[Federal Register Volume 62, Number 211 (Friday, October 31, 1997)]
[Notices]
[Pages 59010-59011]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-28782]
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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 PL. 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. Request to be Selected as Payee--0960-0014. The information
collected on Form SSA-11-BK is used to determine the proper payee for a
Social Security beneficiary, and it is designed to aid in the
investigation of a payee applicant. The form will establish the
applicant's relationship to the beneficiary, the justification, the
concern for the beneficiary and the manner in which the benefits will
be used. The respondents are applicants for
[[Page 59011]]
selection as representative payee for Old-Age, Survivors and Disability
Insurance (OASDI), Supplemental Security Income (SSI) and Black Lung
benefits.
Number of Respondents: 1,709,657.
Frequency of Response: 1.
Average Burden Per Response: 10.5 Minutes.
Estimated Annual Burden: 299,190 Hours.
2. Application for Benefits Under the Federal Mine Safety and
Health Act of 1977, as Amended; (Widow's Claim, Child's Claim and
Dependent's Claim)--0960-0118. Sections 402(g) and 412(a) of the
Federal Mine Safety and Health Act provide that those widows, surviving
children, and dependent parents, brothers or sisters who are not
currently receiving benefits on the deceased miner's account must file
the appropriate application within 6 months of the deceased miner's
death, using Forms SSA-47, 48 and 49. This information is used to
determine eligibility for benefits.
Number of Respondents: 1,800.
Frequency of Response: 1.
Average Burden Per Response: 11 Minutes.
Estimated Annual Burden: 330 Hours.
3. Work History Report--0960-0552. Form SSA-3369-BK is used by the
State Disability Determination Services (DDSs) to determine disability
and to record information about the claimant's work history during the
past 15 years. The respondents are claimants who live in Virginia and
are applying for OASDI and SSI benefits.
Number of Respondents: 32,000.
Frequency of Response: 1.
Average Burden Per Response: 30 Minutes.
Estimated Annual Burden: 16,000 Hours.
4. Disability Report-Child--0960-0504. Form SSA-3820-BK is used by
the State DDSs to record claimants' allegations and sources of evidence
in determining eligibility for children filing for SSI disability
benefits. The respondents are SSI claimants who live in Virginia and
are applying for disabled child's benefits.
Number of Respondents: 10,900.
Frequency of Response: 1.
Average Burden Per Response: 40 Minutes.
Estimated Annual Burden: 7,267 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:
Nicholas E. Tagliareni, 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. Disability Report--0960-0573. The information collected on Form
SSA-3368-F6 is needed for the determination of disability by the State
DDSs. The information will be used to develop medical evidence and to
assess the alleged disability. The respondents are applicants for
disability benefits.
Number of Respondents: 2,438,496.
Frequency of Response: 1.
Average Burden Per Response: 45 minutes.
Estimated Annual Burden: 1,828,872 hours.
2. Work History Report--0960-0572. The information collected on
Form SSA-3369-F6 is needed for the determination of disability by the
State DDSs. The information will be used to document an individual's
past work history. The respondents are applicants for OASDI and SSI
benefits.
Number of Respondents: 1,000,000.
Frequency of Response: 1.
Average Burden Per Response: 30 minutes.
Estimated Annual Burden: 500,000 hours.
3. Medical History and Disability Report, Disabled Child--0960-
0574. The information collected on Form SSA-3820-F4 is needed for the
determination of disability by the State DDSs to obtain various types
of information about a child's condition, his/her treating sources and/
or other medical sources of evidence. The respondents are SSI claimants
who are applying for disabled child's benefits.
Number of Respondents: 523,000.
Frequency of Response: 1.
Average Burden Per Response: 20 minutes.
Estimated Annual Burden: 174,333 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: Laura Oliven, New
Executive Office Building, Room 10230, 725 17th St., NW, Washington,
D.C. 20503
(SSA)
Social Security Administration, DCFAM, Attn: Nicholas E. Tagliareni, 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) 965-4125 or write to him at
the address listed above.
Dated: October 24, 1997.
Nicholas E. Tagliareni,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 97-28782 Filed 10-30-97; 8:45 am]
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