Agency Information Collection Activities: Proposed Request, 31972-31976 [2019-14173]

Download as PDF 31972 Federal Register / Vol. 84, No. 128 / Wednesday, July 3, 2019 / Notices 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. SUPPLEMENTARY INFORMATION: The notice of the President’s major disaster declaration for the State of South Dakota, dated 06/07/2019, is hereby amended to include the following areas as adversely affected by the disaster: Primary Counties (Physical Damage and Economic Injury Loans): Turner Contiguous Counties (Economic Injury Loans Only): None All other information in the original declaration remains unchanged. (Catalog of Federal Domestic Assistance Number 59008) James Rivera, Associate Administrator for Disaster Assistance. [FR Doc. 2019–14145 Filed 7–2–19; 8:45 am] BILLING CODE 8026–03–P SMALL BUSINESS ADMINISTRATION [Disaster Declaration #16016 and #16017; North Carolina Disaster Number NC–00110] Administrative Declaration of a Disaster for the State of North Carolina U.S. Small Business Administration. ACTION: Notice. AGENCY: This is a notice of an Administrative declaration of a disaster for the State of North Carolina dated 06/ 27/2019. Incident: Flooding and Heavy Winds. Incident Period: 06/06/2019. DATES: Issued on 06/27/2019. Physical Loan Application Deadline Date: 08/26/2019. Economic Injury (EIDL) Loan Application Deadline Date: 03/27/2020. ADDRESSES: Submit completed loan applications to: U.S. Small Business Administration, Processing and Disbursement Center, 14925 Kingsport Road, Fort Worth, TX 76155. FOR FURTHER INFORMATION CONTACT: A. Escobar, Office of Disaster Assistance, U.S. Small Business Administration, 409 3rd Street SW, Suite 6050, Washington, DC 20416, (202) 205–6734. SUPPLEMENTARY INFORMATION: Notice is hereby given that as a result of the jspears on DSK30JT082PROD with NOTICES SUMMARY: VerDate Sep<11>2014 19:23 Jul 02, 2019 Jkt 247001 Administrator’s disaster declaration, applications for disaster loans may be filed at the address listed above or other locally announced locations. The following areas have been determined to be adversely affected by the disaster: Primary Counties: Catawba, Mecklenburg. Contiguous Counties: North Carolina: Alexander, Burke, Cabarrus, Caldwell, Gaston, Iredell, Lincoln, Union. South Carolina: Lancaster, York. The Interest Rates are: Percent For Physical Damage: Homeowners with Credit Available Elsewhere ...................... Homeowners without Credit Available Elsewhere .............. Businesses with Credit Available Elsewhere ...................... Businesses without Credit Available Elsewhere .............. Non-Profit Organizations with Credit Available Elsewhere ... Non-Profit Organizations without Credit Available Elsewhere ..................................... For Economic Injury: Businesses & Small Agricultural Cooperatives without Credit Available Elsewhere .............. Non-Profit Organizations without Credit Available Elsewhere ..................................... Public Law 104–13, the Paperwork Reduction Act of 1995, effective October 1, 1995. This notice includes extensions 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, 1.938 Fax: 202–395–6974, Email address: OIRA_Submission@omb.eop.gov 8.000 (SSA), Social Security Administration, OLCA, Attn: Reports Clearance 4.000 Director, 3100 West High Rise, 6401 2.750 Security Blvd., Baltimore, MD 21235, Fax: 410–966–2830, Email address: OR.Reports.Clearance@ssa.gov 3.875 2.750 Or you may submit your comments online through www.regulations.gov, referencing Docket ID Number [SSA– 4.000 2019–0026]. The information collections below are pending at SSA. SSA will submit them 2.750 to OMB within 60 days from the date of this notice. To be sure we consider your The number assigned to this disaster comments, we must receive them no for physical damage is 16016 6 and for later than September 3, 2019. economic injury is 16017 0. Individuals can obtain copies of the The States which received an EIDL collection instruments by writing to the Declaration # are North Carolina, South above email address. Carolina. 1. Application for Child’s Insurance (Catalog of Federal Domestic Assistance Benefits—20 CFR 404.350–404.368, Number 59008) 404.603, & 416.350—0960–0010. Title II Christopher Pilkerton, of the Social Security Act (Act) provides for the payment of monthly benefits to Acting Administrator. children of an insured retired, disabled, [FR Doc. 2019–14151 Filed 7–2–19; 8:45 am] or deceased worker. Section 202(d) of BILLING CODE 8026–03–P the Act discloses the conditions and requirements the applicant must meet when filing an application. SSA uses SOCIAL SECURITY ADMINISTRATION the information on Form SSA–4–BK to [Docket No: SSA–2019–0026] determine entitlement for children of living and deceased workers to monthly Agency Information Collection Social Security payments. Respondents Activities: Proposed Request are guardians completing the form on behalf of the children of living or The Social Security Administration deceased workers, or the children of (SSA) publishes a list of information living or deceased workers. collection packages requiring clearance by the Office of Management and Type of Request: Revision of an OMBBudget (OMB) in compliance with approved information collection. PO 00000 Frm 00141 Fmt 4703 Sfmt 4703 E:\FR\FM\03JYN1.SGM 03JYN1 31973 Federal Register / Vol. 84, No. 128 / Wednesday, July 3, 2019 / Notices Number of respondents Modality of completion Estimated total annual burden (hours) Application for Child’s Insurance Benefits/Death Claim/Paper SSA–4–BK .... Application for Child’s Insurance Benefits/Death Claim/Modernized Claims System (MCS) and Preliminary Claims System (PCS) ............................... Application for Child’s Insurance Benefits/Life Claim/Paper SSA–4–BK ........ Application for Child’s Insurance Benefits/Life Claim/MCS and PCS ............. 1,204 1 12 241 204,777 3,484 422,267 1 1 1 11 12 11 37,542 697 77,416 Totals ........................................................................................................ 631,732 ........................ ........................ 115,896 2. Request for Hearing by Administrative Law Judge—20 CFR 404.929, 404.933, 416.1429, 404.1433, 418.1350, and 42 CFR 405.722—0960– 0269. When SSA denies applicants’, claimants’, or beneficiaries’ requests for new or continuing disability benefits or payments, the Act entitles those applicants, claimants, or beneficiaries to request a hearing to appeal the decision. To request a hearing, individuals complete Form HA–501; the associated Modernized Claims System (MCS) or Supplemental Security Income (SSI) Claims System interview; or the internet application (i501). SSA uses the information to determine if the individual: (1) Filed the request within the prescribed time; (2) is the proper party; and (3) took the steps necessary to obtain the right to a hearing. SSA also uses the information to determine: (1) The individual’s reason(s) for disagreeing with SSA’s prior determinations in the case; (2) if the individual has additional evidence to submit; (3) if the individual wants an oral hearing or a decision on the record; Number of respondents Modality of completion and (4) whether the individual has (or wants to appoint) a representative. The respondents are Social Security disability applicants and recipients who want to appeal SSA’s denial of their request for new or continued benefits for disability and non-medical hearing requests; and Medicare Part B recipients who must pay the Medicare Part B Income-Related Monthly Adjustment Amount. Type of Request: Revision of an OMBapproved information collection. Average burden per response (minutes) Frequency of response Estimated total annual burden (hours) HA–501; MCS; SSI Claims System ................................................................. i501 (Internet iAppeals) ................................................................................... 10,325 653,318 1 1 10 5 1,721 54,443 Totals ........................................................................................................ 663,643 ........................ ........................ 56,164 3. Travel Expense Reimbursement— 20 CFR 404.999(d) and 416.1499— 0960–0434. The Act provides for travel expense reimbursement from Federal and State agencies for claimant travel incidental to medical examinations, and to parties, their representatives, and all reasonably necessary witnesses for jspears on DSK30JT082PROD with NOTICES Average burden per response (minutes) Frequency of response travel exceeding 75 miles to attend medical examinations; reconsideration interviews; and proceedings before an administrative law judge. Reimbursement procedures require the claimant to provide: (1) A list of expenses incurred, and (2) receipts of such expenses. Federal and state personnel review the listings and receipts to verify the reimbursable amount to the requestor. The respondents are claimants for Title II benefits and Title XVI payments, their representatives, and witnesses. 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) 404.99(d) & 416.1499 ...................................................................................... 60,000 1 10 10,000 4. Certificate of Coverage Request—20 CFR 404.1913—0960–0554. The United States (U.S.) has agreements with 30 foreign countries to eliminate double Social Security coverage and taxation where, except for the provisions of the agreement, a worker would be subject to coverage and taxes in both countries. These agreements contain rules for determining the country under whose laws the worker’s period of employment is covered, and to which country the VerDate Sep<11>2014 19:23 Jul 02, 2019 Jkt 247001 worker will pay taxes. The agreements further dictate that, upon the request of the worker or employer, the country under whose system the period of work is covered will issue a certificate of coverage. The certificate serves as proof of exemption from coverage and taxation under the system of the other country. The information we collect assists us in determining a worker’s coverage and in issuing a U.S. certificate of coverage as appropriate. Per our PO 00000 Frm 00142 Fmt 4703 Sfmt 4703 agreements, we ask a set number of questions to the workers and employers prior to issuing a certificate of coverage; however, our agreements with Denmark, Netherlands, Norway, and Sweden require us to ask more questions in those countries. Respondents are workers and employers wishing to establish exemption from foreign Social Security taxes. Type of Request: Revision of an OMBapproved information collection. E:\FR\FM\03JYN1.SGM 03JYN1 31974 Federal Register / Vol. 84, No. 128 / Wednesday, July 3, 2019 / Notices Number of respondents Modality of completion Requests via Letter—Individuals (minus Denmark, Netherlands, Norway, Poland & Sweden) ....................................................................................... Requests via Internet—Individuals (minus Denmark, Netherlands, Norway, Poland & Sweden) ....................................................................................... Requests via Letter—Individuals in Denmark, Netherlands, Norway, & Sweden ............................................................................................................... Requests via Letter—Individuals in Poland ..................................................... Requests via Internet—Individuals in Denmark, Netherlands, Norway, & Sweden ........................................................................................................ Requests via Internet—Individuals in Poland .................................................. Requests via Letter—Employers (minus Denmark, Netherlands, Norway, Poland & Sweden) ....................................................................................... Requests via Internet—Employers (minus Denmark, Netherlands, Norway, Poland, & Sweden) ...................................................................................... Requests via Letter—Employers in Denmark, Netherlands, Norway, & Sweden ............................................................................................................... Requests via Letter—Employers in Poland ..................................................... Requests via Internet—Employers in Denmark, Netherlands, Norway, & Sweden ........................................................................................................ Requests via Internet—Employers in Poland .................................................. Totals ........................................................................................................ 5. Privacy and Disclosure of Official Records and Information; Availability of Information and Records to the Public— 20 CFR 401.40(b)&(c), 401.55(b), 401.100(a), 402.130, 402.185—0960– 0566. SSA established methods for the public to: (1) Access their SSA records; (2) allow SSA to disclose records; (3) 1 40 3,889 9,761 1 40 6,507 284 16 1 1 44 41 208 11 427 25 1 1 44 41 313 17 26,047 1 40 17,365 39,096 1 40 26,064 1,137 57 1 1 44 41 834 39 1,704 86 1 1 44 41 1,250 59 84,473 ........................ ........................ 56,556 Number of respondents consent for release of records, for which we use Form SSA–3288. The respondents are individuals requesting access to, correction of, or disclosure of SSA records. Type of Request: Extension of an OMB-approved information collection. Average burden per response (minutes) Frequency of response Estimated total annual burden (hours) Access to Records ........................................................................................... Designating a Representative for Disclosure of Records ............................... Amendment of Records ................................................................................... Consent of Release of Records ...................................................................... FOIA Requests for Records ............................................................................ Respondents who request access to an extract of their SSN record ............. 10,000 3,000 100 3,000,760 15,000 10 1 1 1 1 1 1 11 120 10 3 5 8.5 1,833 6,000 17 150,038 1,250 1 Totals ........................................................................................................ 3,028,870 ........................ ........................ 159,139 6. Disability Report—Child—20 CFR 416.912—0960–0577—Sections 223(d)(5)(A) and 1631(e)(1) of the Act require SSI claimants to furnish medical and other evidence to prove they are disabled. SSA uses Form SSA–3820 to collect various types of information about a child’s condition from treating sources or other medical sources of evidence. The State Disability Determination Services evaluators use the information from Form SSA–3820 to develop medical and school evidence, and to assess the alleged disability. The information, together with medical evidence, forms the evidentiary basis Number of respondents Modality of completion jspears on DSK30JT082PROD with NOTICES Estimated total annual burden (hours) 5,833 correct or amend their SSA records; (4) consent for release of their records; (5) request records under the Freedom of Information Act (FOIA); and (6) request access to an extract of their SSN record. SSA often collects the necessary information for these requests through a written letter, with the exception of the Modality of completion Average burden per response (minutes) Frequency of response upon which SSA makes its initial disability evaluation. The respondents are claimants seeking SSI childhood disability payments. Type of Request: Revision of an OMBapproved information collection. Average burden per response (minutes) Frequency of response Estimated total annual burden (hours) SSA–3820 ........................................................................................................ EDCS ............................................................................................................... i3820 ................................................................................................................ 177,572 1,000 176,572 1 1 1 90 120 120 266,358 2,000 353,144 Totals ........................................................................................................ 355,144 ........................ ........................ 621,502 VerDate Sep<11>2014 19:23 Jul 02, 2019 Jkt 247001 PO 00000 Frm 00143 Fmt 4703 Sfmt 4703 E:\FR\FM\03JYN1.SGM 03JYN1 31975 Federal Register / Vol. 84, No. 128 / Wednesday, July 3, 2019 / Notices 7. Request for Reconsideration—20 CFR 404.907–404.921, 416.1407– 416.1421, 408.1009, and 418.1325— 0960–0622. The Act states those individuals who are dissatisfied with the results of an initial determination regarding their Title II disability; Tile XVI disability (SSI); Title VIII (Special Veterans benefits); or Title XVIII (Medicare benefits), can request a reconsideration hearing. Individuals use Form SSA–561–U2; the associated MCS or SSI Claims System interview; or the internet application (i561) to initiate a request for reconsideration of a denied claim. SSA uses the information to document the request and to determine an individual’s eligibility or entitlement to Social Security benefits (Title II); SSI payments (Title XVI); Special Veterans Number of respondents Modality of completion Average burden per response (minutes) Frequency of response Estimated total annual burden (hours) SSA–561 and Modernized Claims System (MCS) .......................................... I561 (Internet iAppeals) ................................................................................... 330,370 1,161,300 1 1 8 5 40,049 96,775 Totals ........................................................................................................ 1,491,670 ........................ ........................ 136,824 8. Request to Withdraw a Hearing Request; Request to Withdraw an Appeals Council Request for Review; and Administrative Review Process for Adjudicating Initial Disability Claims— 20 CFR parts 404, 405, and 416—0960– 0710. Claimants have a statutory right under the Act and current regulations to apply for Social Security Disability Insurance (SSDI) benefits or SSI payments. SSA collects information at each step of the administrative process to adjudicate claims fairly and efficiently. SSA collects this information to establish a claimant’s right to administrative review, and determine the severity of the claimant’s alleged impairments. SSA uses the information we collect to determine entitlement or continuing eligibility to SSDI benefits or SSI payments, and to enable appeals of these determinations. Number of respondents 20 CFR section No. jspears on DSK30JT082PROD with NOTICES Benefits (Title VIII); Medicare (Title XVIII); and for initial determinations regarding Medicare Part B incomerelated premium subsidy reductions. The respondents are applicants, claimants, beneficiaries, or recipients filing for reconsideration of an initial determination. Type of Request: Revision of an OMBapproved information collection. In addition, SSA collects information on Forms HA–85 and HA–86 to allow claimants to withdraw a hearing request or an Appeals Council review request. The respondents are applicants for Title II SSDI or Title XVI SSI benefits; their appointed representatives; legal advocates; medical sources; and schools. Type of Request: Revision of an OMBapproved information collection. Average burden per response (minutes) Frequency of response Estimated annual burden (hours) 404.961, 416.1461, 405.330, and 405.366 ..................................................... 404.950, 416.1450, and 405.332 .................................................................... 404.949 and 416.1449 ..................................................................................... 405.334 ............................................................................................................ 404.957, 416.1457, and 405.380 .................................................................... 405.381 ............................................................................................................ 405.401 ............................................................................................................ 404.971 and 416.1471 ..................................................................................... (HA–85; HA–86) .............................................................................................. 404.982 and 416.1482 ..................................................................................... 404.987 & 404.988 and 416.1487 & 416.1488 and 405.601 .......................... 404.1740(b)(1) ................................................................................................. 416.1540(b)(1) ................................................................................................. 404.1512, 404.1740(c)(4), 416.912, and 416.1540(c)(4) ................................ 405.372(c) ........................................................................................................ 405.1(b)(5) ....................................................................................................... 405.372(b) ........................................................................................................ 405.505 ............................................................................................................ 405.1(c)(2) ....................................................................................................... 405.20 .............................................................................................................. 12,220 1,040 2,868 20 21,041 37 5,310 1 1 1 1 1 1 1 20 20 60 60 10 30 10 4,073 347 2,868 20 3,507 19 885 1,606 1,687 12,425 150 150 150 5,310 833 1 1 1 1 1 1 1 1 10 30 30 2 2 2 10 30 268 844 6,213 5 5 5 885 417 833 5,310 5,310 1 1 1 30 10 10 417 885 885 Totals ........................................................................................................ 76,300 ........................ ........................ 22,548 9. Request for Accommodation in Communication Method—0960–0777. SSA allows disabled or impaired Social Security applicants, beneficiaries, recipients, and representative payees to choose one of seven alternative methods of communication they want SSA to use when we send them benefit notices and other related communications. The VerDate Sep<11>2014 19:23 Jul 02, 2019 Jkt 247001 seven alternative methods we offer are: (1) Standard print notice by first-class mail; (2) standard print mail with a follow-up telephone call; (3) certified mail; (4) Braille; (5) Microsoft Word file on data CD; (6) large print (18-point font); or (7) audio CD. However, respondents who want to receive notices from SSA through a PO 00000 Frm 00144 Fmt 4703 Sfmt 4703 communication method other than the seven methods listed above must explain their request to us. Those respondents use Form SSA–9000 to: (1) Describe the type of accommodation they want; (2) disclose their condition necessitating the need for a different type of accommodation; and (3) explain why none of the seven methods E:\FR\FM\03JYN1.SGM 03JYN1 31976 Federal Register / Vol. 84, No. 128 / Wednesday, July 3, 2019 / Notices described above are sufficient for their needs. SSA uses Form SSA–9000 to determine, based on applicable law and regulation, whether to grant the respondents’ requests for an accommodation based on their impairment or disability. SSA collects beneficiaries, recipients, and representative payees who ask SSA to send notices and other communications in an alternative method besides the seven modalities we currently offer. 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–9000/iAccommodate ............................................................................... 5,000 1 20 1,667 10. Report of Adult FunctioningEmployer—20 CFR 404.1512 and 416.912—0960–0805. Section 205(a), 223(d)(5)(A), 1631(d)(1), and 1631(e)(1) of the Act require claimants’ applying for SSDI benefits or SSI payments to provide SSA with medical and other evidence of their disability. 20 CFR 404.1512 and 20 CFR 416.912 of the Code of Federal Regulations provides detailed requirements of the types of evidence SSDI beneficiaries and SSI claimants must provide showing how their impairment(s) affect their ability to work (e.g., evidence of age; education and training, work experience; daily activities; efforts to work; and any other evidence). Past employers familiar with the claimant’s ability to perform work activities complete Form SSA–385–BK, Report of Adult Functioning-Employer to provide SSA with information about the employees day-to-day functioning in the work setting. SSA and Disability Determination Services use the information Form SSA–3385–BK collects as the basis to determine eligibility or continued eligibility for disability benefits. The respondents are claimants’ past employers. Type of Request: Revision of an OMBapproved information collection. Modality of completion Number of responses Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) SSA–3385–BK ................................................................................................. 3,601 1 20 1,200 Dated: June 27, 2019. Naomi Sipple, Reports Clearance Officer, Social Security Administration. [FR Doc. 2019–14173 Filed 7–2–19; 8:45 am] BILLING CODE 4191–02–P SURFACE TRANSPORTATION BOARD [Docket No. FD 36322] Athens Transportation Partners, LLC— Acquisition Exemption—The Athens Line, LLC jspears on DSK30JT082PROD with NOTICES this information electronically through either an in-person interview or a telephone interview during which the SSA employee keys in the information on our iAccommodate Intranet screens. The respondents are disabled or impaired Social Security applicants, Athens Transportation Partners, LLC (ATP) has filed a verified notice of exemption under 49 CFR 1150.31 to acquire from The Athens Line, LLC (Athens Line) approximately 6.5 miles of rail line in Athens, Ga., extending between milepost F–98.8 and milepost F–105.3. (the Line). ATP states that Athens Line recently discontinued service over the Line 1 and has agreed, subject to closing, to convey the Line and the appurtenant rights thereof to ATP pursuant to a Purchase and Sale Agreement. ATP states that it will assume the common carrier 1 See Athens Line—Discontinuance of Serv. Exemption—in Oconee & Clarke Ctys., Ga., AB 1274X (STB served Apr. 25, 2019). VerDate Sep<11>2014 19:23 Jul 02, 2019 Jkt 247001 obligation for the Line and arrange for any common carrier service that may be required. ATP certifies that its projected annual revenues as a result of this transaction will not exceed those that would qualify it as a Class III rail carrier. ATP further certifies that its acquisition of the Line does not involve any provision or agreement that would limit future interchange with a third-party connecting carrier. The transaction may be consummated on or after July 20, 2019, the effective date of the exemption (30 days after the verified notice was filed). If the verified notice contains false or misleading information, the exemption is void ab initio. Petitions to revoke the exemption under 49 U.S.C. 10502(d) may be filed at any time. The filing of a petition to revoke will not automatically stay the effectiveness of the exemption. Petitions to stay must be filed no later than July 12, 2019 (at least seven days before the exemption becomes effective). All pleadings, referring to Docket No. FD 36322, must be filed with the Surface Transportation Board either via e-filing or in writing addressed to 395 E Street SW, Washington, DC 20423–0001. In addition, a copy of each pleading must be served on ATP’s representative, PO 00000 Frm 00145 Fmt 4703 Sfmt 4703 Paul A. Cunningham, Harkins Cunningham, LLP, 1700 K Street NW, Suite 400, Washington, DC 20006. Board decisions and notices are available at www.stb.gov. Decided: June 28, 2019. By the Board, Allison C. Davis, Director, Office of Proceedings. Jeffrey Herzig, Clearance Clerk. [FR Doc. 2019–14260 Filed 7–2–19; 8:45 am] BILLING CODE 4915–01–P SUSQUEHANNA RIVER BASIN COMMISSION Public Hearing Susquehanna River Basin Commission. ACTION: Notice. AGENCY: The Susquehanna River Basin Commission will hold a public hearing on August 1, 2019, in Harrisburg, Pennsylvania. At this public hearing, the Commission will hear testimony on the projects listed in the SUPPLEMENTARY INFORMATION section of this notice. Such projects are intended to be scheduled for Commission action at its next business meeting, tentatively scheduled for September 6, 2019, which will be SUMMARY: E:\FR\FM\03JYN1.SGM 03JYN1

Agencies

[Federal Register Volume 84, Number 128 (Wednesday, July 3, 2019)]
[Notices]
[Pages 31972-31976]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-14173]


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SOCIAL SECURITY ADMINISTRATION

[Docket No: SSA-2019-0026]


Agency Information Collection Activities: Proposed 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 extensions 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-2019-0026].
    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 
September 3, 2019. Individuals can obtain copies of the collection 
instruments by writing to the above email address.
    1. Application for Child's Insurance Benefits--20 CFR 404.350-
404.368, 404.603, & 416.350--0960-0010. Title II of the Social Security 
Act (Act) provides for the payment of monthly benefits to children of 
an insured retired, disabled, or deceased worker. Section 202(d) of the 
Act discloses the conditions and requirements the applicant must meet 
when filing an application. SSA uses the information on Form SSA-4-BK 
to determine entitlement for children of living and deceased workers to 
monthly Social Security payments. Respondents are guardians completing 
the form on behalf of the children of living or deceased workers, or 
the children of living or deceased workers.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 31973]]



----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency  of    burden per     total annual
             Modality of completion                 respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
Application for Child's Insurance Benefits/Death           1,204               1              12             241
 Claim/Paper SSA-4-BK...........................
Application for Child's Insurance Benefits/Death         204,777               1              11          37,542
 Claim/Modernized Claims System (MCS) and
 Preliminary Claims System (PCS)................
Application for Child's Insurance Benefits/Life            3,484               1              12             697
 Claim/Paper SSA-4-BK...........................
Application for Child's Insurance Benefits/Life          422,267               1              11          77,416
 Claim/MCS and PCS..............................
                                                 ---------------------------------------------------------------
    Totals......................................         631,732  ..............  ..............         115,896
----------------------------------------------------------------------------------------------------------------

    2. Request for Hearing by Administrative Law Judge--20 CFR 404.929, 
404.933, 416.1429, 404.1433, 418.1350, and 42 CFR 405.722--0960-0269. 
When SSA denies applicants', claimants', or beneficiaries' requests for 
new or continuing disability benefits or payments, the Act entitles 
those applicants, claimants, or beneficiaries to request a hearing to 
appeal the decision. To request a hearing, individuals complete Form 
HA-501; the associated Modernized Claims System (MCS) or Supplemental 
Security Income (SSI) Claims System interview; or the internet 
application (i501). SSA uses the information to determine if the 
individual: (1) Filed the request within the prescribed time; (2) is 
the proper party; and (3) took the steps necessary to obtain the right 
to a hearing. SSA also uses the information to determine: (1) The 
individual's reason(s) for disagreeing with SSA's prior determinations 
in the case; (2) if the individual has additional evidence to submit; 
(3) if the individual wants an oral hearing or a decision on the 
record; and (4) whether the individual has (or wants to appoint) a 
representative. The respondents are Social Security disability 
applicants and recipients who want to appeal SSA's denial of their 
request for new or continued benefits for disability and non-medical 
hearing requests; and Medicare Part B recipients who must pay the 
Medicare Part B Income-Related Monthly Adjustment Amount.
    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)
----------------------------------------------------------------------------------------------------------------
HA-501; MCS; SSI Claims System..................          10,325               1              10           1,721
i501 (Internet iAppeals)........................         653,318               1               5          54,443
                                                 ---------------------------------------------------------------
    Totals......................................         663,643  ..............  ..............          56,164
----------------------------------------------------------------------------------------------------------------

    3. Travel Expense Reimbursement--20 CFR 404.999(d) and 416.1499--
0960-0434. The Act provides for travel expense reimbursement from 
Federal and State agencies for claimant travel incidental to medical 
examinations, and to parties, their representatives, and all reasonably 
necessary witnesses for travel exceeding 75 miles to attend medical 
examinations; reconsideration interviews; and proceedings before an 
administrative law judge. Reimbursement procedures require the claimant 
to provide: (1) A list of expenses incurred, and (2) receipts of such 
expenses. Federal and state personnel review the listings and receipts 
to verify the reimbursable amount to the requestor. The respondents are 
claimants for Title II benefits and Title XVI payments, their 
representatives, and witnesses.
    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)
----------------------------------------------------------------------------------------------------------------
404.99(d) & 416.1499........................          60,000                1               10           10,000
----------------------------------------------------------------------------------------------------------------

    4. Certificate of Coverage Request--20 CFR 404.1913--0960-0554. The 
United States (U.S.) has agreements with 30 foreign countries to 
eliminate double Social Security coverage and taxation where, except 
for the provisions of the agreement, a worker would be subject to 
coverage and taxes in both countries. These agreements contain rules 
for determining the country under whose laws the worker's period of 
employment is covered, and to which country the worker will pay taxes. 
The agreements further dictate that, upon the request of the worker or 
employer, the country under whose system the period of work is covered 
will issue a certificate of coverage. The certificate serves as proof 
of exemption from coverage and taxation under the system of the other 
country. The information we collect assists us in determining a 
worker's coverage and in issuing a U.S. certificate of coverage as 
appropriate. Per our agreements, we ask a set number of questions to 
the workers and employers prior to issuing a certificate of coverage; 
however, our agreements with Denmark, Netherlands, Norway, and Sweden 
require us to ask more questions in those countries. Respondents are 
workers and employers wishing to establish exemption from foreign 
Social Security taxes.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 31974]]



----------------------------------------------------------------------------------------------------------------
                                                                                      Average        Estimated
                                                     Number of     Frequency  of    burden per     total annual
             Modality of completion                 respondents      response        response         burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
Requests via Letter--Individuals (minus Denmark,           5,833               1              40           3,889
 Netherlands, Norway, Poland & Sweden)..........
Requests via Internet--Individuals (minus                  9,761               1              40           6,507
 Denmark, Netherlands, Norway, Poland & Sweden).
Requests via Letter--Individuals in Denmark,                 284               1              44             208
 Netherlands, Norway, & Sweden..................
Requests via Letter--Individuals in Poland......              16               1              41              11
Requests via Internet--Individuals in Denmark,               427               1              44             313
 Netherlands, Norway, & Sweden..................
Requests via Internet--Individuals in Poland....              25               1              41              17
Requests via Letter--Employers (minus Denmark,            26,047               1              40          17,365
 Netherlands, Norway, Poland & Sweden)..........
Requests via Internet--Employers (minus Denmark,          39,096               1              40          26,064
 Netherlands, Norway, Poland, & Sweden).........
Requests via Letter--Employers in Denmark,                 1,137               1              44             834
 Netherlands, Norway, & Sweden..................
Requests via Letter--Employers in Poland........              57               1              41              39
Requests via Internet--Employers in Denmark,               1,704               1              44           1,250
 Netherlands, Norway, & Sweden..................
Requests via Internet--Employers in Poland......              86               1              41              59
                                                 ---------------------------------------------------------------
    Totals......................................          84,473  ..............  ..............          56,556
----------------------------------------------------------------------------------------------------------------

    5. Privacy and Disclosure of Official Records and Information; 
Availability of Information and Records to the Public--20 CFR 
401.40(b)&(c), 401.55(b), 401.100(a), 402.130, 402.185--0960-0566. SSA 
established methods for the public to: (1) Access their SSA records; 
(2) allow SSA to disclose records; (3) correct or amend their SSA 
records; (4) consent for release of their records; (5) request records 
under the Freedom of Information Act (FOIA); and (6) request access to 
an extract of their SSN record. SSA often collects the necessary 
information for these requests through a written letter, with the 
exception of the consent for release of records, for which we use Form 
SSA-3288. The respondents are individuals requesting access to, 
correction of, or disclosure of SSA records.
    Type of Request: Extension 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)
----------------------------------------------------------------------------------------------------------------
Access to Records...............................          10,000               1              11           1,833
Designating a Representative for Disclosure of             3,000               1             120           6,000
 Records........................................
Amendment of Records............................             100               1              10              17
Consent of Release of Records...................       3,000,760               1               3         150,038
FOIA Requests for Records.......................          15,000               1               5           1,250
Respondents who request access to an extract of               10               1             8.5               1
 their SSN record...............................
                                                 ---------------------------------------------------------------
    Totals......................................       3,028,870  ..............  ..............         159,139
----------------------------------------------------------------------------------------------------------------

    6. Disability Report--Child--20 CFR 416.912--0960-0577--Sections 
223(d)(5)(A) and 1631(e)(1) of the Act require SSI claimants to furnish 
medical and other evidence to prove they are disabled. SSA uses Form 
SSA-3820 to collect various types of information about a child's 
condition from treating sources or other medical sources of evidence. 
The State Disability Determination Services evaluators use the 
information from Form SSA-3820 to develop medical and school evidence, 
and to assess the alleged disability. The information, together with 
medical evidence, forms the evidentiary basis upon which SSA makes its 
initial disability evaluation. The respondents are claimants seeking 
SSI childhood disability payments.
    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-3820........................................         177,572               1              90         266,358
EDCS............................................           1,000               1             120           2,000
i3820...........................................         176,572               1             120         353,144
                                                 ---------------------------------------------------------------
    Totals......................................         355,144  ..............  ..............         621,502
----------------------------------------------------------------------------------------------------------------


[[Page 31975]]

    7. Request for Reconsideration--20 CFR 404.907-404.921, 416.1407-
416.1421, 408.1009, and 418.1325--0960-0622. The Act states those 
individuals who are dissatisfied with the results of an initial 
determination regarding their Title II disability; Tile XVI disability 
(SSI); Title VIII (Special Veterans benefits); or Title XVIII (Medicare 
benefits), can request a reconsideration hearing. Individuals use Form 
SSA-561-U2; the associated MCS or SSI Claims System interview; or the 
internet application (i561) to initiate a request for reconsideration 
of a denied claim. SSA uses the information to document the request and 
to determine an individual's eligibility or entitlement to Social 
Security benefits (Title II); SSI payments (Title XVI); Special 
Veterans Benefits (Title VIII); Medicare (Title XVIII); and for initial 
determinations regarding Medicare Part B income-related premium subsidy 
reductions. The respondents are applicants, claimants, beneficiaries, 
or recipients filing for reconsideration of an initial determination.
    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-561 and Modernized Claims System (MCS)......         330,370               1               8          40,049
I561 (Internet iAppeals)........................       1,161,300               1               5          96,775
                                                 ---------------------------------------------------------------
    Totals......................................       1,491,670  ..............  ..............         136,824
----------------------------------------------------------------------------------------------------------------

    8. Request to Withdraw a Hearing Request; Request to Withdraw an 
Appeals Council Request for Review; and Administrative Review Process 
for Adjudicating Initial Disability Claims--20 CFR parts 404, 405, and 
416--0960-0710. Claimants have a statutory right under the Act and 
current regulations to apply for Social Security Disability Insurance 
(SSDI) benefits or SSI payments. SSA collects information at each step 
of the administrative process to adjudicate claims fairly and 
efficiently. SSA collects this information to establish a claimant's 
right to administrative review, and determine the severity of the 
claimant's alleged impairments. SSA uses the information we collect to 
determine entitlement or continuing eligibility to SSDI benefits or SSI 
payments, and to enable appeals of these determinations. In addition, 
SSA collects information on Forms HA-85 and HA-86 to allow claimants to 
withdraw a hearing request or an Appeals Council review request. The 
respondents are applicants for Title II SSDI or Title XVI SSI benefits; 
their appointed representatives; legal advocates; medical sources; and 
schools.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                                     Number of     Frequency  of    burden per       Estimated
               20 CFR section No.                   respondents      response        response     annual  burden
                                                                                     (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
404.961, 416.1461, 405.330, and 405.366.........          12,220               1              20           4,073
404.950, 416.1450, and 405.332..................           1,040               1              20             347
404.949 and 416.1449............................           2,868               1              60           2,868
405.334.........................................              20               1              60              20
404.957, 416.1457, and 405.380..................          21,041               1              10           3,507
405.381.........................................              37               1              30              19
405.401.........................................           5,310               1              10             885
404.971 and 416.1471............................           1,606               1              10             268
(HA-85; HA-86)..................................
404.982 and 416.1482............................           1,687               1              30             844
404.987 & 404.988 and 416.1487 & 416.1488 and             12,425               1              30           6,213
 405.601........................................
404.1740(b)(1)..................................             150               1               2               5
416.1540(b)(1)..................................             150               1               2               5
404.1512, 404.1740(c)(4), 416.912, and                       150               1               2               5
 416.1540(c)(4).................................
405.372(c)......................................           5,310               1              10             885
405.1(b)(5).....................................             833               1              30             417
405.372(b)......................................
405.505.........................................             833               1              30             417
405.1(c)(2).....................................           5,310               1              10             885
405.20..........................................           5,310               1              10             885
                                                 ---------------------------------------------------------------
    Totals......................................          76,300  ..............  ..............          22,548
----------------------------------------------------------------------------------------------------------------

    9. Request for Accommodation in Communication Method--0960-0777. 
SSA allows disabled or impaired Social Security applicants, 
beneficiaries, recipients, and representative payees to choose one of 
seven alternative methods of communication they want SSA to use when we 
send them benefit notices and other related communications. The seven 
alternative methods we offer are: (1) Standard print notice by first-
class mail; (2) standard print mail with a follow-up telephone call; 
(3) certified mail; (4) Braille; (5) Microsoft Word file on data CD; 
(6) large print (18-point font); or (7) audio CD. However, respondents 
who want to receive notices from SSA through a communication method 
other than the seven methods listed above must explain their request to 
us. Those respondents use Form SSA-9000 to: (1) Describe the type of 
accommodation they want; (2) disclose their condition necessitating the 
need for a different type of accommodation; and (3) explain why none of 
the seven methods

[[Page 31976]]

described above are sufficient for their needs. SSA uses Form SSA-9000 
to determine, based on applicable law and regulation, whether to grant 
the respondents' requests for an accommodation based on their 
impairment or disability. SSA collects this information electronically 
through either an in-person interview or a telephone interview during 
which the SSA employee keys in the information on our iAccommodate 
Intranet screens. The respondents are disabled or impaired Social 
Security applicants, beneficiaries, recipients, and representative 
payees who ask SSA to send notices and other communications in an 
alternative method besides the seven modalities we currently offer.
    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-9000/iAccommodate.......................           5,000                1               20            1,667
----------------------------------------------------------------------------------------------------------------

    10. Report of Adult Functioning-Employer--20 CFR 404.1512 and 
416.912--0960-0805. Section 205(a), 223(d)(5)(A), 1631(d)(1), and 
1631(e)(1) of the Act require claimants' applying for SSDI benefits or 
SSI payments to provide SSA with medical and other evidence of their 
disability. 20 CFR 404.1512 and 20 CFR 416.912 of the Code of Federal 
Regulations provides detailed requirements of the types of evidence 
SSDI beneficiaries and SSI claimants must provide showing how their 
impairment(s) affect their ability to work (e.g., evidence of age; 
education and training, work experience; daily activities; efforts to 
work; and any other evidence). Past employers familiar with the 
claimant's ability to perform work activities complete Form SSA-385-BK, 
Report of Adult Functioning-Employer to provide SSA with information 
about the employees day-to-day functioning in the work setting. SSA and 
Disability Determination Services use the information Form SSA-3385-BK 
collects as the basis to determine eligibility or continued eligibility 
for disability benefits. The respondents are claimants' past employers.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden     Estimated
           Modality of completion                Number of      Frequency  of    per  response     total annual
                                                 responses         response        (minutes)     burden  (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3385-BK.................................           3,601                1               20            1,200
----------------------------------------------------------------------------------------------------------------


    Dated: June 27, 2019.
Naomi Sipple,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2019-14173 Filed 7-2-19; 8:45 am]
 BILLING CODE 4191-02-P