95-8752. Agency Forms Submitted to the Office of Management and Budget for Clearance

[Federal Register Volume 60, Number 67 (Friday, April 7, 1995)]
[Notices]
[Pages 17844-17845]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-8752]



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DEPARTMENT OF HEALTH & HUMAN SERVICES

Social Security Administration


Agency Forms Submitted to the Office of Management and Budget for 
Clearance

    Normally on Fridays, the Social Security Administration publishes a 
list of information collection packages that have been submitted to the 
Office of Management and Budget (OMB) for clearance in compliance with 
Public Law 96-511, The Paperwork Reduction Act. The following clearance 
packages have been submitted to OMB since the last list was published 
in the Federal Register on March 10, 1995.

(Call Reports Clearance Officer on [phone] for copies of 
package.)
    1. Subpoena-Disability Hearing--0960-0428. The information on form 
SSA-1272 is used by the Social Security Administration to subpoena 
evidence or testimony needed in disability hearings. The respondents 
are comprised of Federal and State disability determinations services 
officers.
Number of Respondents: 36
Frequency of Response: 1
Average Burden Per Response: 30 minutes
Estimated Annual Burden: 18 hours

    2. Agency/Employer Questionnaire--0960-0470. The information on 
form SSA-4163 is used by the Social Security Administration to 
determine the need for and the amount of any offset of benefits for 
certain individuals receiving government pensions and also receiving or 
applying for Social Security benefits. The respondents are State 
governments or political subdivisions thereof.

Number of Respondents: 1,000
Frequency of Response: 1
Average Burden Per Response: 3 minutes
Estimated Annual Burden: 50 hours
    3. Response to Notice of Revised Determination--0960-0347. The 
information on form SSA-765 is used by claimants to request a 
disability hearing and/or to submit additional information before a 
revised reconsideration determination is issued. The respondents are 
claimants for disability insurance benefits.

Number of Respondents: 1,925
Frequency of Response: 1
Average Burden Per Response: 30 minutes
Estimated Annual Burden: 963 hours

    4. Notification of Projected Completion Date--0960-NEW. The form 
SSA-891 is used by the Social Security Administration and the State 
disability determination services to notify disability hearings units 
(DHU) that a specific hearing case will not be completed and forwarded 
to the DHU as originally scheduled. The respondents are State 
disability determination services staffs.

Number of Respondents: 20
Frequency of Response: 1
Average Burden Per Response: 5 minutes
mated Annual Burden: 2 hours

    5. Student's Statement Regarding Resumption of School Attendance--
0960-0143. The information on form SSA-1386 is used by the Social 
Security Administration to verify full-time attendance at educational 
institutions and to determine eligibility for student benefits. The 
respondents are student beneficiaries currently receiving SSA benefits.

Number of Respondents: 133,000
Frequency of Response: 1
Average Burden Per Response: 6 minutes
Estimated Annual Burden: 13,300 hours

    6. Authorization for the Social Security Administration to Obtain 
Account Records from a Financial Institution and Request for Records--
0960-0293. The information on form SSA-4641 is used by the Social 
Security Administration to determine whether an applicant meets the 
resources eligibility requirements for Supplemental Security Income and 
Aid to Families with Dependent Children (AFDC). In the AFDC program, 
this information is used only as part of the quality review of the 
program. The respondents are financial institutions.

Number of Respondents: 500,000
Frequency of Response: 1
Average Burden Per Response: 6 minutes
Estimated Annual Burden: 50,000 hours

    7. Statement of Household Expenses and Contributions--0960-0456. 
The information on form SSA-8011 is used by the Social Security 
Administration (SSA) to obtain or corroborate the household expenses 
and contributions the claimant/recipient makes toward the expenses. SSA 
needs the information to correctly determine the amount of unearned 
income received by the claimant/recipient in order to determine the 
individual's eligibility and payment amount under the SSI program. The 
respondents are household members of SSI claimants/recipients.

Number of Respondents: 400,000
Frequency of Response: 1
Average Burden Per Response: 15 minutes
Estimated Annual Burden: 100,000 hours [[Page 17845]] 
OMB Desk Officer: Laura Oliven

    Written comments and recommendations regarding these information 
collections should be sent directly to the appropriate OMB Desk Officer 
designated above at the following address: Office of Management and 
Budget, OIRA New Executive Office Building, Room 10230, Washington, 
D.C. 20503.

    Dated: April 3, 1995.
Charlotte Whitenight,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 95-8752 Filed 4-6-95; 8:45 am]
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