[Federal Register Volume 60, Number 135 (Friday, July 14, 1995)]
[Notices]
[Pages 36326-36327]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-17305]
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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
P.L. 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 June 16, 1995.
(Call Reports Clearance Officer on (410) 965-4142 for copies of
package.)
1. Certificate of Coverage Request--0960-NEW. The information is
used by the Social Security Administration to provide a certificate of
coverage from the United States social security system to an individual
working in a foreign country. This certificate exempts the individual
from paying taxes into a foreign social security system. The
respondents are workers and employers whose work is performed in a
foreign country.
Number of Respondents: 24,000
Frequency of Response: 1
Average Burden Per Response: 30 minutes
Estimated Annual Burden: 12,000 hours
2. Disability Report, Vocational Report--0960-0141. The information
on forms SSA-3368 and SSA-3369 is used by the Social Security
Administration to help make a disability determination. The forms are
essential to case development and adjudication. The respondents are
individuals who file for disability benefits.
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SSA-3368 SSA-3369
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Number of Respondents................. 2,264,000...... 1,000,000
Frequency of Response................. 1.............. 1
Average Burden Per Response........... 45 minutes..... 30 minutes
Estimated Annual Burden............... 1,698,000 hrs.. 500,000 hrs.
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3. SSA Automated SML Application--0960-0475. The information on
form SSA-4123 is used to maintain an automated solicitation mailing
list of qualified vendors wanting to do business with the Social
Security Administration (SSA). The respondents are vendors who wish to
be listed on SSA's automated solicitation mailing list.
Number of Respondents: 4,000
Frequency of Response: 1
Average Burden Per Response: 5 minutes
Estimated Annual Burden: 333 hours
4. Social Security Medical Report (General)--0960-0052. The
information on form SSA-3826 is used by the Social Security
Administration to determine the claimant's physical status prior to
making a disability determination. The information is used to document
disability claims folders with medical evidence.
Number of Respondents: 750,000
Frequency of Response: 1
Average Burden Per Response: 30 minutes
Estimated Annual Burden: 375,000 hours
5. Request for Social Security Earnings Information--0960-0525. The
information on form SSA-7050 is used by the Social Security
Administration (SSA) to identify the request, define the earnings
information being requested, and inform the requestor of the fee for
such information. The above data is then used by SSA to produce the
requested statement. The respondents are individuals and organizations
which use this form to request statements of earnings from SSA.
Number of Respondents: 40,000
Frequency of Response: 1
Average Burden Per Response: 11 minutes
Estimated Annual Burden: 7,333 hours
6. Employee Identification Statement--0960-0473. The information on
form SSA-4156 is used by the Social Security Administration to resolve
situations in which two or more individuals have used the same social
security number (SSN) and an employer has erroneously reported earnings
under an SSN. The affected public is comprised of employers involved in
erroneous wage reporting.
Number of Respondents: 4,750
Frequency of Response: 1
Average Burden Per Response: 10 minutes
Estimated Annual Burden: 792 hours
7. Report of Work Activity--Continuing Disability--0960-0108. The
information on form SSA-3945 is used by the Social Security
Administration to determine whether work performed by an individual,
after his or her entitlement to disability benefits, is cause for that
entitlement to end. The affected public consists of disability
beneficiaries who work after their entitlement.
Number of Respondents: 140,000
Frequency of Response: 1
Average Burden Per Response: 45 minutes
Estimated Annual Burden: 105,000 hours
8. Medical History and Disability Report--0960-0504. The
information on form SSA-3820 is used by the Social Security
Administration to help make a determination in claims for disabled
children. The respondents are claimants for disability benefits.
Number of Respondents: 453,000
Frequency of Response: 1
Average Burden Per Response: 20 minutes
Estimated Annual Burden: 151,000 hours
9. Statement Regarding Student's Attendance--0960-0113. The
information on form SSA-2434 is used
[[Page 36327]]
by the Social Security Administration to determine student status of
the children of coal miners or their widows or brothers of deceased
coal miners eligible for black lung benefits.
Number of Respondents: 4,340
Frequency of Response: 1
Average Burden Per Response: 10 minutes
Estimated Annual Burden: 723 hours
10. Summary of Evidence--0960-0430. The information on form SSA-887
is used to provide a list of the medical/vocational reports pertaining
to the claimant's disability. The list is used in and critical to the
hearings process. The respondents are State and Disability
Determination staff.
Number of Respondents: 22,024
Frequency of Response: 1
Average Burden Per Response: 15 minutes
Estimated Annual Burden: 5,506 hours
11. Request For Change In Time/Place of Disability Hearing-- 0960-
0348. The information on form SSA-769 is used to provide claimants a
structured format for exercising their right to request a change in the
time or place of a scheduled disability hearing. The information will
be used as a basis for granting or denying requests for changes and for
rescheduling hearings. The affected public is comprised of claimants
who wish to request a change in the time or place.
Number of Respondents: 7,483
Frequency of Response: 1
Average Burden Per Response: 8 minutes
Estimated Annual Burden: 998 hours
12. Time Report of Personnel Services for Disability Determination
Services--0960-0408. The information on form SSA-4514 is used by the
Social Security Administration (SSA) for budgeting and accounting for
the funds used by State Agencies for personnel involved in making
disability determinations for SSA. The affected public consists of
State Agencies which make those determinations.
Number of Respondents: 54
Frequency of Response: Quarterly
Average Burden Per Response: 30 minutes
Estimated Annual Burden: 108 hours
13. Payment of Certain Travel Expenses--0960-0504. The information
required by 20 CFR 404.999(d) and 20 CFR 416.1499 is used by the Social
Security Administration to reimburse a claimant who has been required
to travel over 75 miles to appear at a medical examination or
disability hearing. The affected public is comprised of claimants
required to travel more than 75 miles in order to attend a medical
examination or a disability hearing.
Number of Respondents: 50,000
Frequency of Response: 1
Average Burden Per Response: 10 minutes
Estimated Annual Burden: 8,333 hours
14. Request for Reconsideration--Disability Cessation--0960-0504.
The information on form SSA-789 is used by the Social Security
Administration to schedule hearings and to develop additional evidence
for individuals who have received an initial or revised determination
that their disability ceased, did not exist, or is no longer disabling.
The respondents are disability beneficiaries who file a claim for
reconsideration.
Number of Respondents: 15,015
Frequency of Response: 1
Average Burden Per Response: 12
Estimated Annual Burden: 3,003
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: July 7, 1995.
Charlotte Whitenight,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 95-17305 Filed 7-13-95; 8:45 am]
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