[Federal Register Volume 60, Number 135 (Friday, July 14, 1995)] [Notices] [Pages 36326-36327] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 95-17305] ======================================================================= ----------------------------------------------------------------------- SOCIAL SECURITY ADMINISTRATION Agency Forms Submitted to the Office of Management and Budget for Clearance Normally on Fridays, the Social Security Administration publishes a list of information collection packages that have been submitted to the Office of Management and Budget (OMB) for clearance in compliance with P.L. 96-511, The Paperwork Reduction Act. The following clearance packages have been submitted to OMB since the last list was published in the Federal Register on June 16, 1995. (Call Reports Clearance Officer on (410) 965-4142 for copies of package.) 1. Certificate of Coverage Request--0960-NEW. The information is used by the Social Security Administration to provide a certificate of coverage from the United States social security system to an individual working in a foreign country. This certificate exempts the individual from paying taxes into a foreign social security system. The respondents are workers and employers whose work is performed in a foreign country. Number of Respondents: 24,000 Frequency of Response: 1 Average Burden Per Response: 30 minutes Estimated Annual Burden: 12,000 hours 2. Disability Report, Vocational Report--0960-0141. The information on forms SSA-3368 and SSA-3369 is used by the Social Security Administration to help make a disability determination. The forms are essential to case development and adjudication. The respondents are individuals who file for disability benefits. ------------------------------------------------------------------------ SSA-3368 SSA-3369 ------------------------------------------------------------------------ Number of Respondents................. 2,264,000...... 1,000,000 Frequency of Response................. 1.............. 1 Average Burden Per Response........... 45 minutes..... 30 minutes Estimated Annual Burden............... 1,698,000 hrs.. 500,000 hrs. ------------------------------------------------------------------------ 3. SSA Automated SML Application--0960-0475. The information on form SSA-4123 is used to maintain an automated solicitation mailing list of qualified vendors wanting to do business with the Social Security Administration (SSA). The respondents are vendors who wish to be listed on SSA's automated solicitation mailing list. Number of Respondents: 4,000 Frequency of Response: 1 Average Burden Per Response: 5 minutes Estimated Annual Burden: 333 hours 4. Social Security Medical Report (General)--0960-0052. The information on form SSA-3826 is used by the Social Security Administration to determine the claimant's physical status prior to making a disability determination. The information is used to document disability claims folders with medical evidence. Number of Respondents: 750,000 Frequency of Response: 1 Average Burden Per Response: 30 minutes Estimated Annual Burden: 375,000 hours 5. Request for Social Security Earnings Information--0960-0525. The information on form SSA-7050 is used by the Social Security Administration (SSA) to identify the request, define the earnings information being requested, and inform the requestor of the fee for such information. The above data is then used by SSA to produce the requested statement. The respondents are individuals and organizations which use this form to request statements of earnings from SSA. Number of Respondents: 40,000 Frequency of Response: 1 Average Burden Per Response: 11 minutes Estimated Annual Burden: 7,333 hours 6. Employee Identification Statement--0960-0473. The information on form SSA-4156 is used by the Social Security Administration to resolve situations in which two or more individuals have used the same social security number (SSN) and an employer has erroneously reported earnings under an SSN. The affected public is comprised of employers involved in erroneous wage reporting. Number of Respondents: 4,750 Frequency of Response: 1 Average Burden Per Response: 10 minutes Estimated Annual Burden: 792 hours 7. Report of Work Activity--Continuing Disability--0960-0108. The information on form SSA-3945 is used by the Social Security Administration to determine whether work performed by an individual, after his or her entitlement to disability benefits, is cause for that entitlement to end. The affected public consists of disability beneficiaries who work after their entitlement. Number of Respondents: 140,000 Frequency of Response: 1 Average Burden Per Response: 45 minutes Estimated Annual Burden: 105,000 hours 8. Medical History and Disability Report--0960-0504. The information on form SSA-3820 is used by the Social Security Administration to help make a determination in claims for disabled children. The respondents are claimants for disability benefits. Number of Respondents: 453,000 Frequency of Response: 1 Average Burden Per Response: 20 minutes Estimated Annual Burden: 151,000 hours 9. Statement Regarding Student's Attendance--0960-0113. The information on form SSA-2434 is used [[Page 36327]] by the Social Security Administration to determine student status of the children of coal miners or their widows or brothers of deceased coal miners eligible for black lung benefits. Number of Respondents: 4,340 Frequency of Response: 1 Average Burden Per Response: 10 minutes Estimated Annual Burden: 723 hours 10. Summary of Evidence--0960-0430. The information on form SSA-887 is used to provide a list of the medical/vocational reports pertaining to the claimant's disability. The list is used in and critical to the hearings process. The respondents are State and Disability Determination staff. Number of Respondents: 22,024 Frequency of Response: 1 Average Burden Per Response: 15 minutes Estimated Annual Burden: 5,506 hours 11. Request For Change In Time/Place of Disability Hearing-- 0960- 0348. The information on form SSA-769 is used to provide claimants a structured format for exercising their right to request a change in the time or place of a scheduled disability hearing. The information will be used as a basis for granting or denying requests for changes and for rescheduling hearings. The affected public is comprised of claimants who wish to request a change in the time or place. Number of Respondents: 7,483 Frequency of Response: 1 Average Burden Per Response: 8 minutes Estimated Annual Burden: 998 hours 12. Time Report of Personnel Services for Disability Determination Services--0960-0408. The information on form SSA-4514 is used by the Social Security Administration (SSA) for budgeting and accounting for the funds used by State Agencies for personnel involved in making disability determinations for SSA. The affected public consists of State Agencies which make those determinations. Number of Respondents: 54 Frequency of Response: Quarterly Average Burden Per Response: 30 minutes Estimated Annual Burden: 108 hours 13. Payment of Certain Travel Expenses--0960-0504. The information required by 20 CFR 404.999(d) and 20 CFR 416.1499 is used by the Social Security Administration to reimburse a claimant who has been required to travel over 75 miles to appear at a medical examination or disability hearing. The affected public is comprised of claimants required to travel more than 75 miles in order to attend a medical examination or a disability hearing. Number of Respondents: 50,000 Frequency of Response: 1 Average Burden Per Response: 10 minutes Estimated Annual Burden: 8,333 hours 14. Request for Reconsideration--Disability Cessation--0960-0504. The information on form SSA-789 is used by the Social Security Administration to schedule hearings and to develop additional evidence for individuals who have received an initial or revised determination that their disability ceased, did not exist, or is no longer disabling. The respondents are disability beneficiaries who file a claim for reconsideration. Number of Respondents: 15,015 Frequency of Response: 1 Average Burden Per Response: 12 Estimated Annual Burden: 3,003 OMB Desk Officer: Laura Oliven. Written comments and recommendations regarding these information collections should be sent directly to the appropriate OMB Desk Officer designated above at the following address: Office of Management and Budget, OIRA, New Executive Office Building, Room 10230, Washington, D.C. 20503. Dated: July 7, 1995. Charlotte Whitenight, Reports Clearance Officer, Social Security Administration. [FR Doc. 95-17305 Filed 7-13-95; 8:45 am] BILLING CODE 4190-29-P