[Federal Register Volume 79, Number 182 (Friday, September 19, 2014)]
[Notices]
[Pages 56428-56430]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-22341]
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SOCIAL SECURITY ADMINISTRATION
Agency Information Collection Activities: 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 (PRA), 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]
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 October 20, 2014. Individuals can obtain copies of the
OMB clearance packages by writing to [email protected].
1. Marital Relationship Questionnaire--20 CFR 416.1826--0960-0460.
SSA uses Form SSA-4178, Marital Relationship Questionnaire, to
determine if unrelated individuals of the opposite sex who live
together are misrepresenting themselves as husband and wife. SSA needs
this information to determine whether we are making correct payments to
couples and individuals applying for or currently receiving
Supplemental Security Income (SSI) payments. The respondents are
applicants for and recipients of SSI payments.
Type of Request: Revision of an OMB-approved information
collection.
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Average burden Total estimated
Modality of completion Number of Frequency of per response annual burden
respondents response (minutes) (hours)
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SSA-4178.................................... 5,100 1 5 425
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2. SSI Notice of Interim Assistance Reimbursement (IAR)--0960-0546.
Section 1631(g) of the Social Security 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 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, agreement, 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
[[Page 56429]]
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.
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Total
Number of Frequency of Number of Average burden estimated
Modality of completion respondents response responses per response annual burden
(States) (minutes) (hours)
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Reporting Requirements
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(a) State notification of 11 Once per SSI 97,330 1 1,622
receipt of authorization Claimant.
(Electronic Process).
(b) State submission of copy 27 Once per SSI 68,405 3 3,420
of authorization (Manual Claimant.
Process).
(c) State submission of amount 38 Once per SSI 101,352 8 13,514
of IA paid to recipients Claimant.
(using eIAR).
(d) State request for (\1\) As needed....... 2 30 1
determination--dispute
resolution.
(e) State computation of 38 Once per SSI 1,524 30 762
reimbursement due from SSA Claimant.
using paper Form SSA-L8125-F6.
(f) State notification to SSA 20 As needed when 40 15 10
of deceased claimant. SSI claimant
dies while
claim is
pending.
(g) State reviewing/signing of 38 Once during life 38 \2\12 456
IAR Agreement. of the IAR
agreement.
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Recordkeeping Requirements
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(h) Maintenance of 38 One form per SSI \3\165,735 3 8,287
authorization forms. claimant.
(i) Maintenance of accounting 38 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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(j) Written notice from State 38 One per SSI 101,352 7 11,824
to recipient regarding amount claimant.
of payment.
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Periodic Review of Agency Accounting Process
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(k) Retrieve and consolidate 12 One set of forms 12 3 36
authorization and accounting per SSI
forms. claimant for
review by SSA
once every 2 to
3 years.
(l) Participate in periodic 12 For review by 12 16 192
review. SSA once every
2 to 3 years.
(m) Correct administrative and 6 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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Totals.................... 38 Varies.......... 639,161 Varies 45,217
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\1\Average of about 2 States per year.
\2\Hours.
\3\Includes both denied and approved SSI claims.
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.
[[Page 56430]]
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Total
Number of Frequency of Number of Average burden estimated
Modality of completion respondents response responses per response annual burden
(hours)
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HA-1151......................... 5,000 30 150,000 15 37,500
HA-1152......................... 5,000 30 150,000 15 37,500
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Totals...................... 10,000 .............. 300,000 .............. 75,000
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4. Electronic Records Express--20 CFR 404.1512 and 416.912--0960-
0753. Electronic Records Express (ERE) is a Web-based SSA program that
allows medical and educational providers to electronically submit
disability claimant data to SSA. Both medical providers and other third
parties with connections to disability applicants or recipients (e.g.,
teachers and school administrators for child disability applicants) use
this system once they complete the registration process. SSA employees
and State agency employees request the medical and educational records
collected through the ERE Web site. The agency uses the information
collected through ERE to make a determination on an Application for
Benefits. We also use the ERE Web site to order and receive
consultative examinations when we are unable to collect enough medical
records to determine disability findings. The respondents are medical
providers who evaluate or treat disability claimants or recipients, and
other third parties with connections to disability applicants or
recipients (ex: Teachers and school administrators for child disability
applicants), who voluntarily choose to use ERE for submitting
information.
Type of Request: Revision of an OMB-approved information
collection.
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Average burden Total estimated
Modality of completion Number of Frequency of per response annual burden
respondents response (minutes) (hours)
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ERE......................................... 4,508,968 1 10 751,495
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5. 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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Total
Number of Frequency of Average burden estimated
Modality of completion respondents response per response annual 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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Dated: September 16, 2014.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2014-22341 Filed 9-18-14; 8:45 am]
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