[Federal Register Volume 67, Number 190 (Tuesday, October 1, 2002)]
[Notices]
[Pages 61715-61717]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-24808]
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SOCIAL SECURITY ADMINISTRATION
Agency Information Collection Activities: Proposed Request and
Comment Request
The Social Security Administration (SSA) publishes a list of
information collection packages that will require clearance by the
Office of Management and Budget (OMB) in compliance with Public Law
104-13 effective October 1, 1995, The Paperwork Reduction Act of 1995.
The information collection packages that may be included in this notice
are for new information collections, revisions to OMB-approved
information collections and extensions (no change) 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 on ways to minimize
burden on respondents, including the use of automated collection
techniques or other forms of information technology. Written comments
and recommendations regarding the information collection(s) should be
submitted to the OMB Desk Officer and the SSA Reports Clearance
Officer. The information can be mailed and/or faxed to the individuals
at the addresses and fax numbers listed below:
(OMB), Office of Management and Budget, Attn: Desk Officer for SSA, New
Executive Office Building, Room 10235, 725 17th St., NW., Washington,
DC 20503, Fax: 202-395-6974.
(SSA), Social Security Administration, DCFAM, Attn: Reports Clearance
Officer, 1338 Annex Building, 6401 Security Blvd., Baltimore, MD 21235,
Fax: 410-965-6400.
I. The information collections listed below are pending at SSA and
will be submitted to OMB within 60 days from
[[Page 61716]]
the date of this notice. Therefore, your comments should be submitted
to SSA within 60 days from the date of this publication. You can obtain
copies of the collection instruments by calling the SSA Reports
Clearance Officer at 410-965-0454, or by writing to the address listed
above.
1. Black Lung Student Statement Regarding Resumption of School
Attendance and Report of Black Lung Student Beneficiary at End of
School Year--0960-0314. 20 CFR subpart C 410.370. The information
collected on forms SSA-2602 and SSA-2613 is used by SSA to determine
whether or not an entitled student beneficiary will resume (or has
resumed) full-time school attendance at an approved educational
institution. If so, the student will be continuously entitled to
benefits. The respondents are children of disabled or deceased coal
miners and officials of schools they attend.
Type of Request: Extension of an OMB-approved information
collection.
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SSA-2602 SSA-2613
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Number of Respondents......................... 50 100
Frequency of Response......................... 1 1
Average Burden Per Response (in minutes)...... 5 7.5
Estimated Annual Burden (hours)............... 4 12
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2. Voluntary Customer Surveys In Accordance with E.O. 12862 within
the Social Security Administration--0960-0526. These voluntary customer
surveys will be used to ascertain customer satisfaction with the Social
Security Administration in terms of timeliness, appropriateness,
access, and other measures of quality service. Surveys will involve
individuals that are the direct or indirect beneficiaries of SSA
services. The average burden per response for these activities is
estimated to range from 5 minutes for a simple comment card to 2 hours
for participation in a focus group.
Type of Request: Extension of an OMB-approved information
collection.
FY 2003
Number of Respondents: 1,530,854.
Frequency of Response: 1.
Average Burden Per Response: Varies (5 minutes to 2 hours).
Estimated Annual Burden: 139,571 Hours.
FY 2004:
Number of Respondents: 1,527,260.
Frequency of Response: 1.
Average Burden Per Response: Varies (5 minutes to 2 hours).
Estimated Annual Burden: 138,229.
FY 2005:
Number of Respondents: 1,529,990.
Frequency of Response: 1.
Average Burden Per Response: Varies (5 minutes to 2 hours).
Estimated Annual Burden: 138,074.
3. Authorization to Disclose Information to Social Security
Administration--0960-0623--20 CFR subpart O, 404.1512 and subpart I,
416.912. SSA must obtain sufficient medical evidence to make
eligibility determinations for the Social Security disability benefits
and supplemental security income (SSI) payments. For SSA to obtain
medical evidence, an applicant must authorize his or her medical
source(s) to release the information to SSA. The applicant may use one
of the forms SSA-827, SSA-827OP1 or SSA-827 OP2 to provide consent for
the release of information. Generally, the State Disability
Determination Service completes the form(s) based on information
provided by the applicant, and sends the form(s) to the designated
medical source(s). The respondents are applicants for Social Security
disability benefits and SSI payments.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 3,853,928.
Frequency of Response: 4.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 2,569,285 hours.
4. Application for Supplemental Security Income--0960-0444--20 CFR
subpart C, 416.301-416.360. Form SSA-8001-F5 is the application for SSI
payments. The information collected by SSA is used to determine
eligibility for SSI and the amount of benefits payable.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 872,956.
Frequency of Response: 1.
Average Burden Per Response: 15-18 minutes.
Estimated Annual Burden: 219,549 hours.
II. The information collection listed below has been submitted to
OMB for clearance. Your comments on the information collections would
be most useful if received by OMB and SSA within 30 days from the date
of this publication. You can obtain a copy of the OMB clearance package
by calling the SSA Reports Clearance Officer at 410-965-0454 or by
writing to the address listed above.
1. Disability Report-Adult--0960-0579--20 CFR subpart O, 404.1512
and subpart I, 416.912. The Social Security Act requires claimants to
furnish medical and other evidence to prove they are disabled.
Applicants for disability benefits will complete form SSA-3368. The
information will be used, in conjunction with other evidence, by State
DDSs to develop medical evidence, to assess the alleged disability, and
to make a disability determination. The respondents are applicants for
title II and title XVI disability benefits.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 2,116,667.
Frequency of Response: 1.
Average Burden Per Response: 60 minutes.
Estimated annual Burden: 2,116,667 hours.
2. State Contribution Return--0960-0041-20 CFR subpart M, 404.1237
and 404.1249. Information collection on form SSA-3961 is used by the
Social Security Administration (SSA) to identify and account for all
contributions due and paid under section 218 of the Social Security
Act. The respondents are State Social Security agencies (one agency in
each state, Puerto Rico, and the Virgin Islands) and each of
approximately 65 interstate instrumentalities.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 117.
Frequency of Response: 8.5.
Average Burden Per Response: 3 minutes.
Estimated Annual Burden: 50 hours.
3. Report on Individual with Mental Impairment--0960-0058-20 CFR
subpart O, 404.1513. and subpart I, 416.913. Information collected on
form SSA-824 is used by the Social Security Administration to determine
the claimant's medical status prior to making a disability
determination. The respondents are physicians, medical directors,
medical record librarians and other health professionals.
Type of Request: Extension of an OMB-approved information
collection.
[[Page 61717]]
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden Per Response: 36 minutes.
Estimated Annual Burden: 30,000 hours.
4. Missing and Discrepant Wage Reports Letter and Questionnaire--
0960-0432. SSA uses the information on Forms SSA-L93, SSA-95 and SSA-97
to secure the employer information missing from its records (or
discrepant with Internal Revenue Service (IRS) records) by contacting
the involved employers. When secured, SSA is able to properly post the
employee's earnings records. Compliance by employers with SSA requests
facilitates proper posting of employees' wage records. SSA makes two
efforts to obtain wage information from the employer before the case is
turned over to the IRS for penalty assessments. The respondents are
employers with missing or discrepant wage reports.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 360,000.
Frequency of Response: 1.
Average Burden Per Response: 30 minutes.
Estimated Annual Burden: 180,000 hours.
5. Employee Verification Service (EVS).
Background
Under Internal Revenue Service regulations, employers are required
to provide wage and tax data to SSA using form W-2, Wage and Tax
Statement or its electronic equivalent. As part of this process, the
employer must furnish the employee's name and Social Security Number
(SSN). This information must match SSA's records in order for the
employee's wage and tax data to be properly posted to the Earnings
Record. Information that is incorrectly provided to the Agency must be
corrected by the employer using an amended reporting form, which is a
labor-intensive and time-consuming process for both SSA and the
employer. Therefore, to help ensure that employers provide accurate
name and SSN information on their wage reports, SSA is offering the EVS
service whereby employers can verify, via magnetic tape, cartridge,
diskette, paper, and telephone, if the reported name and SSN of their
employee matches SSA's records.
EVS Collection
SSA will use the information collected through the EVS to verify
that the employee name and SSN information, provided by employers,
matches SSA records. SSA will respond to the employer informing them
only of matches and mismatches of submitted information. Respondents
are employers who provide wage and tax data to SSA who elect to use EVS
to verify their employees' names and SSNs.
Type of Request: New information collection.
Number of Respondents: 100,000.
Frequency of Response: 5.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 83,333 hours.
6. 20 CFR part 422.527, Private Printing and Modification of
Prescribed Applications and Other Forms--0960-NEW. SSA uses the
information required by this regulation to process requests from a
person, institution or organization (requesting entities) that want to
reproduce, duplicate, or privately print any SSA application or other
form prescribed by SSA. The requesting entities must obtain prior
approval from SSA and make their requests in writing, providing the
required information set forth in the regulation. Respondents are the
requesting entities that want to reproduce, duplicate, or privately
print any SSA application or other form.
Type of Request: New information collection.
Number of Respondents: 4.
Frequency of Response: 1.
Average Burden Per Response: 8 minutes.
Estimated Annual Burden: \1/2\ hour.
7. Medical Source Statement of Ability To Do Work-Related
Activities (Physical), Form HA-1151; Medical Source Statement of
Ability To Do Work-Related Activities (Mental), Form HA-1152; 20 CFR
404.1513 and 20 CFR 416.913-0960-NEW. SSA's Office of Hearing and
Appeals (OHA) uses the HA-1151 (Physical) and its companion form HA-
1152 (Mental) to collect information that Administrative Law Judges and
the Appeals Council of OHA require to determine the residual functional
capacity (RFC) of individuals who are appealing denied claims for
benefits based on disability. RFC must be determined to decide cases
that cannot be decided based on current work activity or on medical
facts alone. Both forms are completed by medical sources that provide
medical reports based either on existing medical evidence or on
consultative examinations conducted for the purposes of the report.
Respondents to these forms are medical sources that provide medical
reports.
HA-1151
Type of Request: New information collection.
Number of Respondents: 5,000.
Frequency of Response: 20.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 25,000 hours.
HA-1152
Type of Request: New information collection.
Number of Respondents: 5,000.
Frequency of Response: 20.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 25,000 hours.
Dated: September 25, 2002.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 02-24808 Filed 9-30-02; 8:45 am]
BILLING CODE 4191-02-P
