[Federal Register Volume 79, Number 128 (Thursday, July 3, 2014)]
[Notices]
[Pages 38107-38110]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-15621]
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SOCIAL SECURITY ADMINISTRATION
Agency Information Collection Activities: Proposed 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 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].
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
September 2, 2014. Individuals can obtain copies of the collection
instruments by writing to the above email address.
1. Medical Report on Adult with Allegation of Human
Immunodeficiency Virus Infection; Medical Report on Child with
Allegation of Human Immunodeficiency Virus Infection--20 CFR 416.933-20
CFR 416.934 --0960-0500. Section 1631(e)(i) of the Social Security Act
(Act) authorizes the Commissioner of SSA to gather information
necessary to make an immediate determination about an applicant's claim
for Supplemental Security Income (SSI) payments; this procedure is the
Presumptive Disability (PD). SSA uses Forms SSA-4814-F5 and SSA-4815-F6
to collect information necessary to determine if an individual with
human immunodeficiency virus infection, who is applying for SSI
disability payments, meets the requirements for PD. The respondents are
the medical sources of the applicants for SSI disability payments.
Type of Request: Revision of an OMB-approved information
collection.
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Average
Number of Frequency of burden per Estimated
Modality of completion responses response response total annual
(minutes) burden (hours)
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SSA-4814-F5..................................... 46,200 1 10 7,700
SSA-4815-F6..................................... 12,900 1 10 2,150
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Totals...................................... 59,100 .............. .............. 9,850
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[[Page 38108]]
2. SSI Notice of Interim Assistance Reimbursement (IAR)--0960-0546.
Section 1631(g) of the Act authorizes SSA to reimburse an IAR agency
from an individual's retroactive SSI payment for assistance the IAR
agency gave the individual for meeting basic needs while an SSI claim
was pending or when SSI payments were suspended or terminated. The
State or local agency needs an IAR agreement with SSA to participate in
the IAR program. The individual receiving the IAR payment signs an
authorization form with an IAR agency to allow SSA to repay the IAR
agency for funds paid in advance prior to SSA's determination on the
individual's claim. The authorization represents the individual's
intent to file for SSI, if they did not file an application prior to
SSA receiving the authorization. Agencies who wish to enter into an IAR
agreement with SSA need to meet the following requirements:
(a) Reporting Requirements--Each IAR agency agrees to:
(1) Notify SSA of receipt of an authorization for initial claims or
cases they are appealing, and submit a copy of that authorization
either through a manual or electronic process;
(2) inform SSA of the amount of reimbursement;
(3) submit a written request for dispute resolution on a
determination;
(4) notify SSA of interim assistance paid (using the SSA-8125 or
the SSA-L8125-F6);
(5) inform SSA of any deceased claimants who participate in the IAR
program; and,
(6) review and sign an agreement with SSA.
(b) Recordkeeping Requirements--The IAR agencies agree to retain
all notices, agreements, authorizations, and accounting forms for the
period defined in the IAR agreement for the purposes of SSA verifying
transactions covered under the agreement.
(c) Third Party Disclosure Requirements--Each participating IAR
agency agrees to send written notices from the IAR agency to the
recipient regarding payment amounts and appeal rights.
(d) Periodic Review of Agency Accounting Process--The IAR agency
makes the IAR accounting records of paid cases available for SSA review
and verification. SSA conducts reviews either onsite or through the
mail of the authorization forms, notices to the claimant, and
accounting forms. Upon completion of the review, SSA provides a written
report of findings to the IAR agency director. The respondents are
State IAR officers.
Type of Request: Revision of an OMB-approved information
collection.
Reporting Requirements
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Average
Number of Frequency of Number of burden per Estimated
Modality of completion respondents response responses response total annual
(minutes) burden (hours)
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a) State notification of 11 States...... Once per SSI 97,330......... 1 1,622
receipt of authorization claimant.
(Electronic Process).
b) State submission of copy 27 States...... Once per SSI 68,405......... 3 3,420
of authorization (Manual claimant.
Process).
c) State submission of amount 38 States...... Once per SSI 101,352........ 8 13,514
of IA paid to recipients claimant.
(using eIAR).
d) State request for Average is As needed...... 2.............. 30 1
determination--dispute about 2 states
resolution. per year.
e) State computation of 38 States...... Once per SSI 1,524.......... 30 762
reimbursement due form SSA claimant.
using paper form
SSA[dash]L8125-F6.
f) State notification to SSA 20 States...... As needed when 40............. 15 10
of deceased claimant. SSI claimant
dies while
claim is
pending.
g) State reviewing/signing of 38 States...... Once during 38............. 12 hours 456
IAR agreement. life of the
IAR agreement.
h) Maintenance of 38 States...... One form per 165,735 3 8,287
authorization forms. SSI claimant. (includes both
denied and
approved SSI
claims).
i) Maintenance of accounting 38 States...... One set per SSI 101,352........ 3 5,068
forms and notices. claimant.
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Third Party Disclosure Requirements
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Average burden Estimated total
Modality of completion Number of respondents Frequency of response Number of per response annual burden
responses (minutes) (hours)
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j) Written notice from State to recipient 38 States................... Once per SSI claimant....... 101,352 7 11,824
regarding amount of payment.
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[[Page 38109]]
Periodic Review of Agency Accounting Process
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Average
Number of Frequency of Number of burden per Estimated
Modality of completion respondents response responses response total annual
(minutes) burden (hours)
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k) Retrieve and consolidate 12 States....... One set of 12 3 36
authorization and accounting forms per SSI
forms. claimant for
review by SSA
once every 2
to 3 years.
l) Participate in periodic 12 States....... For review by 12 16 192
review. SSA once every
2 to 3 years.
m) Correct administrative and 6 States........ To correct 6 4 24
accounting discrepancies. errors
discovered by
SSA in
periodic
review.
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Total Administrative Burden
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Average burden Estimated total
Number of respondents Frequency of Number of per response annual burden
response responses (minutes) (hours)
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Total....................................... 38 States......................... varies 639,161 varies 45,217
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3. Medical Source Statement of Ability To Do Work Related
Activities (Physical and Mental)--20 CFR 404.1512-404.1514, 404.912-
404.914, 404.1517, 416.917, 404.1519-404.1520, 416.919-416.920,
404.946, 416.946, 404-1546-0960-0662. In some instances when a claimant
appeals a denied disability claim, SSA may ask the claimant to have a
consultative examination, at the agency's expense, if the claimant's
medical sources cannot or will not give the agency sufficient evidence
to determine whether the claimant is disabled. The medical providers
who perform these consultative examinations provide a statement about
the claimant's state of disability. Specifically, these medical source
statements determine the work-related capabilities of these claimants.
SSA collects the medical data on the HA-1151 and HA-1152 to assess the
work-related physical and mental capabilities of claimants who appeal
SSA's previous determination on their issue of disability. The
respondents are medical sources who provide reports based either on
existing medical evidence or on consultative examinations.
Type of Request: Revision of an OMB-approved information
collection.
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Average Total
Number of Frequency of burden per estimated
Modality of completion respondents response response annual burden
(minutes) (hours)
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HA-1151......................................... 5,000 30 15 37,500
HA-1152......................................... 5,000 30 15 37,500
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Totals:..................................... 10,000 .............. .............. 75,000
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4. Application for Access to SSA Systems--20 CFR 401.45-0960-0791.
SSA uses Form SSA-120, Application for Access to SSA Systems, to allow
limited access to SSA's information resources for SSA employees and
non-Federal employees (contractors). SSA requires supervisory approval,
and local or component Security Officer review prior to granting this
access. The respondents are SSA employees and non-Federal Employees
(contractors) who require access to SSA systems to perform their jobs.
Note: Because SSA employees are Federal workers exempt from the
requirements of the PRA, the burden below is only for SSA contractors.
Type of Request: Revision of an OMB-approved information
collection.
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Average Estimated
Number of Frequency of burden of total annual
Modality of collection respondents response response burden
(minutes) (hours)
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SSA-120 (paper version)......................... 2,148 1 2 73
SSA-120 (Internet version)...................... 1,105 1 3 37
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Totals...................................... 3,289 .............. .............. 110
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[[Page 38110]]
Dated: June 30, 2014.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2014-15621 Filed 7-2-14; 8:45 am]
BILLING CODE 4191-02-P