94-18322. Agency Forms Submitted to the Office of Management and Budget for Clearance

[Federal Register Volume 59, Number 145 (Friday, July 29, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-18322]


[[Page Unknown]]

[Federal Register: July 29, 1994]


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DEPARTMENT OF HEALTH AND 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 
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 Friday, July 1, 1994.

(Call Reports Clearance Officer on [phone] for copies of 
package)

    1. Application for Lump-Sum Death Payment--0960-0013. The 
information on form SSA-8 is used by the Social Security Administration 
to determine the eligibility of an applicant for the lump-sum death 
payment. The respondents are widows, widowers, or children of the 
deceased or their representatives.

Number of Respondents: 735,000
Frequency of Response: 1
Average Burden Per Response: 10 minutes
Estimated Annual Burden: 122,500 hours
    2. Statement of Self-Employment Income--0960-0046. The information 
on form SSA-766 is used by the Social Security Administration to 
determine if an individual will have at least the minimum amount of 
self-employment income needed for one or more quarters of coverage in 
the current year. The affected public consists of applicants who lack 
1-4 quarters of coverage in order to be eligible to benefits.

Number of Respondents: 5,000
Frequency of Response: 1
Average Burden Per Response: 5 minutes
Estimated Annual Burden: 417 hours
    3. State Agency Report of Obligations for SSA Disability Programs--
0960-0421. The information on form SSA-4513 is used by the Social 
Security Administration (SSA) to budget and account for expenditures by 
the State Disability Determination Service (DDS) agencies which are 
incurred while making determinations for SSA. The respondents are DDSs 
under contract to SSA.

Number of Respondents: 54
Frequency of Response: 4
Average Burden Per Response: 60 minutes
Estimated Annual Burden: 216 hours

    4. Statement Regarding Contributions--0960-0020. The information on 
form SSA-783 is used by the Social Security Administration to determine 
one-half support, which is an eligibility factor for certain claimants. 
The respondents are claimants who need to prove one-half support by the 
wage earner or other persons having knowledge of the situation.

Number of Respondents: 30,000
Frequency of Response: 1
Average Burden Per Response: 15 minutes
Estimated Annual Burden: 7,500 hours

    5. Statement for Determining Continuing Eligibility for 
Supplemental Security Income--0960-0416. The information on form SSA-
8203 is used by the Social Security Administration to conduct a 
redetermination of a recipient's continuing eligibility to Supplemental 
Security Income Benefits (SSI). It has been revised to include a lead 
question concerning potential entitlement to Social Security benefits 
and to delete the question concerning earned income credits. The 
respondents are SSI recipients who are scheduled for a redetermination.

Number of Respondents: 580,000
Frequency of Response: 1
Average Burden Per Response: 17 minutes
Estimated Annual Burden: 164,333 hours

    6. Application for Search of Census Records for Proof of Age-- 
0960-0097. The information on form SSA-1535 is used by the Social 
Security Administration to provide the Census Bureau with sufficient 
information to accurately search its records for proof of age for an 
individual claiming benefits. The respondents are claimants who need to 
obtain a census record in order to prove their age.

Number of Respondents: 18,000
Frequency of Response: 1
Average Burden Per Response: 12 minutes
Estimated Annual Burden: 3,600 hours 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: OMB Reports Management 
Branch, New Executive Office Building, Room 3208, Washington, D.C. 
20503.
Charlotte Whitenight,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 94-18322 Filed 7-28-94; 8:45 am]
BILLING CODE 4190-29-P