[Federal Register Volume 62, Number 116 (Tuesday, June 17, 1997)]
[Notices]
[Pages 32849-32850]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-15764]
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SOCIAL SECURITY ADMINISTRATION
Information Collection Activities: Proposed Collection Requests
and Comment Requests
This notice lists information collection packages that will require
submission to the Office of Management and Budget (OMB), as well as
information collection packages submitted to OMB for clearance, in
compliance with Pub.L. 104-13 effective October 1, 1995, The Paperwork
Reduction Act of 1995.
I. The information collection(s) listed below require(s)
extension(s) of the current OMB approval(s) or are proposed new
collection(s):
1. Application for Lump-Sum Death Payment--0960-0013. The
information collected on Form SSA-8-F4 is required to authorize payment
of the lump-sum death benefit to a widow, widower, or children as
defined in Section 202(i) of the Social Security Act. The respondents
are widows, widowers or children who receive lump-sum death benefits.
Number of Respondents: 735,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 122,500.
2. Statement Regarding Contributions--0960-0020. Form SSA-783
collects the information necessary to make a determination of one-half
support, or contributions to support, in order to entitle certain child
applicants to Social Security benefits. The respondents are children
who apply for Social Security benefits.
Number of Respondents: 30,000.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 7,500.
3. Application for Search of Census Record for Proof of Age--0960-
0097. The information collected on Form SSA-1535-U3 is required to
provide the Census Bureau with sufficient identifying information,
which will allow an accurate search of census records to establish
proof of age for an individual applying for Social Security benefits.
It is used for individuals who must establish age as a factor of
entitlement. The respondents are individuals applying for Social
Security Benefits.
Number of Respondents: 18,000.
Frequency of Response: 1.
Average Burden Per Response: 12 minutes.
Estimated Annual Burden: 3,600.
4. Claimant's Statement About Loan of Food or Shelter, and
Statement About Food or Shelter Provided to Another--0960-0529. The
information on Forms SSA-5062 and SSA-L5063 will be used by the Social
Security Administration to determine whether food or shelter provided
to a recipient of supplemental security income (SSI) payments should be
counted as income. The respondents are SSI recipients who receive food
or shelter and individuals who provide it to them.
Number of Respondents: 131,080.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 21,847.
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:
Nicholas E. Tagliareni, 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 information collection(s) listed below have been submitted
to OMB:
1. Certification by Religious Group--0960-0093. The information
collected by the Social Security Administration on form SSA-1458 is
used to determine if the religious group of which an individual is a
member qualifies for a self-employment tax exemption under Section
1402(g) of the Internal Revenue Code. The respondents are spokespersons
for religious groups.
Number of Respondents: 180.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 45 hours.
2. RSI/DI Quality Review Case Analysis Questionnaires and Annual
Earnings Test Questionnaire--0960-0189. The information collected on
forms SSA-2930, SSA-2931 and SSA-2932 is used by the Social Security
Administration to establish a national payment accuracy rate for all
cases in payment status and to serve as a source of information
regarding problem areas in the Retirement and Survivors Insurance (RSI)
program and Disability Insurance programs. The information is also used
to measure the accuracy rate for newly adjudicated RSI/DI cases. The
information collected on form SSA-4659 is used to evaluate the annual
earnings test (AET) process to determine the effectiveness of the AET
process. The results will be used to develop ongoing improvements in
the process. The respondents are RSI and DI beneficiaries.
[[Page 32850]]
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SSA-2930 SSA-2931 SSA-2932 SSA-4659
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Number of Respondents....................................... 5,500 2,750 1,375 740
Frequency of Response....................................... 1 1 1 1
Average Burden Per Response (minutes)....................... 20 30 30 20
Estimated Annual Burden (Hours)............................. 1,833 1,375 688 247
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3. Questionnaire for Children Claiming SSI Benefits--0960-0499. The
information collected on form SSA-3881 is used by the Social Security
Administration to evaluate disability in children who apply for
supplement security income payments. The respondents are individuals
who apply for supplement security income benefits for a disable child.
Number of Respondents: 455,000.
Frequency of Response: 1.
Average Burden Per Response: 20 minutes.
Estimated Annual Burden: 151,667 hours.
4. 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.
5. 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.
6. 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 these current rules 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 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,
DC 20503
(SSA)
Social Security Administration, DCFAM, Attn: Nicholas E.
Tagliareni, 1-A-21 Operations Bldg., 6401 Security Blvd., Baltimore, MD
21235
To receive a copy of any of the forms or clearance packages, call
the SSA Reports Clearance Officer on (410) 965-4125 or write to him at
the address listed above.
Dated: June 10, 1997.
Nicholas E. Tagliareni,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 97-15764 Filed 6-16-97; 8:45 am]
BILLING CODE 4190-29-P
