[Federal Register Volume 78, Number 54 (Wednesday, March 20, 2013)]
[Notices]
[Pages 17276-17281]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-06350]
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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 of 1995, effective October 1, 1995. This notice
includes revisions and extensions of OMB-approved information
collections.
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
Director, 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 May
20, 2013. Individuals can obtain copies of the collection instruments
by writing to the above email address.
1. Request for Earnings and Benefit Estimate Statement--20 CFR
404.810--0960-0466. Section 205(c)(2)(A) of the Social Security Act
(Act) requires the Commissioner of SSA to establish and maintain
records of wages paid to, and amounts of self-employment income derived
by, each individual as well as the periods in which such wages were
paid and such income derived. An individual may complete and mail Form
SSA-7004 to SSA to obtain a Statement of Earnings or Quarters of
Coverage. SSA uses the information Form SSA-7004 collects to identify
respondents' Social Security earnings records, extract posted earnings
information, calculate potential benefit estimates, produce the
resulting Social Security statements, and mail them to the requesters.
The respondents are Social Security number holders requesting
information about their Social Security earnings records and estimates
of their potential benefits.
Type of Request: Revision of an OMB-approved information
collection.
[[Page 17277]]
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Estimated
Number of Frequency of Average burden total annual
Modality of collection respondents response per response burden
(min) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-7004 (paper)................................ 17,219 1 5 1,435
SSA-7004 (Internet)............................. 3,198,361 1 5 266,530
---------------------------------------------------------------
Totals...................................... 3,215,580 .............. .............. 267,965
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2. Agency/Employer Government Pension Offset Questionnaire--20 CFR
404.408(a)--0960-0470. When an individual is concurrently receiving
Social Security spousal or surviving spousal benefits and a government
pension, the individual may have the amount of Social Security benefits
reduced by the government pension amount. This is the Government
Pension Offset (GPO). SSA uses Form SSA-L4163 to collect accurate
pension information from the Federal or State government agency paying
the pension for purposes of applying the pension offset provision. The
form is used only when (1) the claimant does not have the information;
and (2) the pension-paying agency has not cooperated with the claimant.
Respondents are State government agencies that have information SSA
needs to determine if the GPO applies and the amount of offset.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Estimated
Number of Frequency of Average burden total annual
Modality of collection respondents response per response burden
(min) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L4163....................................... 1,000 1 3 50
----------------------------------------------------------------------------------------------------------------
3. Employer Verification of Earnings After Death--20 CFR 404.821
and 404.822--0960-0472. When SSA records show a wage earner is deceased
and we receive wage reports from an employer for the wage earner for a
year subsequent to the year of death, SSA mails the employer Form SSA-
L4112 (Employer Verification of Earnings After Death). SSA uses the
information Form SSA-L4112 provides to verify wage information
previously received from the employer is correct for the employee and
the year in question. The respondents are employers who report wages
for employees who have died.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Estimated
Number of Frequency of Average burden total annual
Modality of collection respondents response per response burden
(min) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L4112....................................... 50,000 1 10 8,333
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4. Function Report--Child: Birth to 1st Birthday (SSA-3375), Age 1
to 3rd Birthday (SSA-3376), Age 3 to 6th Birthday (SSA-3377), Age 6 to
12th Birthday, (SSA-3378), and Age 12 to 18th Birthday (SSA-3379)--20
CFR 416.912--0960-0542. SSA uses Forms SSA-3375-BK through SSA-3379-BK
in the disability determination process to request information from a
child's parent or guardian for children applying for Supplemental
Security Income (SSI). The five different versions of the form contain
questions about the child's day-to-day functioning appropriate to a
particular age group; thus, respondents use only one version of the
form for each child.
The adjudicative team (disability examiners and medical/
psychological consultants) of State disability determination services
offices collect the information on the appropriate version of this form
(in conjunction with medical and other evidence) to form a complete
picture of the children's ability to function and their impairment-
related limitations. The adjudicative team uses the completed profile
to determine whether each child's impairment(s) results in marked and
severe functional limitations and whether each child is disabled. The
respondents are parents and guardians of child applicants for SSI.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
respondents response (min) (hours)
----------------------------------------------------------------------------------------------------------------
Function Report--Child: (SSA-3375-BK through 660,000 1 20 220,000
SSA-3379-BK)...............................
----------------------------------------------------------------------------------------------------------------
5. Registration for Appointed Representative Services and Direct
Payment--0960-0732. SSA uses Form SSA-1699 to register appointed
representatives of claimants before SSA who:
Want to register for direct payment of fees;
Registered for direct payment of fees prior to 10/31/09,
but need to update their information;
[[Page 17278]]
Registered as appointed representatives on or after 10/31/
09, but need to update their information; or
Received a notice from SSA instructing them to complete
this form.
By registering these individuals, SSA: (1) Authenticates and authorizes
them to do business with us; (2) allows them to access our records for
the claimants they represent; (3) facilitates direct payment of
authorized fees to appointed representatives; and, (4) collects the
information we need to meet Internal Revenue Service (IRS) requirements
to issue specific IRS forms if we pay an appointed representative in
excess of a specific amount ($600). The respondents are appointed
representatives who want to use Form SSA-1699 for any of the purposes
cited in this Notice.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
respondents response (min) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1699.................................... 52,800 1 20 17,600
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6. Technical Updates to Applicability of the Supplemental Security
Income (SSI) Reduced Benefit Rate for Individuals Residing in Medical
Treatment Facilities--20 CFR 416.708(k)--0960-0758. Section
1611(e)(1)(A) of the Act states that residents of public institutions
are ineligible for SSI. However, Sections 1611(e)(1)(B) and (G) list
certain exceptions to this provision making it necessary for SSA to
collect information from SSI recipients who enter or leave a medical
treatment facility or other public or private institution. SSA's
regulation 20 CFR 416.708(k) establishes the reporting guidelines that
implement this legislative requirement. SSA collects the information to
determine eligibility for SSI and the payment amount. The respondents
are SSI recipients who enter or leave an institution.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
respondents response (min) (hours)
----------------------------------------------------------------------------------------------------------------
Technical Updates Statement................. 34,200 1 7 3,990
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7. Statement for Certificate of Election for Reduced Widow(er)'s
and Surviving Divorced Spouse's Benefits--20 CFR 404.335--0960-0759.
Section 202(q) of the Act provides SSA the authority to reduce benefits
under certain conditions when elected by a title II beneficiary.
However, reduced benefits are not payable to an already entitled spouse
(or divorced spouse) who:
Is at least age 62 and under full retirement age in the
month of the number holder's death; and
Is receiving both reduced spouse's (or divorced spouse's)
benefits and either retirement or disability benefits in the month
before the month of the number holder's death.
To elect reduced widow(er) benefits, a recipient completes Form SSA-
4111. SSA uses the information Form SSA-4111 collects to pay a
qualified dually entitled widow(er) (or surviving divorced spouse) who
elects to receive a reduced widow(er) benefit. The respondents are
qualified dually entitled widow(er)s (or surviving divorced spouse) who
elect to receive a reduced widow(er) benefit.Type of Request:
Revision of an OMB-approved information collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
respondents response (min) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4111.................................... 30,000 1 2 1,000
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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 30 days from the date of this
publication. To be sure we consider your comments, we must receive them
no later than April 19, 2013. Individuals can obtain copies of the OMB
clearance packages by writing to [email protected].
1. Statement for Determining Continuing Eligibility, Supplemental
Security Income Payment(s)--416.204--0960-0416. SSA conducts disability
redeterminations to determine if SSI recipients (1) met and continue to
meet all statutory and regulatory requirements for SSI eligibility and
(2) are receiving the correct SSI payment amount. SSA makes these
redeterminations through periodic use of Form SSA-8203-BK. SSA conducts
this legally mandated information collection in field offices via
personal contact (face-to-face or telephone interview) using the
automated Modernized SSI Claim System (MSSICS). The respondents are SSI
recipients or their representative payees.
Type of Request: Revision of an OMB-approved information
collection.
[[Page 17279]]
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Estimated
Number of Frequency of Average burden total annual
Modality of collection respondents response per response burden
(min) (hours)
----------------------------------------------------------------------------------------------------------------
MSSICS.......................................... 810,824 1 20 270,275
MSSICS/Signature Proxy.......................... 777,085 1 19 246,077
Paper........................................... 27,824 1 20 9,275
---------------------------------------------------------------
Totals...................................... 1,615,733 .............. .............. 525,627
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2. Application for Benefits Under the Italy-U.S. International
Social Security Agreement--20 CFR 404.1925--0960-0445. As per the
November 1, 1978 agreement between the United States and Italian Social
Security agencies, residents of Italy filing an application for U.S.
Social Security benefits directly with one of the Italian Social
Security agencies must complete Form SSA-2528. SSA uses Form SSA-2528
to establish age, relationship, citizenship, marriage, death, military
service, or to evaluate a family bible or other family record when
determining eligibility for benefits. The Italian Social Security
agencies assist applicants in completing Form SSA-2528 and then forward
the application to SSA for processing. The respondents are individuals
living in Italy who wish to file for U.S. Social Security benefits.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
respondents response (min) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-2528.................................... 300 1 20 100
----------------------------------------------------------------------------------------------------------------
3. Information About Joint Checking/Savings Accounts--20 CFR
416.120, 416.1208--0960-0461. SSA considers a person's resources when
evaluating eligibility for SSI. Generally, we consider funds in
checking and savings accounts as resources owned by the individuals
whose names appear on the account. However, individuals applying for
SSI may rebut this assumption of ownership in a joint account by
submitting certain evidence to establish the funds do not belong to
them. SSA uses Form SSA-2574 to collect information from SSI applicants
and recipients who object to the assumption that they own all or part
of the funds in a joint checking or savings account bearing their
names. SSA collects information about the account from both the SSI
applicant/recipient and the other account holder(s). After receiving
the completed form, SSA determines if we should consider the account to
be a resource for the SSI applicant/recipient. The respondents are
applicants and recipients of SSI, and individuals who list themselves
as joint owners of financial accounts with SSI applicants/recipients.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Estimated
Number of Frequency of Average burden total annual
Modality of completion respondents response per response burden
(min) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-2574 Paper Form............................. 50,000 1 7 5,833
Modernized SSI Claims System.................... 150,000 1 7 17,500
---------------------------------------------------------------
Totals...................................... 200,000 .............. .............. 23,333
----------------------------------------------------------------------------------------------------------------
4. Real Property Current Market Value Estimate--0960-0471. SSA
considers an individual's resources when evaluating eligibility for SSI
payments. The value of an individual's resources, including non-home
real property, is one of the eligibility requirements for SSI payments.
SSA obtains current market value estimates of the claimant's real
property through Form SSA-L2794. We allow respondents to use readily
available records to complete the form, or we can accept their best
estimates. We use this form as part of initial applications and in
post-entitlement situations. The respondents are small business
operators in real estate, State and local government employees tasked
with assessing real property values, and other individuals
knowledgeable about local real estate values.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Modality of completion Number of Frequency of per response total annual
respondents response (min) burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L2794................................... 5,438 1 20 1,813
----------------------------------------------------------------------------------------------------------------
5. Certification of Contents of Document(s) or Record(s)--20 CFR
404.715--0960-0689. SSA established procedures for individuals to
provide the evidence necessary to establish rights to Social Security
benefits.
[[Page 17280]]
Examples of such evidence categories include age, relationship,
citizenship, marriage, death, and military service. Form SSA-704 allows
SSA employees, State record custodians, and other custodians of
evidentiary documents to certify and record information from original
documents and records under their custodial ownership to establish
these types of evidence. SSA uses Form SSA-704 in situations where
individuals cannot produce the original evidentiary documentation
required to establish benefits eligibility. The respondents are State
record custodians and other custodians of evidentiary documents.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Modality of completion Number of Frequency of per response total annual
respondents response (min) burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-704..................................... 4,800 1 10 800
----------------------------------------------------------------------------------------------------------------
6. Supplemental Security Income Wage Reporting (Telephone and
Mobile)--20 CFR 416.701-732--0960-0715. SSA requires SSI recipients to
report changes which could affect their eligibility for, and the amount
of, their SSI payments, such as changes in income, resources, and
living arrangements. SSA's SSI Telephone Wage Reporting (SSITWR) and
SSI Mobile Wage Reporting (SSIMWR) enable SSI recipients to meet these
requirements via an automated mechanism to report their monthly wages
by telephone and mobile application, instead of contacting their local
field offices. The SSITWR allows callers to report their wages by
speaking their responses through voice recognition technology, or by
keying in responses using a telephone key pad. The SSIMWR allows
recipients to report their wages through the mobile wage reporting
application on their smartphone. SSITWR and SSIMWR systems collect the
same information and send it to SSA over secure channels. To ensure the
security of the information provided, SSITWR and SSIMWR ask respondents
to provide information SSA can compare against our records for
authentication purposes. Once the system authenticates the identity of
the respondents, they can report their wage data. The respondents are
SSI recipients, deemors, or their representative payees.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Estimated
Number of Frequency of Average burden total annual
Modality of completion respondents response per response burden
(min) (hours)
----------------------------------------------------------------------------------------------------------------
Training/Instruction*........................... 85,000 1 35 49,583
SSITWR.......................................... 80,000 12 5 80,000
SSIMWR.......................................... 5,000 12 3 3,000
---------------------------------------------------------------
Total....................................... 85,000 .............. .............. 132,583
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*Note: The same 85,000 respondents are completing training and a modality of collection, therefore the actual
total number of respondents is still 85,000.
7. Certificate of Incapacity--5 CFR 890.302(d)--0960-0739. Rules
governing the Federal Employee Health Benefits (FEHB) plan require a
physician to verify the disability of Federal employees' children ages
26 and over for such children to retain health benefits under their
employed parents' plans. The physician must verify that the adult
child's disability (1) Pre-dates the child's 26th birthday; (2) is very
serious; and (3) will continue for at least one year. Physicians use
Form SSA-604, the Certificate of Incapacity, to document this
information. The respondents are physicians of SSA employees' children
ages 26 or over who are seeking to retain health benefits under their
parent's FEHB coverage.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Modality of completion Number of Frequency of per response total annual
respondents response (min) burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-604..................................... 50 1 45 38
----------------------------------------------------------------------------------------------------------------
8. Centenarian Project Development Worksheets: Face-to-Face
Interview and Telephone Interview--20 CFR 416.204(b) and 422.135--0960-
0780. SSA conducts interviews with centenary title II beneficiaries and
title XVI recipients age 100 and older to: (1) Assess if the
beneficiaries are still living; (2) prevent fraud, through either
identity misrepresentation or representative payee misuse of funds; and
(3) evaluate the well-being of the beneficiaries. SSA field office
personnel obtain the information through one-time interviews with the
centenarians. If the centenarians have representatives or caregivers,
SSA personnel invite them to the interviews. During the interview, SSA
employees make overall observations of the centenarian and their
representative payee (if applicable). The interviewer uses the
appropriate Centenarian Development Worksheet as a guide for the
interview, in addition to documenting findings during the interview.
Non-completion of the Worksheets, or refusal of the interview, does not
result in the suspension of the centenarian's payments. SSA conducts
the interview either over the telephone or through a face-to-face
discussion with the centenarian. This is a national project
[[Page 17281]]
for our title II beneficiaries and title XVI recipients. Respondents
are SSI recipients or Social Security beneficiaries 100 years old or
older, their representative payees, or their caregivers.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Modality of completion Number of Frequency of per response total annual
respondents response (min) burden (hours)
----------------------------------------------------------------------------------------------------------------
Centenarian Worksheets: Face-to-Face 22,000 1 15 5,500
Interview; Telephone Interview.............
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Dated: March 15, 2013.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2013-06350 Filed 3-19-13; 8:45 am]
BILLING CODE 4191-02-P