[Federal Register Volume 64, Number 38 (Friday, February 26, 1999)]
[Notices]
[Pages 9553-9554]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-4747]
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SOCIAL SECURITY ADMINISTRATION
Agency Information Collection Activities: Comment Request
In compliance with Public Law 104-13, the Paperwork Reduction Act
of 1995, SSA is providing notice of its information collections that
require submission to the Office of Management and Budget (OMB). 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.
The information collections listed below have been submitted to OMB
for clearance. Written comments and recommendations on the information
collections would be most useful if received within 30 days from the
date of this publication. Comments should be directed to the SSA
Reports Clearance Officer and the OMB Desk Officer at the addresses
listed after this publication. You can obtain a copy of the OMB
clearance packages by calling the SSA Reports Clearance Officer on
(410) 965-4145, or by writing to him.
1. Function Report--Adult, SSA-3373-TEST; Function Report--Third
Party, SSA-3380-TEST--0960-NEW. SSA will be testing new prototype
disability forms. The information collected on the forms is needed for
the determination of disability. The forms record information about the
disability applicant's illnesses, injuries, conditions, impairment-
related limitations and ability to function. The respondents are Title
II and Title XVI disability applicants or individuals who know about
the applicant's impairment, limitations and ability to function.
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Adult form Third party form
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Number of Respondents.......... 7,000............. 5,000.
Frequency of Response.......... 1................. 1.
Average Burden Per Response.... 30 minutes........ 30 minutes.
Estimated Annual Burden........ 3,500 hours....... 2,500 hours.
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2. Symptoms Report--0960-NEW. SSA will be testing new prototype
disability forms, including the SSA-3370-TEST. The information
collected on the form is needed for the determination of disability.
The form records information about the disability applicant's
description of symptoms of his or her illness, injury or condition. The
respondents are applicants for Title II and Title XVI disability
benefits.
Number of Respondents: 7,500
Frequency of Response: 1
Average Burden Per Response: 25 minutes
Estimated Annual Burden: 3,125 hours
SSA Address: Social Security Administration, DCFAM, Attn: Frederick W.
Brickenkamp, 6401 Security Blvd., 1-A-21 Operations Bldg., Baltimore,
MD 21235.
OMB Address: Office of Management and Budget, OIRA, Attn: Lori Schack,
New Executive Office Building, Room 10230, 725 17th St., NW,
Washington, DC 20503.
[[Page 9554]]
Dated: February 19, 1999.
Frederick W. Brickenkamp,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 99-4747 Filed 2-25-99; 8:45 am]
BILLING CODE 4190-29-P
