------------------------------------------------------------------------------------------------

    2. Modified Benefit Formula Questionnaire--0960-0395. SSA collects 
information on Form SSA-150 to determine which formula to use in 
computing the Social Security benefit for someone who receives a 
pension from employment not covered by Social Security. The Windfall 
Elimination Provision (WEP) requires use of a benefit formula replacing 
a smaller percentage of a worker's pre-retirement earnings. However, 
the resulting amount cannot show a difference in the benefit computed 
using the modified and regular formulas greater than one-half the 
amount of the pension received in the first month an individual is 
entitled to both the pension and the Social Security benefit. The SSA-
150 collects the information needed to make all the necessary benefit 
computations. SSA requires respondents to furnish the information on 
Form SSA-150 so we can calculate their benefits using the data they 
supply. SSA calculates the benefits of applicants who do not respond to 
this questionnaire using the full WEP reduction. SSA employees collect 
this information once from the applicant at the time they file their 
claim. The respondents are applicants for old age and disability 
benefits.

[[Page 11294]]

    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-150.....................................          90,000                1                8           12,000
----------------------------------------------------------------------------------------------------------------

    3. Modified Benefit Formula Questionnaire-Employer--20 CFR 401 & 
402--0960-0477. Sections 215(a)(7) and 215(d)(3) of the Social Security 
Act (Act) require SSA to use a modified benefit formula to compute 
Social Security retirement or disability benefits for persons first 
eligible (after 1985) for both a Social Security benefit and a pension 
or annuity, based on employment not covered by Social Security. This 
method is the Windfall Elimination Provision (WEP). SSA makes a 
determination regarding whether the WEP is applicable and when to apply 
it to a person's benefit. SSA uses Form SSA-58 to verify the claimant's 
allegations on Form SSA-150 (OMB #0906-0395, Modified Benefits Formula 
Questionnaire). SSA also uses Form SSA-58 to determine if the modified 
benefit formula is applicable and when to apply it to a person's 
benefits. SSA sends Form SSA-58 to an employer for pension related 
information, if the claimant is unable to provide it. The respondents 
are employers of people who are eligible after 1985 for both Social 
Security benefits and a pension based on work not covered by SSA.
    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-58......................................          30,000                1               20           10,000
----------------------------------------------------------------------------------------------------------------

    4. Questionnaire for Children Claiming Supplemental Security Income 
(SSI) Benefits--0960-0499. Section 1631(d)(2) of the Act allows SSA to 
determine the eligibility of an applicant's claim for SSI payments. 
Parents or legal guardians seeking to obtain or retain SSI eligibility 
for their children use Form SSA-3881-BK to provide SSA with the 
addresses of non-medical sources such as schools, counselors, agencies, 
organizations, or therapists who would have information about a child's 
functioning. SSA uses this information to help determine a child's 
claim or continuing eligibility for SSI. The respondents are applicants 
who appeal SSI childhood disability decisions or recipients undergoing 
a continuing disability review.
    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)
----------------------------------------------------------------------------------------------------------------
SSA-3881-BK (Paper Version).....................          84,500               1              30          42,250
SSA-3881-BK (Electronic Disability Collect                45,500               1              30          22,750
 System)........................................
                                                 ---------------------------------------------------------------
    Totals......................................         130,000  ..............  ..............          65,000
----------------------------------------------------------------------------------------------------------------

    5. Work History Report--20 CFR 404.1515, 404.1560, 404.1565, 
416.960 and 416.3965--0960-0578. Under certain circumstances, SSA asks 
individuals applying for disability about work they have performed in 
the past. Applicants use Form SSA-3369, Work History Report, to provide 
detailed information about jobs held prior to becoming unable to work. 
State Disability Determination Services evaluate the information, 
together with medical evidence, to determine eligibility for disability 
payments. Respondents are disability applicants and third parties 
assisting applicants.
    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)
----------------------------------------------------------------------------------------------------------------
SSA-3369 (Paper Version)........................       1,553,900               1              60       1,553,900
SSA-3369 (Electronic Disability Collect System).          38,049               1              60          38,049
                                                 ---------------------------------------------------------------
    Totals......................................       1,591,949  ..............  ..............       1,591,949
----------------------------------------------------------------------------------------------------------------

    6. Authorization to Obtain Earnings Data From the Social Security 
Administration--0960-0602. On occasion, public and private 
organizations and agencies need to obtain detailed earnings information

[[Page 11295]]

about specific Social Security number (SSN) holding wage earners for 
business purposes (e.g. pension funds, State agencies, etc.). 
Respondents use Form SSA-581 to identify the SSN holder whose 
information they are requesting, and provide authorization from the SSN 
holder, when applicable. SSA uses the information provided on Form SSA-
581 to: (1) Identify the wage earner; (2) establish the period of 
earnings information requested; (3) verify the wage earner authorized 
SSA to release this information to the requesting party; and (4) 
produce the Itemized Statement of Earnings (SSA-1826). The respondents 
are private businesses, state or local agencies, and other federal 
agencies.
    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-581.....................................          24,000                1                2              800
----------------------------------------------------------------------------------------------------------------

    7. Appeal of Determination for Help with Medicare Prescription Drug 
Plan Costs--0960-0695. Public Law 108-173, the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 (MMA), established the 
Medicare Part D program for voluntary prescription drug coverage for 
certain low-income individuals. The MMA stipulates the provision of 
subsidies for individuals who are eligible for the program and who meet 
eligibility criteria for help with premium, deductible, and co-payment 
costs. SSA uses Form SSA-1021, Appeal of Determination for Help with 
Medicare Prescription Drug Plan Costs, to obtain information from 
individuals who appeal SSA's decisions regarding eligibility or 
continuing eligibility for a Medicare Part D subsidy. The respondents 
are Medicare beneficiaries, or proper applicants acting on behalf of a 
Medicare beneficiary, who do not agree with the outcome of an SSA 
subsidy eligibility determination, and are filing an appeal.
    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)
----------------------------------------------------------------------------------------------------------------
SSA-1021 (Paper Version)........................           3,283               1              10             547
SSA-1021 (Internet Version; Medicare Application          11,037               1              10           1,840
 Processing System).............................
                                                 ---------------------------------------------------------------
    Totals......................................          14,320  ..............  ..............           2,387
----------------------------------------------------------------------------------------------------------------

    8. Social Security Administration Eligible Non-Attorney 
Representative--20 CFR 404.1717, 404.1745-404.1799, 416.1517, and 
416.1545-416.1599--0960-0699. Section 3 of the Social Security 
Disability Applicants Access to Professional Representation Act (PRA) 
of 2010, Public Law 111-142, permanently extends the direct payment 
provision of Section 303 of the Social Security Protection Act (SSPA) 
of 2004, Public Law 108-203. The PRA permits SSA to extend direct 
payment of approved fees from claimants' past-due benefits to certain 
non-attorney representatives. Prior to the enactment of the SSPA and 
PRA, only attorneys could receive direct payment of SSA-approved fees. 
Under the PRA, non-attorneys must meet certain prerequisites to be 
eligible for direct payment of fees. These prerequisites include: (1) A 
bachelor's degree from an accredited institution of higher education, 
or four years of relevant professional experience and a high school 
diploma or General Education Development certificate; (2) passing a 
written examination administered by SSA testing the knowledge of 
relevant provisions of the Act under Titles II and XVI; (3) securing 
and maintaining continuous professional liability insurance, or 
equivalent, to protect claimants from malpractice; (4) passing a 
criminal background check; (5) demonstrating ongoing completion of 
continuing education courses. The PRA requires SSA to collect the 
information needed to determine if applicants have satisfied these 
prerequisites. SSA uses the information we collect on Form SSA-1691 to 
determine whether an applicant fulfilled the statutory prerequisites 
and regulatory requirements as listed above. To verify this 
information, we also request the five required items listed above from 
each new applicant, and we request items #3 and #5 from all non-
attorney representatives (new and existing) on a yearly basis. Every 
year, SSA evaluates the applications; conducts verification 
investigations; and issues recommendations regarding applicants' 
eligibility to sit for the examination and eligibility to receive 
direct payment. The respondents are non-attorneys who want to receive 
direct payment of their fees for representational services before SSA.
    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)
----------------------------------------------------------------------------------------------------------------
New Respondents--Paper Application (complete and             200               1              45             547
 submit)--404.1717(b) & (c); 416.1517(b) & (c)..
New Respondents Examination--404.1717(a)(5);                 200               1             120             400
 416.1517(a)(5).................................
New Respondents--Submission of proof of                      200               1              10              33
 Bachelor's Degree or Equivalent Qualifications--
 404.1717(a)(3); 416.1517(a)(3).................

[[Page 11296]]

 
New and Existing Respondents--CE Submission via              710               1              20             237
 email/mail/or FAX of training courses taken as
 prescribed by SSA--404.1717(a)(7);
 416.1517(a)(7).................................
New and Existing Respondents--Proof of                       672               1              10             112
 Continuous Professional or Business Liability
 Insurance Coverage (Scan and Email)--
 404.1717(a)(6); 416.1517(a)(6).................
New and Existing Respondents--Proof of                        38               1              15              10
 Continuous Professional or Business Liability
 Insurance Coverage (Copy and Mail)--
 404.1717(a)(6); 416.1517(a)(6).................
New and Existing Respondents--Written Protests--              45               1              45              34
 404.1717(d); 416.1517(d).......................
                                                 ---------------------------------------------------------------
    Totals......................................           2,065  ..............  ..............             976
----------------------------------------------------------------------------------------------------------------

    9. Sheltered Workshop Wage Reporting--0960-0771. Sheltered 
workshops are non-profit organizations or institutions that implement a 
recognized program of rehabilitation for handicapped workers, or 
provide such workers with remunerative employment or other occupational 
rehabilitating activity of an educational or therapeutic nature. 
Sheltered workshops perform a service for their clients by reporting 
monthly wages directly to SSA. SSA uses the information these workshops 
provide to verify and post monthly wages to the SSI recipient's record. 
Most workshops report monthly wage totals to their local SSA office so 
we can adjust the client's SSI payment amount in a timely manner and 
prevent overpayments. Sheltered workshops are motivated to report wages 
voluntarily as a service to their clients. Respondents are sheltered 
workshops that report monthly wages for services performed in the 
workshop.
    Type of Request: Extension of an OMB-approved information 
collection.

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                         Average burden  Estimated total
                       Modality of completion                           Number of       Frequency of      (Number of      per response    annual burden
                                                                       respondents        response        responses)       (minutes)         (hours)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Sheltered Workshop Wage Reporting..................................             800               12          (9,600)               15            2,400
--------------------------------------------------------------------------------------------------------------------------------------------------------

    10. Medicare Income-Related Monthly Adjustment Amount--Life-
Changing Event Form--0960-0784. Federally mandated reductions in the 
Federal Medicare Part B and prescription drug coverage subsidies result 
in selected Medicare recipients paying higher premiums with income 
above a specific threshold. The amount of the premium subsidy reduction 
is an income-related monthly adjustment amount (IRMAA). The Internal 
Revenue Service (IRS) transmits income tax return data to SSA for SSA 
to determine the IRMAA. SSA uses the Form SSA-44 to determine if a 
recipient qualifies for a reduction in the IRMAA. If affected Medicare 
recipients believe SSA should use more recent tax data because of a 
life-changing event that significantly reduces their income, they can 
report these changes to SSA and ask for a new initial determination of 
their IRMAA. The respondents are Medicare Part B and prescription drug 
coverage recipients and enrollees with modified adjusted gross income 
over a high-income threshold who experience one of eight significant 
life-changing events.
    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)
----------------------------------------------------------------------------------------------------------------
SSA-44 (Personal Interview in SSA field office).         140,378               1              30          70,189
SSA-44 (Paper Version)..........................          60,162               1              45          45,122
                                                 ---------------------------------------------------------------
    Totals......................................         200,540  ..............  ..............         115,311
----------------------------------------------------------------------------------------------------------------

    II. SSA submitted the information collection below to OMB for 
clearance. Your comments regarding the information collection would be 
most useful if OMB and SSA receive them 30 days from the date of this 
publication. To be sure we consider your comments, we must receive them 
no later than March 23, 2017. Individuals can obtain copies of the OMB 
clearance package by writing to OR.Reports.Clearance@ssa.gov.
    Statement of Agricultural Employer (Year Prior to 1988; and 1988 
and later)--20 CFR 404.702, 404.802, 404.1056--0960-0036. If 
agricultural workers believe their employers (1) did not report their 
wages, or (2) reported incorrect wage amounts, SSA will assist them in 
resolving this issue. Specifically, SSA will send Forms SSA-1002-F3 or 
SSA-1003-F3 to the agricultural employers to collect evidence of wages 
paid. The respondents are agricultural employers whose workers request 
wage verification or correction for their earnings records.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 11297]]



----------------------------------------------------------------------------------------------------------------
                                                                    Average burden     Estimated
      Modality of completion           Number of     Frequency of    per response    total annual
                                      respondents      response        (minutes)    burden (hours)
--------------------------------------------------------------------------------------------------
SSA-1002..........................           7,500               1              30           3,750
SSA-1003..........................          25,000               1              30          12,500
                                   -----------------------------------------------------------------------------
    Totals........................          32,500  ..............  ..............          16,250
----------------------------------------------------------------------------------------------------------------


    Dated: February 15, 2017.
Naomi R. Sipple,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2017-03308 Filed 2-17-17; 8:45 am]
 BILLING CODE 4191-02-P