[Federal Register Volume 62, Number 75 (Friday, April 18, 1997)]
[Notices]
[Pages 19154-19155]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-10085]
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SOCIAL SECURITY ADMINISTRATION
Agency Information Collection Activities: Proposed Collection
Requests
This notice lists information collection packages that will require
submission to the Office of Management and Budget (OMB), in compliance
with Public Law 104-13 effective October 1, 1995, The Paperwork
Reduction Act of 1995.
1. Consent for Release of Information--0960-0567. The information
collected on form SSA-3288 is used by the Social Security
Administration (SSA) to ensure that an individual consents to the
release of his/her personal information to another individual. The
respondents are individuals assenting to the disclosure of information
from their social security records to someone else.
Number of Respondents: 200,000.
Frequency of response: 1.
Average Burden Per Response: 3 minutes.
Estimated Annual Burden: 10,000 hours.
2. Application for Special Age 72-or-Over Monthly Payments--0960-
0096. The information collected on form SSA-19 is used by SSA to
determine entitlement of individuals to special age 72-or-over
payments. The respondents are applicants who file for the special
payment.
Number of Respondents: 15.
Frequency of Response: 1.
Average Burden Per Response: 20 minutes.
Estimated Average Burden: 5 hours.
3. Request for Self-Employment Information (SSA-2765), Request for
Employment Information (SSA-3365), Request for Employer Information
(SSA-4002)--0960-0508. The information is needed by SSA when earnings
information reported to the agency is incomplete or incorrect. The
information is used to post the reported earnings to the appropriate
earnings record. The respondents are employers of the wage earners or
employees and self-employed individuals for whom the earnings were
reported.
Number of Respondents: 3,000,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 500,000 hours.
4. State Agency Report of Obligations for SSA Disability Program--
0960-0421. The information collected on form SSA-4513 is used by SSA in
a detailed analysis and evaluation of costs incurred by the State
Disability Determination Services (DDS) in making determinations of
disability for SSA and to determine funding levels for each DDS. The
respondents are State DDS offices.
Number of Respondents: 54.
Frequency of Response: 4.
Average Burden Per Response: 1 hour.
Estimated Annual Burden: 216 hours.
5. State Vocational Rehabilitation Agency Claim (SSA-199) and
Subpart V--Payments for Vocational Rehabilitation Services, 20 CFR
Sections 404.2104, 404.2108, 404.2113, 404.2117, 404.2121, 416.2204,
416.2208, 416.2213 and 416.2217--0960-0310. The information collected
on form SSA-199 and through this current rule is used by the Social
Security Administration to determine if State vocational rehabilitation
agencies are providing appropriate services, including referrals when
necessary, and whether those claims for services should be paid.
Number of Respondents: 80-100.
Frequency of Response: On occasion.
Average Burden Per Response: Varies from 23 minutes to 4 hours.
Estimated Annual Burden: 8,465 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: 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
[[Page 19155]]
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.
To receive a copy of any of the forms or clearance packages, call
the SSA Reports Clearance Officer on (410) 965-4123 or write to her at
the address listed above.
Dated: April 11, 1997.
Frederick W. Brickenkamp,
Forms Management Officer, Social Security Administration.
[FR Doc. 97-10085 Filed 4-17-97; 8:45 am]
BILLING CODE 4190-29-P
