[Federal Register Volume 62, Number 160 (Tuesday, August 19, 1997)]
[Notices]
[Pages 44163-44164]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-21783]
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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 Public Law 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. Railroad Employment Questionnaire--0960-0078. Form SSA-671 is
used to secure sufficient information for required coordination with
the Railroad Retirement Board for Social Security claims processing.
The form is completed whenever claimants indicate that they have been
employed in the railroad industry. The respondents are retired
employees of the railroad industry or their dependents.
Number of Respondents: 125,000.
Frequency of Response: 1.
Average Burden Per Response: 5 minutes.
Estimated Annual Burden: 10,417 hours.
2. Employment Relationship Questionnaire--0960-0040. Form SSA-7160
covers all possible employment situations, and is used by the Social
Security Administration to determine an individual's work status. The
respondents are applicants for Social Security benefits.
Number of Respondents: 47,500.
Frequency of Response: 1.
Average Burden Per Response: 25 minutes.
Estimated Annual Burden: 19,792 hours.
3. Questionnaire About Employment or Self-Employment Outside the
United States--0960-0050. The information on Form SSA-7163 is needed to
determine whether work performed outside the United States by
beneficiaries is cause for deductions from their monthly benefits; to
determine whether the foreign work test or the regular work test is
applicable; and to determine the months, if any, for which deductions
should be imposed. The respondents are beneficiaries who live and work
outside the United States.
Number of Respondents: 20,000.
Frequency of Response: 1.
Average Burden Per Response: 12 minutes.
Estimated Annual Burden: 4,000 hours.
4. Disability Report--0960-0573. The information collected on Form
SSA-3368 is needed for the determination of disability by the State
Disability Determination Services. The information will be used to
develop medical evidence and to assess the alleged disability. The
respondents are applicants for disability benefits.
Number of Respondents: 2,438,496.
Frequency of Response: 1.
Average Burden Per Response: 45 minutes.
Estimated Annual Burden: 1,828,872 hours.
5. Work History Report--0960-0572. The information collected on
Form SSA-3369 is needed for the determination of disability by the
State Disability Determination Services. The respondents are applicants
for disability benefits. The information will be used to document an
individual's past work history.
Number of Respondents: 1,000,000.
Frequency of Response: 1.
Average Burden Per Response: 30 minutes.
Estimated Annual Burden: 500,000 hours.
6. Medical History and Disability Report, Disabled Child--0960-
0574. The information collected on Form SSA-3820 is needed for the
determination of disability by the State Disability Determination
Services. The SSA-3820 will be used to obtain various types of
information about a child's condition, his/her treating sources and/or
other medical sources of evidence. The respondents are applicants for
disability benefits.
Number of Respondents: 523,000.
Frequency of Response: 1.
Average Burden Per Response: 20 minutes.
Estimated Annual Burden: 174,333 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:
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
[[Page 44164]]
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. Subpart T--State Supplementation Provisions; Agreement;
Payments, 20 CFR 416.2099--0960-0240. Section 1618 of the Social
Security Act contains pass-along provisions of the Social Security
amendments. These provisions require that States which supplement the
Federal SSI benefit pass along Federal cost-of-living increases to
individuals who are eligible for State supplementary payments. If a
State fails to keep payments at the required level, it becomes
ineligible for Medicaid reimbursement under Title XIX of the Social
Security Act. Regulations in 20 CFR 416.2099 require States to report
mandatory minimum and optional supplementary payment data to SSA. The
information is used to determine compliance with laws and regulations.
The respondents are States which supplement Federal SSI payments.
Number of Respondents: 26.
Frequency of Response: 15 States report quarterly; 11 States report
annually.
Average Burden Per Response: 1 hour.
Estimated Annual Burden: 71 hours.
2. 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 hours.
3. 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 hours.
4. 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 hours.
5. Claimant's Statement About Loan of Food or Shelter, and
Statement About Food or Shelter Provided to Another-- 0960-0529. Form
SSA-5062 will be used to obtain an SSI applicant's statement about
whether the food and/or shelter provided to him/her is a loan. Form
SSA-5063 will be used to obtain an individual's statement about whether
the food and/or shelter he/she provides to an SSI applicant is a loan.
SSA needs to know if a bona fide loan exists in order to determine
whether the food and/or shelter should (or should not) be counted as
income, which can affect eligibility for SSI and the amount of SSI
benefits payable. The respondents are SSI applicants who receive food
and/or shelter (SSA-5062) and individuals who provide food and/or
shelter to SSI applicants (SSA-5063).
Number of Respondents: 131,080.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 21,847 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,
D.C. 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: August 12, 1997.
Nicholas E. Tagliareni,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 97-21783 Filed 8-18-97; 8:45 am]
BILLING CODE 4190-29-P
