[Federal Register Volume 60, Number 231 (Friday, December 1, 1995)] [Notices] [Pages 61726-61728] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 95-29139] ======================================================================= ----------------------------------------------------------------------- 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 will require submission to the Office of Management and Budget (OMB) for clearance in compliance with P.L. 96-511, as amended (P.L. 104-13 effective October 1, 1995), The Paperwork Reduction Act. Since the last list was published in the Federal Register on November 17, 1995, the following information collections have been proposed or will require extension of the current OMB approvals. (Call the Reports Clearance Officer on (410) 965-4142 for a copy of the form(s) or package(s), or write to her at the address listed after the information collections.) SSA Reports Clearance Officer: Charlotte S. Whitenight. 1. Quarterly Statistical Report on Recipients and Payments Under State-administered Assistance Programs for Aged, Blind and Disabled (Individuals and Couples) Recipients--0960-0130. The information collected on the SSA-9741 is used to provide statistical data on recipients and assistance payments under the SSI State-administered State supplementation programs. These data are needed to complement the data available for the federally administered programs under SSA and to more fully explain the impact of the public income support programs on the needy, aged, blind and disabled. The respondents are state agencies who administer supplementary payment programs under SSI. Number of Respondents: 23 Frequency of Response: 4 times annually Average Burden Per Response: 1 hour Estimated Annual Burden: 92 hours 2. Record of SSI Inquiry--0960-0140. The information collected on form SSA-3462 is used to document the earliest possible filing date and to determine potential eligibility for SSI benefits. The respondents are individuals who inquire about SSI eligibility for themselves or another individual. Number of Respondents: 1,200,000 Frequency of Response: 1 Average Burden Per Response: 5 minutes Estimated Annual Burden: 100,000 3. Request for Workers' Compensation/Public Disability Information--0960-0098. The information collected on form SSA-1709 is used to verify workers compensation and public disability benefits payment amounts and to compute the correct reduction to the disability insurance benefits. The respondents are state and local governments and/or business that administer workers' compensation or other disability benefits. Number of Annual Responses: 140,000 Frequency of Response: As needed to verify changes in the amount of workers compensation/public disability benefits Average Burden Per Response: 15 minutes Estimated Annual Burden: 35,000 hours 4. Employee Work Activity Questionnaire--0960-0483. The information collected on form SSA-3033 is used to determine if a disability claimant has or has not either engaged in substantial gainful activity or received a non-specific subsidy. Such a determination is necessary in evaluating a claimant's eligibility for Social Security disability benefits. The respondents are current or former employers of disability claimants. Number of Respondents: 12,500 Frequency of Response: 1 Average Burden Per Response: 15 minutes Estimated Annual Burden: 3,125 hours 5. Followup Survey for the Project Network Evaluation--0960-NEW. Project Network is a demonstration project that tests alternative approaches to assisting people with disabilities in [[Page 61727]] finding and maintaining employment. Followup information collected from project participants (treatment and control group members) will be used to evaluate the extent to which the different demonstration service- delivery systems assisted people with disabilities to find and maintain employment. The respondents are selected participants in the initial Project Network survey. Number of Respondents: 1,558 Frequency of Response: 1 Average Burden Per Response: 90 minutes Estimated Annual Burden: 2,337 hours Written comments and recommendations regarding these information collections 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: Charlotte S. Whitenight, 6401 Security Blvd., 1-B-22 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. The following information collections, which were published in the Federal Register on October 6, 1995, have been submitted to OMB: 1. Request To Be Selected As Payee--0960-0014. The information collected on form SSA-11-BK is used by the Social Security Administration to help determine the proper payee for a person who cannot receive his or her own Social Security benefits. The respondents will be individuals who apply to receive Social Security benefits on behalf of someone else. Number of Respondents: 605,000. Frequency of Response: 1. Average Burden per Response: 10.5 minutes. Estimated Annual Burden: 105,875 hours. 2. Disability Update Report--0960-0511. The information on form SSA-455 is used by the Social Security Administration to determine if a full medical continuing disability review (CDR) should be conducted. The respondents will be Social Security disability insurance beneficiaries who are scheduled to receive a CDR. Number of Respondents: 431,200. Frequency of Response: 1. Average Burden Per Response: 15 minutes. Estimated Annual Burden: 107,800 hours. 3. Statement Regarding Marriage--0960-0017. The information collected via form SSA-753 is used by the Social Security Administration to make determinations regarding entitlement to spouse's benefits when a common law marriage is alleged. The respondents are third parties who can supply evidence concerning the existence of a common law marriage. Number of Respondents: 40,000. Frequency of Response: 1 Average Burden Per Response: 9 minutes. Estimated Annual Burden: 6,000 hours. 4. State Contribution Return--0960-0041. The information on form SSA-3961 is used by the Social Security Administration to identify and account for all contributions due and paid by the states (or interstate instrumentalities) under Section 218 of the Social Security Act. The respondents are state agencies. Number of Respondents: 117. Frequency of Response: on occasion. Average Burden Per Response: 3 minutes. Estimated Annual Burden: 500 hours. 5. Statement of Death by Funeral Director--0960-0142. The information collected on the SSA-721 is used by the Social Security Administration to verify the death of an individual insured under the Social Security Act and to determine if there is a survivor eligible for a lump sum death payment. The respondents will be funeral directors with knowledge of the death of a person insured for Social Security benefits. Number of Respondents: 900,000. Frequency of Response: 1. Average Burden Per Response: 3.5 minutes. Estimated Annual Burden: 52,500 hours. 6. Annual Report of Earnings (long and short forms)--0960-0057. The information on forms SSA-777 and SSA-7770 is used by the Social Security Administration to determine the amount of yearly earnings of beneficiaries so that the proper benefit amounts are paid to them. The respondents will be beneficiaries under age 70 who have earned over the exempt amount for the year and still received benefits. Number of Respondents: (SSA-777)-200,000; (SSA-7770)-1,000,000. ---------------------------------------------------------------------------------------------------------------- SSA-777 SSA-7770 ---------------------------------------------------------------------------------------------------------------- Frequency of Response.............. 1.................................... 1. Average Burden per Response........ 17 minutes........................... 8 minutes. Estimated Annual Burden............ 190,000 hours........................ 190,000 hours. ---------------------------------------------------------------------------------------------------------------- 7. Public Information Campaigns and News Releases--0960-0544. The purpose of the public information campaigns and news releases is to better inform the public about the programs and activities of the Social Security Administration (SSA). The information is used by SSA to determine media interest in airing and printing the public information materials and news releases and to determine which materials are used, how often, its effectiveness, and the need for more local announcements. The respondents are newspapers and public broadcasting systems such as television, cable, and radio stations. Number of Respondents: TV-500, Newspaper--500, Radio--1,500, Cable--148. Frequency of Response: Public Service Announcements--4, News Releases--4, Educational Tapes--2. Average Burden Per Response: 1 minute (solicitation card) 2 minutes (business reply card). Estimated Annual Burden: 298 hours. 8. Work Reintegration Study--0960-0543. The information on the two forms used in this study will aid the Social Security Administration in determining what steps it can take to help beneficiaries who are disabled due to a back condition to return to work. Number of Respondents: 1,500. Frequency of Response: 1. Average Burden Per Response: 1 hour. Estimated Annual Burden: 1,500 hours. Written comments and recommendations regarding these information collections should be sent within 30 days of the date of this publication. Comments may be directed to OMB and SSA at the following addresses: (OMB) Office of Management and Budget, OIRA, Attn: Laura Oliven, New Executive Office Building, Room 10230, Washington, DC 20503. [[Page 61728]] (SSA) Social Security Administration, DCFAM, Attn: Charlotte S. Whitenight, 6401 Security Blvd, 1-A-21 Operations Bldg., Baltimore, MD 21235. Dated: November 21, 1995. Charlotte Whitenight, Reports Clearance Officer, Social Security Administration. [FR Doc. 95-29139 Filed 11-30-95; 8:45 am] BILLING CODE 4190-29-P