[Federal Register Volume 62, Number 50 (Friday, March 14, 1997)]
[Notices]
[Pages 12262-12264]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-6240]
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SOCIAL SECURITY ADMINISTRATION
Agency Information Collection Activities; Proposed Collection
Requests and Submissions for OMB Review
This notice lists information collection packages that will require
submission to the Office of Management and Budget as well as
information collection packages submitted to the Office of Management
and Budget for clearance.
I. The Social Security Administration publishes a list of
information collection packages that will require submission 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 collection(s) listed below requires
extension of the current OMB approval(s):
1. 0960-0462--You Can Make Your Payments by Credit Cards. The
information on Forms SSA-4588 & SSA-4589 will be used to update the
individual's social security record to reflect that a payment has been
made on their overpayment and to effectuate payment through the
appropriate credit card company.
Number of Respondents: 12,000.
Frequency of Response: 1.
Average Burden Per Response: 5 minutes.
Estimated Annual Burden: 1,000 hours.
2. 0960-0323--Third Party Liability Information Statement. Form
SSA-8019 is used by the Social Security Administration to gather
information or to make changes in existing information about third
party insurance (other than Medicare or Medicaid), which could be
responsible for payment for a beneficiary's medical care.
Number of Respondents: 65,400.
Frequency of Response: 1.
Average Burden Per Response: 5 minutes.
[[Page 12263]]
Estimated Annual Burden: 5,450 hours.
3. 0960-0068--Representative Payee Report. Sections 205(j) and
1631(a)(2) of the Social Security Act provide for the payment of
supplemental social security benefits to a relative, another person or
an organization when the best interests of the beneficiary will be
served. Form SSA-6230 (20 CFR 404.2065) is sent to parents, stepparents
and grandparents with custody of minor children receiving social
security benefits. Form SSA-623 (20 CFR 404.2065 and 416.665) is sent
to all other payees with or without custody of the beneficiary. Both
forms are used to determine the continuing suitability of the
individual/organization to serve as representative payee.
Number of Respondents: 5,315,160.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 1,328,790 hours.
4. Telephone Replacement Card Pilot Test--0960-NEW. The Social
Security Administration will conduct a pilot study on obtaining
information by telephone from individuals who need a duplicate Social
Security Number (SSN) card. The information will be used to properly
identify an individual prior to releasing a replacement SSN card, thus
eliminating the need for the respondent to take or mail his/her
identify documents to a Social Security office. The information
provided, which should be known by the true Social Security number
holder, will be compared to information available in our current
electronic systems. The respondents are individuals in the pilot study
who request a duplicate SSN replacement card by telephone.
Number of Respondents: 500,000.
Frequency of Response: 1.
Average Burden Per Response: 2 minutes.
Estimated Annual Burden: 16,667 hours.
To receive a copy of the form(s) or clearance package(s), call the
SSA Reports Clearance Officer on (410) 965-4123 or write to her at the
address listed below the information collection(s). 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: Judith T. Hasche, 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 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. Claimant's Medications--0960-0289. The information on form HA-
4632 is used by the Social Security Administration to compile a current
list of medications used by a claimant. The list is provided to an
Administrative Law Judge (ALJ), who is considering the disability
aspects of the claim. The affected public consists of claimants for
disability benefits, who have requested a hearing before an ALJ.
Number of Respondents: 227,107.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 56,777 hours.
2. Request for SSI Benefit Estimate--0960-0492. The Social Security
Administration collects the information on Form SSA-3716 for the sole
purpose of complying with an SSI recipient's request for an estimate of
the impact of his/her work on the receipt of SSI benefits.
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden Per Response: 5 minutes.
Estimated Annual Burden: 4,167 hours.
3. Statement of Employer--0960-0030. The information collected on
Form SSA-7011 is used by the Social Security Administration to
substantiate allegations of wages paid to workers when those wages do
not appear in SSA's records of earnings, and the worker does not have
proof of payment. This information is used to process claims for social
security benefits and to resolve discrepancies in earnings records. The
respondents are certain employers who can verify allegations of wages
made by the wage earner.
Number of Respondents: 925,000.
Frequency of Response: 1.
Average Burden Per Response: 20 minutes.
Estimated Annual Burden: 308,333 hours.
4. Supplemental Security Income Notice of Interim Assistance
Reimbursement (two forms). Forms SSA-8125 0960-0546 and SSA-L8125 0960-
0563 collect interim assistance reimbursement (IAR) information from
States which provide such assistance. Form SSA-8125 is used in most
situations where IAR is applicable. Form SSA-L8125 is used in
situations where an individual entitled to underpayments has received
IAR from a State and his/her benefit will be controlled by SSA through
the installment process. The respondents are states which provide IAR
to SSI claimants.
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SSA-8125 SSA-L8125
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Number of Respondents........... 80,000............ 60,000.
Frequency of Response........... 1................. 1.
Average Burden Per Response..... 10 minutes........ 10 minutes.
Estimated Annual Burden......... 13,333 hours...... 10,000 hours.
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5. Work Reintegration Study--0960-0543. The purpose of the Work
Reintegration Study is to identify those incentives and interventions
that are most successful in assisting persons who are disabled due to a
back condition to return to work. The information collected will be
used primarily to complete a cross-national analysis of this issue.
Data also will be gathered on subjects of particular importance in the
U.S. The findings will provide policymakers with information that will
be highly useful in establishing disability policy. The respondents are
persons entitled to Social Security Disability Insurance, Supplemental
Security Income (SSI) or State Temporary Disability Insurance.
Number of Respondents: 800.
Frequency of Response: 1.
Average Burden Per Response: 1 hour.
Estimated Annual Burden: 800 hours.
6. Personal Earnings and Benefit Estimate Statement (PEBES)--
Identity Verification Survey--0960-NEW. The Social Security
Administration (SSA) is conducting a survey to verify the identity and
address of individuals who request their PEBES by means of the Form
SSA-7004-SM, Request for Earnings and Benefit Statement and through the
Internet. The information is needed to determine the number of invalid
requests for PEBES using the SSA-7004-SM compared to the number of
invalid PEBES requests using the Internet. The information will be used
in the evaluation of whether to adopt the Internet as an appropriate
vehicle to
[[Page 12264]]
obtain PEBES requests. The respondents are a sample of PEBES requestors
whose identity and address could not be verified through other means.
Number of Respondents: 300.
Frequency of Response: 1.
Average Burden Per Response: 5 minutes.
Estimated Annual Burden: 25 hours.
To receive a copy of the form or clearance packages, call the SSA
Reports Clearance Officer on (410) 965-4123 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 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: March 6, 1997.
Judith T. Hasche,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 97-6240 Filed 3-13-97; 8:45 am]
BILLING CODE 4190-29-P
