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