[Federal Register Volume 61, Number 62 (Friday, March 29, 1996)]
[Notices]
[Pages 14189-14190]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-7376]
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SOCIAL SECURITY ADMINISTRATION
Agency Information Collection Activities: Proposed Collection
Request
Normally on Fridays, 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 Pub. L. 104-13 effective October 1, 1995, The Paperwork Reduction
Act of 1995. Since the last list was published in the Federal Register
on March 15, 1996, the information collections listed below have been
proposed or will require extension of the current OMB approvals:
(Call the SSA Reports Clearance Officer on (410) 965-4142 for a copy
of the form(s) or package(s), or write to her at the address listed
below the information collections)
1. Application for a Social Security Card--0960-0066. The
information collected on form SS-5 is used by the Social Security
Administration to assign Social Security Numbers so that individuals
may obtain employment, report earnings, open bank accounts, pay taxes,
apply for benefits and for other purposes. The affected public consists
of individuals who apply for Social Security Numbers.
Number of Respondents: 20,000,000.
Frequency of Response: 1.
Average Burden Per Response: 8 minute.
Estimated Annual Burden: 2,666,667 hours.
2. Statement Regarding Date of Birth and Citizenship--0960-0016.
The information collected on form SSA-702 is used by the Social
Security Administration in conjunction with other evidence to establish
a claimant's age or citizenship when better proofs are not available.
The affected public consists of individuals who have
[[Page 14190]]
knowledge of the birth and citizenship of an applicant.
Number of Respondents: 18,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 3,000.
3. Application for Mother's or Father's Insurance Benefits--0960-
0003. The information collected on form SSA-5 is used by the Social
Security Administration to determine an applicant's eligibility to
mother's or father's insurance benefits. The affected public comprises
individuals who wish to file an application for such benefits.
Number of Respondents: 180,000.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 45,000 hours.
4. Marriage Certification--0960-0009. The information collected on
form SSA-3 is needed to provide evidence of an alleged marriage. Social
Security uses the information to update records of marital status of an
individual. The affected public comprises persons who apply for Social
Security benefits and allege a current marriage.
Number of Respondents: 20,000.
Frequency of Response: 1.
Average Burden Per Response: 5 minutes.
Estimated Annual Burden: 16,667 hours.
5. Report on Individual with Childhood Impairment--0960-0084. The
information collected by SSA-1323 is used to determine the dates and
results of psychometric testing and how the impairment affects the
individual's progress in school. The affected public comprises public
and private school officials and agencies which provide medical
treatment to the applicant or claimant for benefits.
Number of Respondents: 7,000.
Average Burden Per Response: 20 minutes.
Estimated Annual Burden: 2,333.
6. Report on Individual with Mental Impairment--0960-0058. The
information collected on form SSA-824 is used to determine a claimant's
physical and mental status prior to making a disability determination.
The affected public consists of treating physicians, medical directors,
medical record libraries, and other health professionals.
Number of Respondents: 50,000.
Average Burden Per Response: 36 minutes.
Estimated Annual Burden: 30,000.
7. Claimant's Recent Medical Treatment--0960-0292. The information
collected on form HA-4631 is used by the Social Security Administration
to provide an updated medical history for a disability claimant who
requests a hearing. The respondents are claimants for disability
benefits who have requested a hearing and do not have updated medical
evidence in file.
Number of Respondents: 211,006.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 35,168.
8. Request for Review of Hearing Decision/Order--0960-0277. The
information collected on form HA-520 is needed in order to afford
claimants their statutory right under the Social Security Act to
request review of a hearing decision. The data will be used to
determine the course of action appropriate to resolve each issue. The
affected public are claimants denied or dissatisfied with a decision
made regarding their claim.
Number of Respondents: 87,632.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 14,605.
9. Claimant's Work Background--0960-0300. The information collected
on form HA-4633 is used by the Social Security Administration in cases
in which claimants for disability benefits have requested a hearing on
the decision regarding their claim. A completed form provides an
updated summary of a claimant's past relevant work and helps the
Administrative Law Judge to better decide whether or not the claimant
is disabled. The respondents are claimants who have requested a hearing
and whose relevant work background is not in file.
Number of Respondents: 200,958.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 50,240.
10. Medical Use Report, 20 CFR 416.268-0960-0552. The information
required by this regulation is used by the Social Security
Administration to determine if an individual is entitled to special
Supplemental Security Income (SSI) payments. The respondents are SSI
recipients whose payments were stopped based on earnings.
Number of Respondents: 25,000.
Frequency of Response: 1.
Average Burden Per Response: 3 minutes.
Estimated Annual Burden: 1,250.
Written comments and recommendations regarding these information
collections 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:
Charlotte S. Whitenight, 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.
Dated: March 21, 1996.
Charlotte Whitenight,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 96-7376 Filed 3-28-96; 8:45 am]
BILLING CODE 4190-29-M
