Agency Information Collection Activities: Proposed Request and Comment Request, 12455-12458 [2018-05627]
Download as PDF
<![CDATA[
12455
Federal Register / Vol. 83, No. 55 / Wednesday, March 21, 2018 / Notices
(Catalog of Federal Domestic Assistance
Number 59008)
The notice
of the President’s major disaster
declaration for the Commonwealth of
Puerto Rico, dated 09/10/2017, is hereby
amended to extend the deadline for
filing applications for physical damages
as a result of this disaster to 06/18/2018.
All other information in the original
declaration remains unchanged.
SUPPLEMENTARY INFORMATION:
James E. Rivera,
Associate Administrator for Disaster
Assistance.
[FR Doc. 2018–05634 Filed 3–20–18; 8:45 am]
BILLING CODE 8025–01–P
SMALL BUSINESS ADMINISTRATION
(Catalog of Federal Domestic Assistance
Number 59008)
[Disaster Declaration #15298 and #15299;
PUERTO RICO Disaster Number PR–00029]
James E. Rivera,
Associate Administrator for Disaster
Assistance.
Presidential Declaration Amendment of
a Major Disaster for the
Commonwealth of Puerto Rico
U.S. Small Business
Administration.
ACTION: Amendment 5.
[FR Doc. 2018–05629 Filed 3–20–18; 8:45 am]
BILLING CODE 8025–01–P
AGENCY:
SOCIAL SECURITY ADMINISTRATION
[Docket No: SSA–2018–0008]
This is an amendment of the
Presidential declaration of a major
disaster for the Commonwealth of
Puerto Rico (FEMA–4336–DR), dated
09/10/2017.
Incident: Hurricane Irma.
Incident Period: 09/05/2017 through
09/07/2017.
DATES: Issued on 03/14/2018.
Physical Loan Application Deadline
Date: 06/18/2018.
Economic Injury (EIDL) Loan
Application Deadline Date: 06/11/2018.
ADDRESS: 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, (202) 205–6734.
SUMMARY:
Agency Information Collection
Activities: Proposed Request and
Comment Request
The Social Security Administration
(SSA) publishes a list of information
collection packages requiring clearance
by the Office of Management and
Budget (OMB) in compliance with
Public Law 104–13, the Paperwork
Reduction Act of 1995, effective October
1, 1995. This notice includes an
extension of an OMB-approved
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
Number of
respondents
Modality of completion
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–
2018–0008].
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 May 21,
2018. Individuals can obtain copies of
the collection instruments by writing to
the above email address.
1. Application for Parent’s Insurance
Benefits—20 CFR 404.370–404.374 and
20 CFR 404.601–404.603—0960–0012.
Section 202(h) of the Social Security Act
(Act) establishes the conditions of
eligibility a claimant must meet to
receive monthly benefits as a parent of
a deceased worker. SSA uses
information from Form SSA–7–F6 to
determine if the claimant meets the
eligibility and application criteria. The
respondents are applicants for, and
recipients of, Social Security Old Age,
Survivors, and Disability Insurance
(OASDI).
Type of Request: Revision of an OMBapproved information collection.
Average
burden
per response
(minutes)
Frequency
of response
Estimated
total
annual
burden
(hours)
164
4
1
1
15
15
41
1
Total ..........................................................................................................
sradovich on DSK3GMQ082PROD with NOTICES
Modernized Claims System (MCS)/Signature Proxy .......................................
Paper ...............................................................................................................
168
........................
........................
42
2. Request for Withdrawal of
Application—20 CFR 404.640—0960–
0015. Form SSA–521 documents the
information SSA needs to process the
withdrawal of an application for
benefits. A paper SSA–521 is our
preferred instrument for executing a
withdrawal request; however, any
VerDate Sep<11>2014
18:34 Mar 20, 2018
Jkt 244001
written request for withdrawal the
claimant signs, or proper applicant signs
on the claimant’s behalf, will suffice.
Individuals who wish to withdraw their
applications for benefits complete Form
SSA–521, or sign the completed form
for each request to withdraw. SSA uses
the information from the SSA–521 to
PO 00000
Frm 00123
Fmt 4703
Sfmt 4703
process the request for withdrawal. The
respondents are applicants or claimants
for Retirement, Survivors, Disability,
and Health Insurance benefits.
Type of Request: Revision of an OMBapproved information collection.
E:\FR\FM\21MRN1.SGM
21MRN1
12456
Federal Register / Vol. 83, No. 55 / Wednesday, March 21, 2018 / Notices
Modality of completion
Number of
respondents
Frequency
of response
Average
burden
per response
(minutes)
Estimated
total
annual
burden
(hours)
SSA–521 ..........................................................................................................
31,827
1
5
2,652
3. Statement of Self-Employment
Income—20 CFR 404.101, 404.110,
404.1096(a)(d)—0960–0046. To qualify
for insured status, and collect Social
Security benefits, self-employed
individuals must demonstrate they
earned the minimum amount of selfemployment income (SEI) in a current
credit additional quarters of coverage to
give the individual insured status,
expediting benefit payments.
Respondents are self-employed
individuals potentially eligible for
Social Security benefits.
Type of Request: Revision of an OMBapproved information collection.
year. SSA uses Form SSA–766,
Statement of Self-Employment Income,
to collect the information we need to
determine if the individual earned at
least the minimum amount of SEI
needed for one or more quarters of
coverage in the current year. Based on
the information we obtain, we may
Modality of completion
Number of
respondents
Frequency
of response
Average
burden
per response
(minutes)
Estimated
total
annual
burden
(hours)
SSA–766 ..........................................................................................................
2,500
1
5
208
4. Request for Workers’
Compensation/Public Disability Benefit
Information—20 CFR 404.408(e)—0960–
0098. Claimants for Social Security
disability payments who are also
receiving Worker’s Compensation/
Public Disability Benefits (WC/PDB)
must notify SSA about their WC/PDB,
so the agency can reduce claimants’
or an administering public agency
complete this form. The respondents are
Federal, State, and local agencies;
insurance carriers; and public or private
self-insured companies administering
WC/PDB benefits to disability
claimants.
Type of Request: Revision of an OMBapproved information collection.
Social Security disability payments
accordingly. If claimants provide
necessary evidence, such as a copy of
their award notice, benefit check, etc.,
that is sufficient verification. In cases
where claimants cannot provide such
evidence, SSA uses Form SSA–1709.
The entity paying the WC/PDB benefits,
its agent (such as an insurance carrier),
Modality of completion
Number of
respondents
Frequency
of response
Average
burden
per response
(minutes)
Estimated
total
annual
burden
(hours)
SSA–1709 ........................................................................................................
120,000
1
15
30,000
5. Third Party Liability Information
Statement—42 CFR 433.136–433.139—
0960–0323. To reduce Medicaid costs,
Medicaid state agencies identify third
party insurers liable for medical care or
services for Medicaid beneficiaries.
Regulations at 42 CFR 433.136–433.139
of the Code of Federal Regulations,
require Medicaid state agencies to
obtain this information on Medicaid
applications and redeterminations as a
condition of Medicaid eligibility. States
may enter into agreements with the
Commissioner of Social Security to
make Medicaid eligibility
determinations for aged, blind, and
disabled beneficiaries in those states.
Applications for and redeterminations
of Supplemental Security Income (SSI)
eligibility in jurisdictions with such
agreements are applications and
redeterminations of Medicaid eligibility.
Under these agreements, SSA obtains
third party liability information using
Number of
respondents
sradovich on DSK3GMQ082PROD with NOTICES
Modality of completion
Form SSA–8019–U2, and provides that
information to the Medicaid state
agencies. The Medicaid state agencies
use the information to bill third parties
liable for medical care, support, or
services for a beneficiary to guarantee
that Medicaid remains the payer of last
resort. The respondents are SSI
claimants and recipients.
Type of Request: Revision of an OMBapproved information collection.
Average
burden
per response
(minutes)
Frequency
of response
Estimated
total
annual
burden
(hours)
SSA–8019–U2 Paper form ..............................................................................
SSI Claims System ..........................................................................................
200
49,621
1
1
5
5
17
4,135
Totals ........................................................................................................
49,821
........................
........................
4,152
VerDate Sep<11>2014
18:34 Mar 20, 2018
Jkt 244001
PO 00000
Frm 00124
Fmt 4703
Sfmt 4703
E:\FR\FM\21MRN1.SGM
21MRN1
12457
Federal Register / Vol. 83, No. 55 / Wednesday, March 21, 2018 / Notices
6. Permanent Residence in the United
States Under Color of Law (PRUCOL)—
20 CFR 416.1615 and 416.1618—0960–
0451. As per 20 CFR 416.1415 and
416.1618 of the Code of Federal
Regulations, SSA requires claimants or
recipients to submit evidence of their
alien status when they apply for SSI
payments, and periodically thereafter as
part of the eligibility determination
process for SSI. When SSA cannot
verify evidence of alien status through
the regular claimant interview process,
SSA verifies the validity of the evidence
of PRUCOL for grandfathered
nonqualified aliens with the Department
of Homeland Security (DHS), and
determines if the individual qualifies for
PRUCOL status based on the DHS
response. SSA does not maintain any
forms or applications for respondents to
use, rather, the regulations listed in 20
CFR 416.1615 and 416.1618 specify the
information respondents need to submit
to SSA to show evidence of PRUCOL.
Without this information, SSA is unable
to determine whether the PRUCOL
individual is eligible for SSI payments.
Respondents are qualified and
unqualified aliens who apply for SSI
payments under PRUCOL.
Type of Request: Extension of an
OMB-approved information collection.
Modality of completion
Number of
respondents
Frequency
of response
Average
burden
per response
(minutes)
Estimated
total
annual
burden
(hours)
Personal or Telephone Interview .....................................................................
1,049
1
5
87
7. Authorization for the Social
Security Administration to Obtain
Account Records from a Financial
Institution and Request for Records
(Medicare)—20 CFR 418.3420—0960–
0729. The Medicare Prescription Drug,
Improvement, and Modernization Act of
2003 (MMA) established the Medicare
Part D program for voluntary
prescription drug coverage of premium,
deductible, and copayment costs for
individuals with limited income and
resources. The MMA mandates that the
Government provide subsidies for those
individuals who qualify for the
program, and who meet eligibility
criteria for help with premium,
deductible, or co-payment costs. SSA
uses the SSA–4640, Authorization for
the Social Security Administration to
Obtain Account Records from a
Financial Institution and Request for
Records (Medicare), to determine if
subsidy applicants or recipients qualify,
Number of
respondents
Modality of completion
or continue to qualify, for the subsidy.
SSA uses Form SSA–4640 to: (1) Obtain
the individual’s consent to verify
balances of financial institution (FI)
accounts; and (2) obtain verification of
such balances from the FI. Respondents
are Medicare Part D program subsidy
applicants or claimants, and their
financial institutions.
Type of Request: Revision of an OMBapproved information collection.
Average
burden
per response
(minutes)
Frequency
of response
Estimated
total
annual
burden
(hours)
Medicare Part D Subsidy Applicants ...............................................................
Financial Institutions ........................................................................................
5,000
5,000
1
1
1
4
83
333
Total ..........................................................................................................
10,000
........................
........................
416
sradovich on DSK3GMQ082PROD with NOTICES
II. SSA submitted the information
collections below to OMB for clearance.
Your comments regarding these
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
April 20, 2018. Individuals can obtain
copies of the OMB clearance packages
by writing to OR.Reports.Clearance@
ssa.gov.
1. 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 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 paper
Form HA–520, or the internet
application, i520. SSA uses the
information we collect 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
Number of
respondents
Modality of completion
HA–520—Paper ...............................................................................................
i520—Internet ..................................................................................................
VerDate Sep<11>2014
18:34 Mar 20, 2018
Jkt 244001
PO 00000
Frm 00125
Fmt 4703
Sfmt 4703
Council review. The Appeals Council
then 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: A New Information
Collection Request.
Average
burden
per response
(minutes)
Frequency
of response
105,000
70,000
E:\FR\FM\21MRN1.SGM
1
1
21MRN1
10
15
Estimated
total
annual
burden
(hours)
17,500
17,500
12458
Federal Register / Vol. 83, No. 55 / Wednesday, March 21, 2018 / Notices
Number of
respondents
Modality of completion
Total ..........................................................................................................
2. Claimant’s Recent Medical
Treatment—20 CFR 404.1512 and
416.912—0960–0292. When DDSs deny
a claim at the reconsideration level, the
claimant has a right to request a hearing
before an administrative law judge
(ALJ). For the hearing, SSA asks the
claimant to complete and return the
HA–4631 if the claimant’s file does not
reflect a current, complete medical
history as the claimant proceeds
175,000
through the appeals process. ALJs must
obtain the information to update and
complete the record and to verify the
accuracy of the information. Through
this process, ALJs can ascertain whether
the claimant’s situation changed. The
ALJs and hearing office staff use the
response to make arrangements for
consultative examination(s) and the
attendance of an expert witness(es), if
appropriate. During the hearing, the ALJ
Frequency
of response
Average
burden
per response
(minutes)
........................
Estimated
total
annual
burden
(hours)
........................
35,000
offers any completed questionnaires as
exhibits and may use them to: (1)
Refresh the claimant’s memory, and (2)
shape their questions. The respondents
are claimants requesting hearings on
entitlement to OASDI benefits or SSI
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)
HA–4631 ..........................................................................................................
200,000
1
20
33,333
Dated: March 15, 2018.
Naomi R. Sipple,
Reports Clearance Officer, Social Security
Administration.
DATES:
FOR FURTHER INFORMATION CONTACT:
Pedro Ramirez, (202) 245–0333. Federal
Information Relay Service (FIRS) for the
hearing impaired: (800) 877–8339.
[FR Doc. 2018–05627 Filed 3–20–18; 8:45 am]
BILLING CODE 4191–02–P
SURFACE TRANSPORTATION BOARD
[Docket No. EP 290 (Sub-No. 5) (2018–2)]
Quarterly Rail Cost Adjustment Factor
Surface Transportation Board.
Approval of rail cost adjustment
AGENCY:
ACTION:
factor.
The Board approves the
second quarter 2018 Rail Cost
Adjustment Factor (RCAF) and cost
index filed by the Association of
American Railroads. The second quarter
2018 RCAF (Unadjusted) is 1.041. The
second quarter 2018 RCAF (Adjusted) is
0.440. The second quarter 2018 RCAF–
5 is 0.411. In addition, the Board is
including recalculated RCAF figures for
the second quarter of 2017 through the
first quarter of 2018, which AAR
submitted pursuant to the Board’s
January 29, 2018 decision. The
recalculated RCAF figures for the
second quarter of 2017 through the first
quarter of 2018 were recalculated as if
AAR had used the geometric average
productivity growth of 0.994 for the
2011–2015 five-year period in its
original filings. The recalculated figures
are included in Table C of the Board’s
decision.
sradovich on DSK3GMQ082PROD with NOTICES
SUMMARY:
VerDate Sep<11>2014
18:34 Mar 20, 2018
Jkt 244001
Applicable Date: April 1, 2018.
SUPPLEMENTARY INFORMATION:
Additional information is contained in
the Board’s decision, which is available
on our website, https://www.stb.gov.
Copies of the decision may be
purchased by contacting the Office of
Public Assistance, Governmental
Affairs, and Compliance at (202) 245–
0238. Assistance for the hearing
impaired is available through FIRS at
(800) 877–8339.
This action is categorically excluded
from environmental review under 49
CFR 1105.6(c).
Decided: March 15, 2018.
By the Board, Board Members Begeman
and Miller.
Jeffrey Herzig,
Clearance Clerk.
[FR Doc. 2018–05697 Filed 3–20–18; 8:45 am]
BILLING CODE 4915–01–P
PO 00000
Frm 00126
Fmt 4703
Sfmt 4703
DEPARTMENT OF TRANSPORTATION
National Highway Traffic Safety
Administration
[Docket No. NHTSA–2017–0100; Notice 1]
Volkswagen Group of America, Inc.,
Receipt of Petition for Decision of
Inconsequential Noncompliance
National Highway Traffic
Safety Administration (NHTSA),
Department of Transportation (DOT).
ACTION: Receipt of petition.
AGENCY:
Volkswagen Group of
America, Inc. (Volkswagen), has
determined that certain seat belt
assemblies that it sold to its dealers as
replacement equipment for certain
model year (MY) 2009–2014
Volkswagen Routan motor vehicles do
not fully comply with Federal Motor
Vehicle Safety Standard (FMVSS) No.
209, Seat Belt Assemblies. Volkswagen
filed a noncompliance report dated
November 8, 2017. Volkswagen then
petitioned NHTSA on November 29,
2017, for a decision that the subject
noncompliance is inconsequential as it
relates to motor vehicle safety.
DATES: The closing date for comments
on the petition is April 20, 2018.
ADDRESSES: Interested persons are
invited to submit written data, views,
and arguments on this petition.
Comments must refer to the docket and
notice number cited in the title of this
notice and submitted by any of the
following methods:
SUMMARY:
E:\FR\FM\21MRN1.SGM
21MRN1
]]>Agencies
[Federal Register Volume 83, Number 55 (Wednesday, March 21, 2018)]
[Notices]
[Pages 12455-12458]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-05627]
=======================================================================
-----------------------------------------------------------------------
SOCIAL SECURITY ADMINISTRATION
[Docket No: SSA-2018-0008]
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 an extension of an OMB-approved 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: [email protected].
(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: [email protected].
Or you may submit your comments online through www.regulations.gov,
referencing Docket ID Number [SSA-2018-0008].
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 May
21, 2018. Individuals can obtain copies of the collection instruments
by writing to the above email address.
1. Application for Parent's Insurance Benefits--20 CFR 404.370-
404.374 and 20 CFR 404.601-404.603--0960-0012. Section 202(h) of the
Social Security Act (Act) establishes the conditions of eligibility a
claimant must meet to receive monthly benefits as a parent of a
deceased worker. SSA uses information from Form SSA-7-F6 to determine
if the claimant meets the eligibility and application criteria. The
respondents are applicants for, and recipients of, Social Security Old
Age, Survivors, and Disability Insurance (OASDI).
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)
----------------------------------------------------------------------------------------------------------------
Modernized Claims System (MCS)/Signature Proxy.. 164 1 15 41
Paper........................................... 4 1 15 1
---------------------------------------------------------------
Total....................................... 168 .............. .............. 42
----------------------------------------------------------------------------------------------------------------
2. Request for Withdrawal of Application--20 CFR 404.640--0960-
0015. Form SSA-521 documents the information SSA needs to process the
withdrawal of an application for benefits. A paper SSA-521 is our
preferred instrument for executing a withdrawal request; however, any
written request for withdrawal the claimant signs, or proper applicant
signs on the claimant's behalf, will suffice. Individuals who wish to
withdraw their applications for benefits complete Form SSA-521, or sign
the completed form for each request to withdraw. SSA uses the
information from the SSA-521 to process the request for withdrawal. The
respondents are applicants or claimants for Retirement, Survivors,
Disability, and Health Insurance benefits.
Type of Request: Revision of an OMB-approved information
collection.
[[Page 12456]]
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Modality of completion Number of Frequency of per response total annual
respondents response (minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-521..................................... 31,827 1 5 2,652
----------------------------------------------------------------------------------------------------------------
3. Statement of Self-Employment Income--20 CFR 404.101, 404.110,
404.1096(a)(d)--0960-0046. To qualify for insured status, and collect
Social Security benefits, self-employed individuals must demonstrate
they earned the minimum amount of self-employment income (SEI) in a
current year. SSA uses Form SSA-766, Statement of Self-Employment
Income, to collect the information we need to determine if the
individual earned at least the minimum amount of SEI needed for one or
more quarters of coverage in the current year. Based on the information
we obtain, we may credit additional quarters of coverage to give the
individual insured status, expediting benefit payments. Respondents are
self-employed individuals potentially eligible for Social Security
benefits.
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-766..................................... 2,500 1 5 208
----------------------------------------------------------------------------------------------------------------
4. Request for Workers' Compensation/Public Disability Benefit
Information--20 CFR 404.408(e)--0960-0098. Claimants for Social
Security disability payments who are also receiving Worker's
Compensation/Public Disability Benefits (WC/PDB) must notify SSA about
their WC/PDB, so the agency can reduce claimants' Social Security
disability payments accordingly. If claimants provide necessary
evidence, such as a copy of their award notice, benefit check, etc.,
that is sufficient verification. In cases where claimants cannot
provide such evidence, SSA uses Form SSA-1709. The entity paying the
WC/PDB benefits, its agent (such as an insurance carrier), or an
administering public agency complete this form. The respondents are
Federal, State, and local agencies; insurance carriers; and public or
private self-insured companies administering WC/PDB benefits to
disability claimants.
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-1709.................................... 120,000 1 15 30,000
----------------------------------------------------------------------------------------------------------------
5. Third Party Liability Information Statement--42 CFR 433.136-
433.139--0960-0323. To reduce Medicaid costs, Medicaid state agencies
identify third party insurers liable for medical care or services for
Medicaid beneficiaries. Regulations at 42 CFR 433.136-433.139 of the
Code of Federal Regulations, require Medicaid state agencies to obtain
this information on Medicaid applications and redeterminations as a
condition of Medicaid eligibility. States may enter into agreements
with the Commissioner of Social Security to make Medicaid eligibility
determinations for aged, blind, and disabled beneficiaries in those
states. Applications for and redeterminations of Supplemental Security
Income (SSI) eligibility in jurisdictions with such agreements are
applications and redeterminations of Medicaid eligibility. Under these
agreements, SSA obtains third party liability information using Form
SSA-8019-U2, and provides that information to the Medicaid state
agencies. The Medicaid state agencies use the information to bill third
parties liable for medical care, support, or services for a beneficiary
to guarantee that Medicaid remains the payer of last resort. The
respondents are SSI claimants and recipients.
Type of Request: 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-8019-U2 Paper form.......................... 200 1 5 17
SSI Claims System............................... 49,621 1 5 4,135
---------------------------------------------------------------
Totals...................................... 49,821 .............. .............. 4,152
----------------------------------------------------------------------------------------------------------------
[[Page 12457]]
6. Permanent Residence in the United States Under Color of Law
(PRUCOL)--20 CFR 416.1615 and 416.1618--0960-0451. As per 20 CFR
416.1415 and 416.1618 of the Code of Federal Regulations, SSA requires
claimants or recipients to submit evidence of their alien status when
they apply for SSI payments, and periodically thereafter as part of the
eligibility determination process for SSI. When SSA cannot verify
evidence of alien status through the regular claimant interview
process, SSA verifies the validity of the evidence of PRUCOL for
grandfathered nonqualified aliens with the Department of Homeland
Security (DHS), and determines if the individual qualifies for PRUCOL
status based on the DHS response. SSA does not maintain any forms or
applications for respondents to use, rather, the regulations listed in
20 CFR 416.1615 and 416.1618 specify the information respondents need
to submit to SSA to show evidence of PRUCOL. Without this information,
SSA is unable to determine whether the PRUCOL individual is eligible
for SSI payments. Respondents are qualified and unqualified aliens who
apply for SSI payments under PRUCOL.
Type of Request: Extension 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)
----------------------------------------------------------------------------------------------------------------
Personal or Telephone Interview............. 1,049 1 5 87
----------------------------------------------------------------------------------------------------------------
7. Authorization for the Social Security Administration to Obtain
Account Records from a Financial Institution and Request for Records
(Medicare)--20 CFR 418.3420--0960-0729. The Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (MMA) established the
Medicare Part D program for voluntary prescription drug coverage of
premium, deductible, and copayment costs for individuals with limited
income and resources. The MMA mandates that the Government provide
subsidies for those individuals who qualify for the program, and who
meet eligibility criteria for help with premium, deductible, or co-
payment costs. SSA uses the SSA-4640, Authorization for the Social
Security Administration to Obtain Account Records from a Financial
Institution and Request for Records (Medicare), to determine if subsidy
applicants or recipients qualify, or continue to qualify, for the
subsidy. SSA uses Form SSA-4640 to: (1) Obtain the individual's consent
to verify balances of financial institution (FI) accounts; and (2)
obtain verification of such balances from the FI. Respondents are
Medicare Part D program subsidy applicants or claimants, and their
financial institutions.
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)
----------------------------------------------------------------------------------------------------------------
Medicare Part D Subsidy Applicants.............. 5,000 1 1 83
Financial Institutions.......................... 5,000 1 4 333
---------------------------------------------------------------
Total....................................... 10,000 .............. .............. 416
----------------------------------------------------------------------------------------------------------------
II. SSA submitted the information collections below to OMB for
clearance. Your comments regarding these 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 April 20, 2018. Individuals can obtain copies of the
OMB clearance packages by writing to [email protected].
1. 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 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 paper Form HA-
520, or the internet application, i520. SSA uses the information we
collect 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 then
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: A New Information Collection Request.
----------------------------------------------------------------------------------------------------------------
Average Estimated
Number of Frequency of burden per total annual
Modality of completion respondents response response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
HA-520--Paper................................... 105,000 1 10 17,500
i520--Internet.................................. 70,000 1 15 17,500
---------------------------------------------------------------
[[Page 12458]]
Total....................................... 175,000 .............. .............. 35,000
----------------------------------------------------------------------------------------------------------------
2. Claimant's Recent Medical Treatment--20 CFR 404.1512 and
416.912--0960-0292. When DDSs deny a claim at the reconsideration
level, the claimant has a right to request a hearing before an
administrative law judge (ALJ). For the hearing, SSA asks the claimant
to complete and return the HA-4631 if the claimant's file does not
reflect a current, complete medical history as the claimant proceeds
through the appeals process. ALJs must obtain the information to update
and complete the record and to verify the accuracy of the information.
Through this process, ALJs can ascertain whether the claimant's
situation changed. The ALJs and hearing office staff use the response
to make arrangements for consultative examination(s) and the attendance
of an expert witness(es), if appropriate. During the hearing, the ALJ
offers any completed questionnaires as exhibits and may use them to:
(1) Refresh the claimant's memory, and (2) shape their questions. The
respondents are claimants requesting hearings on entitlement to OASDI
benefits or SSI payments.
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-4631..................................... 200,000 1 20 33,333
----------------------------------------------------------------------------------------------------------------
Dated: March 15, 2018.
Naomi R. Sipple,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2018-05627 Filed 3-20-18; 8:45 am]
BILLING CODE 4191-02-P
