[Federal Register Volume 83, Number 55 (Wednesday, March 21, 2018)]
[Notices]
[Pages 12455-12458]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-05627]
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SOCIAL SECURITY ADMINISTRATION
[Docket No: SSA-2018-0008]
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 an extension of an OMB-approved information collection, and
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].
Or you may submit your comments online through www.regulations.gov,
referencing Docket ID Number [SSA-2018-0008].
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
21, 2018. Individuals can obtain copies of the collection instruments
by writing to the above email address.
1. Application for Parent's Insurance Benefits--20 CFR 404.370-
404.374 and 20 CFR 404.601-404.603--0960-0012. Section 202(h) of the
Social Security Act (Act) establishes the conditions of eligibility a
claimant must meet to receive monthly benefits as a parent of a
deceased worker. SSA uses information from Form SSA-7-F6 to determine
if the claimant meets the eligibility and application criteria. The
respondents are applicants for, and recipients of, Social Security Old
Age, Survivors, and Disability Insurance (OASDI).
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 completion respondents response response burden
(minutes) (hours)
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Modernized Claims System (MCS)/Signature Proxy.. 164 1 15 41
Paper........................................... 4 1 15 1
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Total....................................... 168 .............. .............. 42
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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 SSA-521 is our
preferred instrument for executing a withdrawal request; however, any
written request for withdrawal the claimant signs, or proper applicant
signs 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 or claimants for Retirement, Survivors,
Disability, and Health Insurance benefits.
Type of Request: Revision of an OMB-approved information
collection.
[[Page 12456]]
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Average burden Estimated
Modality of completion Number of Frequency of per response total annual
respondents response (minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-521..................................... 31,827 1 5 2,652
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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 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 earned 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, expediting benefit payments. Respondents are
self-employed individuals potentially eligible for Social Security
benefits.
Type of Request: Revision of an OMB-approved information
collection.
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Average burden Estimated
Modality of completion Number of Frequency of per response total annual
respondents response (minutes) burden (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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Average burden Estimated
Modality of completion Number of Frequency of per response total annual
respondents response (minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1709.................................... 120,000 1 15 30,000
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5. Third Party Liability Information Statement--42 CFR 433.136-
433.139--0960-0323. To reduce Medicaid costs, Medicaid state agencies
identify third party insurers liable for medical care or services for
Medicaid beneficiaries. Regulations at 42 CFR 433.136-433.139 of the
Code of Federal Regulations, require Medicaid state agencies to obtain
this information on Medicaid applications and redeterminations as a
condition of Medicaid eligibility. States may enter into agreements
with the Commissioner of Social Security to make Medicaid eligibility
determinations for aged, blind, and disabled beneficiaries in those
states. Applications for and redeterminations of Supplemental Security
Income (SSI) eligibility in jurisdictions with such agreements are
applications and redeterminations of Medicaid eligibility. Under these
agreements, SSA obtains third party liability information using Form
SSA-8019-U2, and provides that information to the Medicaid state
agencies. The Medicaid state agencies use the information to bill third
parties liable for medical care, support, or services for a beneficiary
to guarantee that Medicaid remains the payer of last resort. The
respondents are SSI claimants and recipients.
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 completion respondents response response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-8019-U2 Paper form.......................... 200 1 5 17
SSI Claims System............................... 49,621 1 5 4,135
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Totals...................................... 49,821 .............. .............. 4,152
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[[Page 12457]]
6. Permanent Residence in the United States Under Color of Law
(PRUCOL)--20 CFR 416.1615 and 416.1618--0960-0451. As per 20 CFR
416.1415 and 416.1618 of the Code of Federal Regulations, SSA requires
claimants or recipients to submit evidence of their alien status when
they apply for SSI payments, and periodically thereafter as part of the
eligibility determination process for SSI. When SSA cannot verify
evidence of alien status through the regular claimant interview
process, SSA verifies the validity of the evidence of PRUCOL for
grandfathered nonqualified aliens with the Department of Homeland
Security (DHS), and determines if the individual qualifies for PRUCOL
status based on the DHS response. SSA does not maintain any forms or
applications for respondents to use, rather, the regulations listed in
20 CFR 416.1615 and 416.1618 specify the information respondents need
to submit to SSA to show evidence of PRUCOL. Without this information,
SSA is unable to determine whether the PRUCOL individual is eligible
for SSI payments. Respondents are qualified and unqualified aliens who
apply for SSI payments under PRUCOL.
Type of Request: Extension of an OMB-approved information
collection.
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Average burden Estimated
Modality of completion Number of Frequency of per response total annual
respondents response (minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
Personal or Telephone Interview............. 1,049 1 5 87
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7. Authorization for the Social Security Administration to Obtain
Account Records from a Financial Institution and Request for Records
(Medicare)--20 CFR 418.3420--0960-0729. The Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (MMA) established the
Medicare Part D program for voluntary prescription drug coverage of
premium, deductible, and copayment costs for individuals with limited
income and resources. The MMA mandates that the Government provide
subsidies for those individuals who qualify for the program, and who
meet eligibility criteria for help with premium, deductible, or co-
payment costs. SSA uses the SSA-4640, Authorization for the Social
Security Administration to Obtain Account Records from a Financial
Institution and Request for Records (Medicare), to determine if subsidy
applicants or recipients qualify, or continue to qualify, for the
subsidy. SSA uses Form SSA-4640 to: (1) Obtain the individual's consent
to verify balances of financial institution (FI) accounts; and (2)
obtain verification of such balances from the FI. Respondents are
Medicare Part D program subsidy applicants or claimants, and their
financial institutions.
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 completion respondents response response burden
(minutes) (hours)
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Medicare Part D Subsidy Applicants.............. 5,000 1 1 83
Financial Institutions.......................... 5,000 1 4 333
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Total....................................... 10,000 .............. .............. 416
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II. SSA submitted the information collections below to OMB for
clearance. Your comments regarding these 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 20, 2018. Individuals can obtain copies of the
OMB clearance packages by writing to [email protected].
1. Request for Review of Hearing Decision/Order--20 CFR 404.967-
404.981, 416.1467-416.1481--0960-0277. Claimants have a statutory right
under the Act and current regulations to request review of an
administrative law judge's (ALJ) hearing decision or dismissal of a
hearing request on Title II and Title XVI claims. Claimants may request
Appeals Council review by filing a written request using paper Form HA-
520, or the internet application, i520. SSA uses the information we
collect to establish the claimant filed the request for review within
the prescribed time, and to ensure the claimant completed the requisite
steps permitting the Appeals Council review. The Appeals Council then
uses the information to: (1) Document the claimant's reason(s) for
disagreeing with the ALJ's decision or dismissal; (2) determine whether
the claimant has additional evidence to submit; and (3) determine
whether the claimant has a representative or wants to appoint one. The
respondents are claimants requesting review of an ALJ's decision or
dismissal of hearing.
Type of Request: A New Information Collection Request.
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Average Estimated
Number of Frequency of burden per total annual
Modality of completion respondents response response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
HA-520--Paper................................... 105,000 1 10 17,500
i520--Internet.................................. 70,000 1 15 17,500
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[[Page 12458]]
Total....................................... 175,000 .............. .............. 35,000
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2. Claimant's Recent Medical Treatment--20 CFR 404.1512 and
416.912--0960-0292. When DDSs deny a claim at the reconsideration
level, the claimant has a right to request a hearing before an
administrative law judge (ALJ). For the hearing, SSA asks the claimant
to complete and return the HA-4631 if the claimant's file does not
reflect a current, complete medical history as the claimant proceeds
through the appeals process. ALJs must obtain the information to update
and complete the record and to verify the accuracy of the information.
Through this process, ALJs can ascertain whether the claimant's
situation changed. The ALJs and hearing office staff use the response
to make arrangements for consultative examination(s) and the attendance
of an expert witness(es), if appropriate. During the hearing, the ALJ
offers any completed questionnaires as exhibits and may use them to:
(1) Refresh the claimant's memory, and (2) shape their questions. The
respondents are claimants requesting hearings on entitlement to OASDI
benefits or SSI payments.
Type of Request: Revision of an OMB-approved information
collection.
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Average burden Estimated
Modality of completion Number of Frequency of per response total annual
respondents response (minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
HA-4631..................................... 200,000 1 20 33,333
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Dated: March 15, 2018.
Naomi R. Sipple,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2018-05627 Filed 3-20-18; 8:45 am]
BILLING CODE 4191-02-P