[Federal Register Volume 79, Number 41 (Monday, March 3, 2014)]
[Notices]
[Pages 11852-11854]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-04577]
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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 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, OLCA, Attn: Reports Clearance
Director, 3100 West High Rise, 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
2, 2014. Individuals can obtain copies of the collection instruments by
writing to the above email address.
1. Disability Update Report--20 CFR 404.1589-404.1595 and 416.988-
416.996--0960-0511. As part of our statutory requirements, SSA
periodically uses Form SSA-455, the Disability Update Report, to
evaluate current Title II disability beneficiaries' and Title XVI
disability payment recipients' continued eligibility for
[[Page 11853]]
Social Security disability payments. Specifically, SSA uses the form to
determine if: (1) There is enough evidence to warrant referring the
respondent for a full medical Continuing Disability Review (CDR); (2)
the respondent's impairment(s) is still present and is indicative of no
medical improvement, precluding the need for a CDR; or (3) there are
unresolved work-related issues for the respondent. SSA mails Form SSA-
455 to specific disability recipients, whom we select as possibly
qualifying for the continuing disability review process. SSA pre-fills
the form with data specific to the disability recipient, except for the
sections we ask the beneficiary to complete. When SSA receives the
completed form, we scan it into SSA's system. This allows us to gather
the information electronically to enable SSA to process the returned
forms through automated decision logic to decide the proper course of
action to take. The respondents are recipients of Title II and Title
XVI Social Security disability payments.
Type of Request: Revision of an OMB-approved information
collection.
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Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
respondents response (minutes) (hours)
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SSA-455..................................... 1,500,000 1 15 375,000
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2. Request for Evidence from Doctor and Request for Evidence from
Hospital--20 CFR 404 Subpart P and 20 CFR 416 Subpart I--0960-0722.
Sections 223(d)(5) and 1614(a)(3)(H)(i) of the Social Security Act
require claimants to furnish medical evidence of their disability when
filing a disability claim. SSA uses Forms HA-66 and HA-67 to obtain
evidence from medical sources identified by the claimants as having
information relative to their impairments or ability to do work-related
activities. In addition to accepting manual paper responses, SSA sends
a barcode with the HA-66 and HA-67, allowing respondents to fax the
information directly into the electronic claims folder rather than
submitting it manually. SSA uses the information to determine
eligibility for benefits. The respondents are medical sources, doctors,
and hospitals that evaluate the claimants.
Type of Request: Revision of an OMB-approved information
collection.
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Average Estimated
Number of Frequency of Number of burden per total annual
Modality of completion respondents response responses response burden
(minutes) (hours)
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HA-66--Paper.................... 3,060 22 67,320 15 16,830
HA-66--Electronic............... 8,940 22 196,680 15 49,170
HA-67--Paper.................... 3,060 22 67,320 15 16,830
HA-67--Electronic............... 8,940 22 196,680 15 49,170
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Totals........................ 24,000 .............. 528,000 .............. 132,000
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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 2, 2014. Individuals can obtain copies of the OMB
clearance packages by writing to [email protected].
1. Advanced Notice of Termination of Child's Benefits & Student's
Statement Regarding School Attendance--20 CFR 404.350-404.352, 404.367-
404.368--0960-0105. SSA collects information on Forms SSA-1372-BK and
SSA-1372-BK-FC to determine whether children of an insured worker meet
the eligibility requirements for student benefits. The data we collect
allows SSA to determine entitlement to initial and continuing student
benefits. The respondents are student claimants for Social Security
benefits, their respective schools and, in some cases, their
representative payees.
Type of Request: Revision of an OMB-approved information
collection.
SSA-1372-BK:
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Average Estimated
Number of Frequency of burden per total annual
Type of respondent respondents response response burden
(minutes) (hours)
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Individuals/Households.......................... 99,850 1 8 13,313
State/Local/Tribal Government................... 99,850 1 3 4,993
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Totals...................................... 199,700 .............. .............. 18,306
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SSA-1372-BK-FC:
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Average Estimated
Number of Frequency of burden per total annual
Type of respondent respondents response response burden
(minutes) (hours)
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Individuals/Households.......................... 150 1 8 20
[[Page 11854]]
State/Local/Tribal Government................... 150 1 3 8
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Totals...................................... 300 .............. .............. 28
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Grand Total............................. 200,000 .............. .............. 18,334
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2. Work History Report--20 CFR 404.1515, 404.1560, 404.1565,
416.960 and 416.3965--0960-0578. Under certain circumstances, SSA asks
individuals applying for disability about work they have performed in
the past. Applicants use Form SSA-3369, Work History Report, to provide
detailed information about jobs held prior to becoming unable to work.
State Disability Determination Services evaluate the information,
together with medical evidence, to determine eligibility for disability
payments. Respondents are disability applicants and third parties
assisting applicants.
Type of Request: Revision of an OMB-approved information
collection.
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Average Estimated
Number of Frequency of burden per total annual
Modality of collection respondents response response burden
(minutes) (hours)
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SSA-3369 (Paper form)........................... 1,553,900 1 60 1,553,900
Electronic Disability Collect System 3369....... 38,049 1 60 38,049
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Totals...................................... 1,591,949 .............. .............. 1,591,949
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Dated: February 28, 2014.
Naomi Sipple,
Management Analyst, Reports Clearance, Social Security Administration.
[FR Doc. 2014-04577 Filed 2-28-14; 8:45 am]
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