[Federal Register Volume 80, Number 35 (Monday, February 23, 2015)]
[Notices]
[Pages 9499-9501]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-03545]
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SOCIAL SECURITY ADMINISTRATION
[Docket No: SSA-2015-0005]
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 and one 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, OLCA, Attn: Reports Clearance
Director, 3100 West High Rise, 6401 Security Blvd., Baltimore, MD
21235, Fax: 410-966-2830, Email address: [email protected].
Or you may submit your comments online through www.regulations.gov,
referencing Docket ID Number [SSA-2015-0005].
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 24, 2015. Individuals can obtain copies of the collection
instruments by writing to the above email address.
[[Page 9500]]
1. Data Exchange Request Form--0960-NEW. SSA maintains
approximately 3,000 data exchange agreements and regularly receives new
requests from Federal, State, local, and foreign governments, as well
as private organizations, to share data electronically. SSA engages in
various forms of data exchanges from Social Security number
verifications to computer matches for benefit eligibility, depending on
the requestor's business needs. Section 1106 of the Social Security Act
(Act) requires we consider the requestor's legal authority to receive
the data, our disclosure policies, systems' feasibility, systems'
security, and costs before entering into a data exchange agreement. We
will use Form SSA-157, Data Exchange Request Form, for this purpose.
Requesting agencies, governments, or private organizations will use the
form when voluntarily initiating a request for data exchange from SSA.
Respondents are Federal, State, local, and foreign governments, as well
as private organizations seeking to share data electronically with SSA.
Type of Request: This is a new information collection.
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Average Estimated
Number of Frequency of burden per total annual
Modality of completion responses response response burden
(minutes) (hours)
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SSA-157................................................. 60 1 30 30
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2. Request for Withdrawal of Application--20 CFR 404.640--0960-
0015. Form SSA-521 documents the information SSA needs to process the
withdrawal of an application for benefits. A paper Form SSA-521 is our
preferred instrument for executing a withdrawal request; however, any
written request for withdrawal signed by the claimant or a proper
applicant on the claimant's behalf will suffice. Individuals who wish
to withdraw their applications for benefits complete Form SSA-521, or
sign the completed form for each request to withdraw. SSA uses the
information from the SSA-521 to process the request for withdrawal. The
respondents are applicants for Retirement, Survivors, Disability, and
Health Insurance benefits.
Type of Request: Revision of an OMB-approved information
collection.
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Total
Average estimated
Modality of completion Number of Frequency of burden per annual
respondents response response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-521................................................. 39,000 1 5 3,250
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3. Statement of Self-Employment Income--20 CFR 404.101, 404.110,
404.1096(a)-(d)--0960-0046. To qualify for insured status and thus
collect Social Security benefits, self-employed individuals must
demonstrate they earned the minimum amount of self-employment income
(SEI) in a current year. SSA uses Form SSA-766, Statement of Self-
Employment Income, to collect the information we need to determine if
the individual will have at least the minimum amount of SEI needed for
one or more quarters of coverage in the current year. Based on the
information we obtain, we may credit additional quarters of coverage to
give the individual insured status thus expediting benefit payments.
Respondents are self-employed individuals who may be eligible for
Social Security benefits.
Type of Request: Revision of an OMB-approved information
collection.
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Total
Average estimated
Modality of completion Number of Frequency of burden per annual
respondents response response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-766................................................. 2,500 1 5 208
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4. Request for Workers' Compensation/Public Disability Benefit
Information--20 CFR 404.408(e)--0960-0098. Claimants for Social
Security disability payments who are also receiving Worker's
Compensation/Public Disability Benefits (WC/PDB) must notify SSA about
their WC/PDB, so the agency can reduce claimants' Social Security
disability payments accordingly. If claimants provide necessary
evidence, such as a copy of their award notice, benefit check, etc.,
that is sufficient verification. In cases where claimants cannot
provide such evidence, SSA uses Form SSA-1709. The entity paying the
WC/PDB benefits, its agent (such as an insurance carrier), or an
administering public agency complete this form. The respondents are
Federal, State, and local agencies, insurance carriers, and public or
private self-insured companies administering WC/PDB benefits to
disability claimants.
Type of Request: Revision of an OMB-approved information
collection.
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Total
Average estimated
Modality of completion Number of Frequency of burden per annual
respondents response response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1709................................................ 120,000 1 15 30,000
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[[Page 9501]]
II. SSA submitted the information collection below to OMB for
clearance. Your comments regarding the information collection 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 March 25, 2015. Individuals can obtain copies of the OMB
clearance package by writing to [email protected].
Application for Mother's or Father's Insurance Benefits--20 CFR
404.339-404.342, 20 CFR 404.601-404.603--0960-0003. Section 202(g) of
the Act provides for the payment of monthly benefits to the widow or
widower of an insured individual if the surviving spouse is caring for
the deceased worker's child (who is entitled to Social Security
benefits). SSA uses the information on Form SSA-5-BK to determine an
individual's eligibility for mother's or father's insurance benefits.
The respondents are individuals caring for a child of the deceased
worker who is applying for mother's or father's insurance benefits
under the Old Age, Survivors, and Disability Insurance program.
Type of Request: Revision of an OMB-approved information
collection.
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Total
Average estimated
Modality of completion Number of Frequency burden per annual
respondents of response response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-5-F6 (paper)............................................ 1,611 1 15 403
Modernized Claim System (MCS)............................... 26,045 1 15 6,511
MCS/Signature Proxy......................................... 26,044 1 14 6,077
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Total................................................... 53,700 ........... ........... 12,991
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Dated: February 18, 2015.
Faye Lipsky,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2015-03545 Filed 2-20-15; 8:45 am]
BILLING CODE 4191-02-P