Agency Information Collection Activities: Proposed Request and Comment Request, 26736-26739 [2018-12395]

Download as PDF 26736 Federal Register / Vol. 83, No. 111 / Friday, June 8, 2018 / Notices Modality of completion Number of respondents Frequency of response Average burden of response (hours) Estimated total annual burden (hours) SSA–680 .......................................................................................................... 30 1 5 150 II. SSA submitted the information collection below to OMB for clearance. Your comments regarding this 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 July 9, 2018. Individuals can obtain copies of the OMB clearance packages by writing to OR.Reports.Clearance@ssa.gov. Statement of Reclamation Action—31 CFR 210—0960–0734. Regulations governing the Federal Government Participation in the Automated Clearing House: (1) Allow SSA to send Social Security payments to Canada; and (2) mandate the reclamation of funds paid erroneously to a Canadian bank, or financial institution, after the death of a Social Security beneficiary. SSA uses Form SSA–1713, Notice of Reclamation Action, to determine if, how, and when the Canadian bank or financial institution is going to return erroneous payments after the death of a Social Number of respondents Modality of completion Security beneficiary who elected to have payments sent to Canada. Form SSA– 1712 (or SSA–1712 CN), Notice of Reclamation-Canada Payment Made in the United States, is the cover sheet SSA prepares to request return of the payment. The respondents are Canadian banks and financial institutions who erroneously received Social Security payments. Type of Request: Revision of an OMBapproved information collection. Frequency of response Average burden of response (minutes) Estimated total annual burden (hours) SSA–1712 ........................................................................................................ SSA–1713 ........................................................................................................ 8 7 1 1 5 5 1 1 Totals ........................................................................................................ 15 ........................ ........................ 2 Dated: June 4, 2018. Faye Lipsky, Reports Clearance Director, Social Security Administration. [FR Doc. 2018–12391 Filed 6–7–18; 8:45 am] BILLING CODE 4191–02–P SOCIAL SECURITY ADMINISTRATION [Docket No. SSA–2018–0024] Agency Information Collection Activities: Proposed Request and Comment Request amozie on DSK3GDR082PROD with NOTICES1 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– 2018–0024]. Number of respondents Modality of completion SSA–7160–F4—Individuals ............................................................................. SSA–7160–F4—Businesses ............................................................................ SSA–7160–F4—State/Local Governemnt ....................................................... VerDate Sep<11>2014 16:53 Jun 07, 2018 Jkt 241001 PO 00000 Frm 00096 Fmt 4703 Sfmt 4703 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 August 7, 2018. Individuals can obtain copies of the collection instruments by writing to the above email address. 1. Employment Relationship Questionnaire—20 CFR 404.1007— 0960–0040. When SSA needs information to determine a worker’s employment status for the purpose of maintaining a worker’s earning records, the agency uses Form SSA–7160–F4 to determine the existence of an employeremployee relationship. We use the information to develop the employment relationship; specifically, to determine whether a beneficiary is self-employed or an employee. The respondents are individuals seeking to establish their status as employees, and their alleged employers. Type of Request: Revision of an OMBapproved information collection. Frequency of response 8,000 7,200 800 E:\FR\FM\08JNN1.SGM 1 1 1 08JNN1 Average burden per response (minutes) 25 25 25 Estimated total annual burden (hours) 3,333 3,000 333 26737 Federal Register / Vol. 83, No. 111 / Friday, June 8, 2018 / Notices Total .......................................................................................................... 2. Application for Circuit Court Law— 20 CFR 404.985 & 416.1458—0960– 0581. Persons claiming an acquiescence ruling (AR) would change SSA’s prior determination or decision must submit a written readjudication request with specific information. SSA reviews the information in the requests to determine Average burden per response (minutes) 16,000 ........................ ........................ if the issues stated in the AR pertain to the claimant’s case, and if the claimant is entitled to readjudication. If readjudication is appropriate, SSA considers the issues the AR covers. Any new determination or decision is subject to administrative or judicial review as specified in the regulations, and the Number of rspondents Modality of completion AR-based Readjudication Requests ................................................................ 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 July 9, 2018. Individuals can obtain copies of the OMB clearance packages by writing to OR.Reports.Clearance@ssa.gov. Frequency of response Number of respondents Modality of completion 6,666 claimants must provide information to request readjudication. Respondents are claimants for Social Security benefits and Supplemental Security Income (SSI) payments who request readjudication. Type of Request: Extension of an OMB-approved information collection. Frequency of response 10,000 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 Estimated total annual burden (hours) Average burden per response (minutes) 1 Estimated Total annual burden (hours) 17 2,833 respondents are applicants for, and recipients of, Social Security Old Age, Survivors, and Disability Insurance (OASDI). Correction Notice: SSA is updating the burden information for this collection, so it differs from the information we published at 83 FR 12455, on 3/21/18. 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–7–F6—Modernized Claims System and Paper Versions ....................... 168 1 15 42 written request for withdrawal signed by the claimant or a proper applicant 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 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 process the request for withdrawal. The respondents are applicants for Retirement, Survivors, Disability, and Health Insurance benefits. 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–521 .......................................................................................................... amozie on DSK3GDR082PROD with NOTICES1 Modality of completion 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 VerDate Sep<11>2014 16:53 Jun 07, 2018 Jkt 241001 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 PO 00000 Frm 00097 Fmt 4703 Sfmt 4703 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. E:\FR\FM\08JNN1.SGM 08JNN1 26738 Federal Register / Vol. 83, No. 111 / Friday, June 8, 2018 / Notices 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 2 CFR 433.136–433.139 require Medicaid state agencies to obtain this information on Medicaid applications and redeterminations as a condition of Medicaid eligibility. States may enter into agreements with the Commissioner of Social Security to make Medicaid eligibility determinations for aged, blind, and disabled beneficiaries in those states. Applications for and redeterminations of 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 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. Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) SSA–8019–U2—Paper Version ....................................................................... SSA–8019–U2—SSI Claims Sysetm Version ................................................. 200 49,621 1 1 5 5 17 4,135 Totals ........................................................................................................ 49,821 ........................ ........................ 4,152 amozie on DSK3GDR082PROD with NOTICES1 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 VerDate Sep<11>2014 16:53 Jun 07, 2018 Jkt 241001 PO 00000 Frm 00098 Fmt 4703 Sfmt 4703 E:\FR\FM\08JNN1.SGM 08JNN1 26739 Federal Register / Vol. 83, No. 111 / Friday, June 8, 2018 / Notices 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 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. 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, Type of Request: Revision of an OMBapproved information collection. Number of respondents Modality of completion Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) SSA–4640—Medicare Part D Subsidy Applicants .......................................... SSA–4640—Financial Institutions ................................................................... 5,000 5,000 1 1 1 4 83 333 Total .......................................................................................................... 10,000 ........................ ........................ 416 Dated: June 4, 2018. Faye Lipsky, Reports Clearance Director, Social Security Administration. [FR Doc. 2018–12395 Filed 6–7–18; 8:45 am] BILLING CODE 4191–02–P SOCIAL SECURITY ADMINISTRATION [Docket No. SSA 2017–0059] Privacy Act of 1974; Matching Program AGENCY: Social Security Administration (SSA). Notice of a new matching program. ACTION: In accordance with the provisions of the Privacy Act, as amended, this notice announces a new matching program with the Railroad Retirement Board (RRB). This matching agreement sets forth the terms, safeguards, and procedures under which RRB, as the source agency, will disclose RRB annuity payment data to SSA, the recipient agency. SSA will use the information to verify Supplemental Security Income (SSI) and Special Veterans Benefits (SVB) eligibility and benefit payment amounts. SSA will also record the railroad annuity amounts RRB paid to SSI and SVB recipients in the Supplemental Security Income Record (SSR). DATES: The deadline to submit comments on the proposed matching program is 30 days from the date of publication in the Federal Register. The matching program will be applicable on September 2, 2018 and will expire on March 1, 2020, or once a minimum of 30 days after publication of this notice amozie on DSK3GDR082PROD with NOTICES1 SUMMARY: VerDate Sep<11>2014 16:53 Jun 07, 2018 Jkt 241001 has elapsed, whichever is later. The matching program will be in effect for a period of 18 months. ADDRESSES: Interested parties may comment on this notice by either telefaxing to (410) 966–0869, writing to Mary Ann Zimmerman, Acting Executive Director, Office of Privacy and Disclosure, Office of the General Counsel, Social Security Administration, G–401WHR Building, 6401 Security Boulevard, Baltimore, MD 21235–6401, or email at Mary.Ann.Zimmerman@ssa.gov. All comments received will be available for public inspection by contacting Ms. Zimmerman at this street address. FOR FURTHER INFORMATION CONTACT: Interested parties may submit general questions about the matching program to Mary Ann Zimmerman, Acting Executive Director, Office of Privacy and Disclosure, Office of the General Counsel, by any of the means shown above. Mary Ann Zimmerman, Acting Executive Director, Office of Privacy and Disclosure, Office of the General Counsel. Participating Agencies: SSA and RRB. Authority for Conducting the Matching Program: The legal authority for this agreement is executed in compliance with the Privacy Act of 1974, as amended by the Computer Matching and Privacy Protection Act of 1988, the regulations and guidance promulgated thereunder. Legal authority for the disclosure under this agreement for the SSI portion are 1631(e)(1)(A) and (B) and 1631(f) of the Social Security Act (Act) (42 U.S.C. 1383(e)(1)(A) and (B) and 1383(f)). The legal authority for the disclosure under this agreement for PO 00000 Frm 00099 Fmt 4703 Sfmt 4703 the SVB portion is 806(b) of the Act (42 U.S.C. 1006(b)). Purpose(s): The purpose of this matching program is to set forth the terms, safeguards, and procedures under which RRB, as the source agency, will disclose RRB annuity payment data to SSA, the recipient agency. SSA will use the information to verify SSI and SVB eligibility and benefit payment amounts. SSA will also record the railroad annuity amounts RRB paid to SSI and SVB recipients in the SSR. Categories of Individuals: The individuals whose information is involved in this matching program are applicants for and recipients of SSI payments and SVB benefits. Categories of Records: SSA will match the Social Security number, name, date of birth, and RRB claim number on the RRB file and the SSR. System(s) of Records: RRB will provide SSA with an electronic data file containing annuity payment data from RRB’s system of records, RRB–22 Railroad Retirement, Survivor, and Pensioner Benefits System, last published on May 15, 2015 (80 FR 28018). SSA will match RRB’s data with data maintained in the SSR, Supplemental Security Income Record and Special Veterans Benefits, SSA/ OITPBS, 60–0103, published on January 11, 2006 (71 FR 1830) and December 10, 2007 (72 FR 69723). SVB data also resides on the SSR. [FR Doc. 2018–12314 Filed 6–7–18; 8:45 am] BILLING CODE 4191–02–P E:\FR\FM\08JNN1.SGM 08JNN1

Agencies

[Federal Register Volume 83, Number 111 (Friday, June 8, 2018)]
[Notices]
[Pages 26736-26739]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-12395]


-----------------------------------------------------------------------

SOCIAL SECURITY ADMINISTRATION

[Docket No. SSA-2018-0024]


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: [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-2018-0024].
    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 
August 7, 2018. Individuals can obtain copies of the collection 
instruments by writing to the above email address.
    1. Employment Relationship Questionnaire--20 CFR 404.1007--0960-
0040. When SSA needs information to determine a worker's employment 
status for the purpose of maintaining a worker's earning records, the 
agency uses Form SSA-7160-F4 to determine the existence of an employer-
employee relationship. We use the information to develop the employment 
relationship; specifically, to determine whether a beneficiary is self-
employed or an employee. The respondents are individuals seeking to 
establish their status as employees, and their alleged employers.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                                     Estimated
                                                     Number of     Frequency of   Average burden   total annual
             Modality of completion                 respondents      response      per  response      burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-7160-F4--Individuals........................           8,000               1              25           3,333
SSA-7160-F4--Businesses.........................           7,200               1              25           3,000
SSA-7160-F4--State/Local Governemnt.............             800               1              25             333
                                                 ---------------------------------------------------------------

[[Page 26737]]

 
    Total.......................................          16,000  ..............  ..............           6,666
----------------------------------------------------------------------------------------------------------------

    2. Application for Circuit Court Law--20 CFR 404.985 & 416.1458--
0960-0581. Persons claiming an acquiescence ruling (AR) would change 
SSA's prior determination or decision must submit a written 
readjudication request with specific information. SSA reviews the 
information in the requests to determine if the issues stated in the AR 
pertain to the claimant's case, and if the claimant is entitled to 
readjudication. If readjudication is appropriate, SSA considers the 
issues the AR covers. Any new determination or decision is subject to 
administrative or judicial review as specified in the regulations, and 
the claimants must provide information to request readjudication. 
Respondents are claimants for Social Security benefits and Supplemental 
Security Income (SSI) payments who request readjudication.
    Type of Request: Extension of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                                     Estimated
                                                     Number of     Frequency of   Average burden   Total annual
             Modality of completion                 rspondents       response      per response       burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
AR-based Readjudication Requests................          10,000               1              17           2,833
----------------------------------------------------------------------------------------------------------------

    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 July 9, 2018. Individuals can obtain copies of the 
OMB clearance packages by writing to [email protected].
    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).
    Correction Notice: SSA is updating the burden information for this 
collection, so it differs from the information we published at 83 FR 
12455, on 3/21/18.
    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-7-F6--Modernized Claims System and Paper             168                1               15               42
 Versions...................................
----------------------------------------------------------------------------------------------------------------

    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 signed by the claimant or a proper 
applicant 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 for Retirement, Survivors, Disability, and 
Health Insurance 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-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.

[[Page 26738]]



----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden  Estimated total
           Modality of completion                Number of       Frequency of    per  response    annual burden
                                                respondents        response        (minutes)         (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 total
           Modality of completion                Number of       Frequency of    per  response    annual burden
                                                respondents        response        (minutes)         (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 2 CFR 433.136-433.139 require 
Medicaid state agencies to obtain this information on Medicaid 
applications and redeterminations as a condition of Medicaid 
eligibility. States may enter into agreements with the Commissioner of 
Social Security to make Medicaid eligibility determinations for aged, 
blind, and disabled beneficiaries in those states. Applications for and 
redeterminations of 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 Version......................             200               1               5              17
SSA-8019-U2--SSI Claims Sysetm Version..........          49,621               1               5           4,135
                                                 ---------------------------------------------------------------
    Totals......................................          49,821  ..............  ..............           4,152
----------------------------------------------------------------------------------------------------------------

    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 total
           Modality of completion                Number of       Frequency of     per response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
Personal or Telephone Interview.............           1,049                1                5               87
----------------------------------------------------------------------------------------------------------------


[[Page 26739]]

    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)
----------------------------------------------------------------------------------------------------------------
SSA-4640--Medicare Part D Subsidy Applicants....           5,000               1               1              83
SSA-4640--Financial Institutions................           5,000               1               4             333
                                                 ---------------------------------------------------------------
    Total.......................................          10,000  ..............  ..............             416
----------------------------------------------------------------------------------------------------------------


    Dated: June 4, 2018.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2018-12395 Filed 6-7-18; 8:45 am]
 BILLING CODE 4191-02-P