[Federal Register Volume 64, Number 10 (Friday, January 15, 1999)]
[Notices]
[Pages 2695-2696]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-555]
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SOCIAL SECURITY ADMINISTRATION
Information Collection Activities; Proposed Collection Requests
and Comment Requests
This notice lists information collection packages that will require
submission to the Office of Management and Budget (OMB), as well as
information collection packages submitted to OMB for clearance, in
compliance with Pub. L. 104-13 effective October 1, 1995, The Paperwork
Reduction Act of 1995.
I. The information collection(s) listed below require(s)
extension(s) of the current OMB approval(s) or are proposed new
collection(s):
1. Inquiry to File an SSI Child's Application--0960-0557. The
information collected on Form SSA-293 is used by the Social Security
Administration (SSA) to document the earliest possible filing date and
to determine potential eligibility for SSI child's benefits. The
respondents are individuals, such as hospital social workers, who
inquire about SSI eligibility for low birth weight babies.
Number of Respondents: 2,100
Frequency of Response: 1
Average Burden Per Response: 10 minutes
Estimated Average Burden: 350 hours
2. Request for Workers' Compensation/Public Disability
Information--0960-0098. Form SSA-1709 is used by SSA to request and/or
to verify information about worker's compensation or public disability
benefits given to Social Security disability insurance benefit
recipients so that their monthly benefit adjustments are properly made.
The respondents are State and local governments and/or businesses that
administer workers' compensation or other disability benefits.
Number of Respondents: 140,000
Frequency of Response: 1
Average Burden Per Response: 15 minutes
Estimated Average Burden: 35,000 hours
3. Individuals Who Inquire About SSI Eligibility for Themselves--
0960-0140. Form SSA-3462 is completed by SSA personnel, via telephone
or personal interview, and it may be used to determine potential
eligibility for SSI benefits. The respondents are individuals who
inquire about SSI eligibility for themselves or someone else.
Number of Respondents: 2,134,100
Frequency of Response: 1
Average Burden Per Response: 5 minutes
Estimated Average Burden: 177,842 hours
4. State Mental Institution Policy Review--0960-0110. The
information collected on form SSA-9584 is used by the Social Security
Administration to determine whether an institution's policies and
practices conform with
[[Page 2696]]
SSA's regulations in the use of benefits, and whether the institution
is performing other duties and responsibilities required of a
representative payee. The information also provides the basis for
conducting the actual onsite review and is used in the preparation of
the subsequent report of findings and recommendations which is provided
to the institution. The respondents are state mental institutions which
serve as representative payees for Social Security beneficiaries.
Number of Respondents: 183
Frequency of Response: 1
Average Burden Per Response: 1 hour
Estimated Average Burden: 183 hours
Written comments and recommendations regarding the information
collection(s) should be sent within 60 days from the date of this
publication, directly to the SSA Reports Clearance Officer at the
following address: Social Security Administration, DCFAM, Attn:
Frederick W. Brickenkamp, 6401 Security Blvd., 1-A-21 Operations Bldg.,
Baltimore, MD 21235.
In addition to your comments on the accuracy of the agency's burden
estimate, we are soliciting comments on the need for the information;
its practical utility; ways to enhance its quality, utility and
clarity; and on ways to minimize burden on respondents, including the
use of automated collection techniques or other forms of information
technology.
II. The information collection(s) listed below have been submitted
to OMB:
1. Application for U.S. Benefits Under the Canada-U.S.
International Agreement--0960-0371. The information collected on Form
SSA-1294 is used to determine entitlement to benefits. The respondents
are individuals who live in Canada and file for U.S. Social Security
Benefits.
Number of Respondents: 1,000
Frequency of Response: 1
Average Burden Per Response: 15 minutes
Estimated Annual Burden: 250 hours
2. Quarterly Statistical Report on Recipients and Payments Under
State-Administered Assistance Programs for Aged, Blind and Disabled
(Individuals and Couples) Recipients--0960-0130. The information
collected on Form SSA-9741 is used to provide statistical data on
recipients and assistance payments under the SSI State-administered
State supplementation program. These data collections are needed to
complement the information available for the Federally administered
programs under SSA, and to more fully explain the impact of the public
income support programs on the needy, aged, blind and disabled. The
respondents are state agencies who administer supplementary payment
programs under SSI.
Number of Respondents: 30
Frequency of Response: 4 times annually
Average Burden Per Response: 1 hour
Estimated Annual Burden: 120 hours
3. Statement of Death by Funeral Director--0960-0142. SSA uses the
information collected on Form SSA-721 to verify the death of an
individual insured under the Social Security Act and to determine if
there is a survivor eligible for a lump-sum death payment. The
respondents are funeral directors with knowledge of the death of a
person insured for Social Security benefits.
Number of Respondents: 900,000
Frequency of Response: 1
Average Burden Per Response: 3.5 minutes
Estimated Average Burden: 52,500 hours
4. Statement Regarding Marriage--0960-0017. SSA uses the
information collected on Form SSA-753 to make determinations regarding
entitlement to spouse's benefits when a common-law marriage is alleged.
The respondents are third parties who can supply evidence concerning
the existence of a common-law marriage.
Number of Respondents: 40,000
Frequency of Response: 1
Average Burden Per Response: 9 minutes
Estimated Average Burden: 6,000 hours
Written comments and recommendations regarding the information
collection(s) should be directed within 30 days to the OMB Desk Officer
and SSA Reports Clearance Officer at the following addresses:
(OMB), Office of Management and Budget, OIRA Attn: Lori Schack, New
Executive Office Building, Room 10230, 725 17th St., NW, Washington,
D.C. 20503
(SSA), Social Security Administration, DCFAM, Attn: Frederick W.
Brickenkamp, 1-A-21 Operations Bldg., 6401 Security Blvd., Baltimore,
MD 21235.
To receive a copy of any of the forms or clearance packages, call
the SSA Reports Clearance Officer on (410) 965-4145 or write to him at
the address listed above.
Date: January 6, 1999.
Frederick W. Brickenkamp,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 99-555 Filed 1-14-99; 8:45 am]
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