[Federal Register Volume 77, Number 20 (Tuesday, January 31, 2012)]
[Notices]
[Pages 4854-4857]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-1947]
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SOCIAL SECURITY ADMINISTRATION
Agency Information Collection Activities: Proposed Request and
Comment Request
The Social Security Administration (SSA) publishes a list of
information collection packages requiring clearance by the Office of
Management and Budget (OMB) in compliance with Public Law 104-13, the
Paperwork Reduction Act (PRA) of 1995, effective October 1, 1995. This
notice includes revisions and extensions of OMB-approved information
collections, and a new information collection.
SSA is soliciting comments on the accuracy of the agency's burden
estimate; the need for the information; its practical utility; ways to
enhance its quality, utility, and clarity; and ways to minimize burden
on respondents, including the use of automated collection techniques or
other forms of information technology. Mail, email, or fax your
comments and recommendations on the information collection(s) to the
OMB Desk Officer and SSA Reports Clearance Officer at the following
addresses or fax numbers.
(OMB)
Office of Management and Budget, Attn: Desk Officer for SSA. Fax: (202)
395-6974. Email address: [email protected].
(SSA)
Social Security Administration, DCRDP, Attn: Reports Clearance Officer,
107 Altmeyer Building, 6401 Security Blvd., Baltimore, MD 21235. Fax:
(410) 966-2830. Email address: [email protected].
I. The information collections below are pending at SSA. SSA will
submit them to OMB within 60 days from the date of this notice. To be
sure we consider your comments, we must receive them no later than
April 2, 2012. Individuals can obtain copies of the collection
instruments by calling the SSA Reports Clearance Officer at (410) 965-
8783 or by writing to the above email address.
1. Electronic Health Records Partnering Program Evaluation Form--24
CFR 495.300-495.370--0960-New. The Health Information Technology for
Economic and Clinical Health (HITECH) Act promotes the adoption and
meaningful use of health information technology (IT), particularly in
the context of working with government agencies. Similarly, Section
3004 of the Public Health Service Act requires health care providers or
health insurance issuers with government contracts to implement,
acquire, or upgrade their health IT systems and
[[Page 4855]]
products to meet adopted standards and implementation specifications.
To support expansion of SSA's health IT initiative as defined under
HITECH, SSA developed Form SSA-680, the Partnering Program Evaluation
Form. The SSA-680 allows healthcare providers to provide the
information SSA needs to determine their ability to exchange health
information with us electronically. We intend to evaluate potential
partners (i.e., healthcare providers and organizations) on (1) the
accessibility of the health information they possess and (2) the
content value of their electronic health records' systems for our
disability adjudication processes. SSA reviews the completeness of
organizations' SSA-680 responses as one part of our careful analysis of
their readiness to enter into a health IT partnership with us. The
respondents are healthcare providers and organizations exchanging
information with the agency.
Type of Request: This is a new information collection request.
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Average burden Estimated total
Collection instrument Number of Frequency of per response annual burden
responses response (hours) (hours)
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SSA-680..................................... 30 1 5 150
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2. Third Party Liability Information Statement--42 CFR 433.136-
433.139--0960-0323. To reduce Medicaid costs, Medicaid state agencies
must identify third party insurers liable for medical care or services
for Medicaid beneficiaries. Regulations at 42 CFR 433.136-433.139
require Medicaid state agencies to obtain this information on Medicaid
applications and redeterminations as a condition of Medicaid
eligibility. States may enter into agreements with the Commissioner of
Social Security to make Medicaid eligibility determinations for aged,
blind, and disabled beneficiaries in those states. Applications for and
redeterminations of Supplemental Security Income (SSI) eligibility in
jurisdictions with such agreements are applications and
redeterminations of Medicaid eligibility. Under these agreements, SSA
obtains third party liability information using Form SSA-8019, and
provides that information to the Medicaid state agencies. The Medicaid
state agencies use the information to bill third parties liable for
medical care, support, or services for a beneficiary to guarantee that
Medicaid remains the payer of last resort. The respondents are SSI
claimants and recipients.
Type of Request: Extension of an OMB-approved information
collection.
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Estimated
Number of Frequency of Average burden total annual
Collection instrument responses response per response burden
(minutes) (hours)
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SSA-8012 Paper form............................. 130 1 5 11
SSA Intranet Modernized SSI Claims System 66,904 1 5 5,575
(MSSICS).......................................
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Totals...................................... 67,034 .............. .............. 5,586
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3. Prohibition of Payment of SSI Benefits to Fugitive Felons and
Parole/Probation Violators--20 CFR 416.708(o)--0960-0617. Section
1611(e)(4) of the Social Security Act (Act) precludes eligibility for
SSI payments for certain fugitives and probation/parole violators.
Regulations at 20 CFR 416.708(o) require individuals applying for or
receiving SSI benefits to report to SSA that (1) they are fleeing to
avoid prosecution for a crime; (2) they are fleeing to avoid custody or
confinement after conviction of a crime; or (3) they are violating a
condition of probation or parole. SSA will use the information we
receive to deny eligibility, or suspend recipients SSI payments. The
respondents are SSI applicants and recipients, or representative payees
of SSI applicants and recipients, who are reporting their status as a
fugitive felon or probation/parole violator.
Type of Request: Extension of an OMB-approved information
collection.
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Average burden Estimated total
Collection instrument Number of Frequency of per response annual burden
responses response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
MSSICS...................................... 1,000 1 1 17
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II. SSA submitted the information collections below to OMB for
clearance. Your comments regarding the information collections would be
most useful if OMB and SSA receive them within 30 days from the date of
this publication. To be sure we consider your comments, we must receive
them no later than March 1, 2012. Individuals can obtain copies of the
OMB clearance packages by calling the SSA Reports Clearance Officer at
(410) 965-8783 or by writing to the above email address.
1. Statement of Marital Relationship (By one of the parties)--20
CFR 404.726--0960-0038. SSA must obtain a signed statement from a
spousal applicant if the applicant claims a common-law marriage to the
insured in a state in which such marriages are recognized, and no
formal marriage documentation exists. SSA uses information we collect
on Form SSA-754-F4 to determine if an individual applying for spousal
benefits meets the criteria of common-law marriage under state law. The
respondents are applicants for spouse's Social Security benefits or SSI
payments.
[[Page 4856]]
This is a correction notice. SSA published this information
collection as an extension on November 16, 2011 at 76 FR 71105. Since
we are revising the Privacy Act Statement, this is actually a revision
of an OMB-approved information collection.
Type of Request: Revision of an OMB-approved information
collection.
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Average burden Estimated total
Collection instrument Number of Frequency of per response annual burden
responses response (minutes) (hours)
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SSA-754-F4.................................. 30,000 1 30 15,000
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2. Medicaid Use Report--20 CFR 416.268--0960-0267. Section 20 CFR
416.268 of the Code of Federal Regulations requires SSA to determine
eligibility for (1) special SSI cash payments and (2) special SSI
eligibility status for a person who works despite a disabling
condition. It also explains how, in order to qualify for special SSI
eligibility status, an individual must establish that termination of
eligibility for benefits under title XIX of the Act would seriously
inhibit the ability to continue employment. SSA uses the information
required by this regulation to determine if an individual is entitled
to special title XVI SSI payments and, consequently, to Medicaid. The
respondents are SSI recipients for whom SSA has stopped payments based
on earnings.
Type of Request: Extension of an OMB-approved information
collection.
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Average burden Estimated total
Regulation section Number of Frequency of per response annual burden
responses response (minutes) (hours)
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20 CFR 416.268.............................. 60,000 1 3 3,000
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3. Supplemental Security Income (SSI) Claim Information Notice--20
CFR 416.210--0960-0324. Section 1611(e)(2) of the Act requires
individuals to file for and obtain all payments (annuities, pensions,
disability benefits, veteran's compensation, etc.) for which they are
eligible before qualifying for SSI payments. Individuals do not qualify
for SSI if they do not first apply for all other benefits. SSA uses the
information on Form SSA-L8050-U3 to verify and establish a claimant's
or recipient's eligibility under the SSI program. Respondents are SSI
applicants or recipients who may be eligible for other payments from
public or private programs.
Type of Request: Revision of an OMB-approved information
collection.
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Average burden Estimated total
Collection instrument Number of Frequency of per response annual burden
responses response (minutes) (hours)
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SSA-L-8050-U3............................... 7,500 1 10 1,250
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4. Filing Claims Under the Federal Tort Claims Act--20 CFR 429.101-
429.110--0960-0667. The Federal Tort Claims Act is the legal mechanism
for compensating persons injured by negligent or wrongful acts that
occur during the performance of official duties by Federal employees.
In accordance with the law, SSA accepts monetary claims filed under the
Federal Tort Claims Act for damages against the United States, loss of
property, personal injury, or death resulting from an SSA employee's
wrongful act or omission. The regulation sections this information
collection comprises require claimants to provide information SSA can
use to investigate and determine whether to make an award, compromise,
or settlement under the Federal Tort Claims Act. The respondents are
individuals or entities making a claim under the Federal Tort Claims
Act.
Type of Request: Extension of an OMB-approved information
collection.
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Estimated
Number of Frequency of Average burden total annual
Regulation section responses response per response burden
(minutes) (hours)
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20 CFR 429.102; 20 CFR 492.103 \1\.............. -- -- -- 1
20 CFR 429.104(a)............................... 31 1 5 3
20 CFR 429.104(b)............................... 25 1 5 2
20 CFR 429.104(c)............................... 2 1 5 .17
20 CFR 429.106(b)............................... 10 1 10 2
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Totals...................................... 68 .............. .............. 8
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\1\ The 1 hour represents a placeholder burden. We are not reporting a burden for this collection because
respondents complete OMB-approved Form SF-95 (OMB Control 1105-0008).
[[Page 4857]]
Dated: January 25, 2012.
Faye Lipsky,
Reports Clearance Officer, Office of Regulations and Reports Clearance,
Social Security Administration.
[FR Doc. 2012-1947 Filed 1-30-12; 8:45 am]
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