[Federal Register Volume 62, Number 40 (Friday, February 28, 1997)]
[Notices]
[Pages 9233-9234]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-4368]
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SOCIAL SECURITY ADMINISTRATION
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
The Social Security Administration publishes a list of information
collection packages submitted to the Office of Management and Budget
(OMB) for clearance in compliance with Public Law 104-13 effective
October 1, 1995, The Paperwork Reduction Act of 1995. The information
collections listed below have been submitted to OMB:
1. Physical Residual Functional Capacity Assessment; Mental
Residual Functional Capacity Assessment--0960-0431. The information
collected on forms SSA-4734-BK and SSA-4734 SUP is needed by the Social
Security Administration to assist in the adjudication of disability
claims involving physical and/or mental impairments. The forms assist
the State Disability Determination Services (DDS) to evaluate
impairment(s) by providing a standardized data collection format to
present findings in a clear, concise and consistent manner. The
respondents are State DDSs administering title II and title XVI
disability programs.
Number of Responses: 1,693,425.
Frequency of Response: 1.
Average Burden Per Response: 20 minutes.
Estimated Annual Burden: 564,475 hours.
2. Letter to Employer Requesting Wage Information--0960-0138. The
information collected on form SSA-L4201 is used by the Social Security
Administration to determine eligibility and proper payment for
Supplemental Security Income (SSI) applicants/recipients. The
respondents are employers of applicants for and recipients of SSI
payments.
Number of Respondents: 133,000.
Frequency of Response: 1.
Average Burden Per Response: 30 minutes.
Estimated Annual Burden: 66,500 hours.
3. State Agency Schedule for Equipment Purchases for SSA Disability
Program--0960-0406. The information collected on form SSA-871 is used
by the Social Security Administration to budget and account for
expenditures of funds for equipment purchases by the State Disability
Determination Services that administer the disability program. The
respondents are State Disability Determination Services.
Number of Respondents: 54.
Frequency of Response: Annually.
Average Burden Per Response: 1 hour.
Estimated Annual Burden: 54 hours.
To receive a copy of the forms or clearance packages, call the SSA
Reports Clearance Officer on (410) 965-4125 or write to her at the
address listed below. Written comments and recommendations regarding
the information collection(s) should be directed within 30 days to the
OMB
[[Page 9234]]
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: Judith T. Hasche, 1-A-21
Operations Bldg., 6401 Security Blvd., Baltimore, MD 21235
Dated: February 14, 1997
Judith T. Hasche,
SSA Reports Clearance Officer, Social Security Administration.
[FR Doc. 97-4368 Filed 2-27-97; 8:45 am]
BILLING CODE 4190-29-P
