[Federal Register Volume 61, Number 106 (Friday, May 31, 1996)] [Notices] [Pages 27380-27382] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 96-13595] ======================================================================= ----------------------------------------------------------------------- SOCIAL SECURITY ADMINISTRATION Agency Information Collection Activities: Proposed Collection Request Normally on Fridays, the Social Security Administration publishes a list of information collection packages that will require submission to the Office of Management and Budget (OMB) for clearance in compliance with Pub. L. 104-13 effective October 1, 1995, The Paperwork Reduction Act of 1995. Since the last list was published in the Federal Register on May 17, 1996, the information collections listed below have been proposed or will require extension of the current OMB approvals: (Call the SSA Reports Clearance Officer on (410) 965-4125 for a copy of the form(s) or package(s), or write to her at the address listed below the information collections.) 1. Statement of Income and Resources--0960-0124. The form SSA-8010 is used to obtain information about income and resources of individuals whose income may be ``deemed'' (considered available) to applicants/ recipients of SSI. The information is used by the Social Security Administration to make initial or continuing eligibility determinations and to determine the amount of the SSI payment. The respondents are individuals whose income may be ``deemed'' to the SSI applicant/ recipient. Number of Respondents: 355,000. Frequency of Response: 1. Average Burden Per Response: 25 minutes. Estimated Annual Burden: 147,917 hours. 2. Application for Supplemental Security Income--0960-0444. The information collected on the SSA-8001 is used by the Social Security Administration to determine whether applicants for SSI benefits meet all statutory and regulatory requirements for eligibility and, if so, the amount of benefits payable. The respondents are applicants for SSI benefits. [[Page 27381]] Number of Respondents: 1,781,849. Frequency of Response: 1. Average Burden Per Response: 15 minutes. Estimated Annual Burden: 445,462. 3. Application for Widow's or Widower's Insurance Benefits--0960- 0004. The information collected on form SSA-10 is used by the Social Security Administration to determine whether applicants for widow's/ widower's benefits meet all the statutory and regulatory requirements for eligibility. The respondent's are surviving widow's and widower's age 60 or older, or age 50, if disabled. Number of Respondents: 640,000. Frequency of Response: 1. Average Burden Per Response: 15 minutes. Estimated Annual Burden: 160,000 hours. 4. Request for Waiver and Recovery Questionnaire--0960-0037. The form SSA-632 collects information on the circumstances surrounding overpayments of Social Security benefits to recipients. The information is used by the Social Security Administration to determine if recovery of the overpayment amount can be waived or must be repaid, and if so, how recovery will be made. The respondents are recipients who have been overpaid Social Security, Medicare, Black Lung or SSI benefits. Number of Respondents: 500,000. Frequency of Response: On occasion. Average Burden Per Response: 25 minutes. Estimated Annual Burden: 208,333 hours. 5. Application for Parent's Insurance Benefits--0960-0012. The information collected on form SSA-7 is used by the Social Security Administration to determine entitlement of an individual to parent's insurance benefits. The respondents are parents who were dependent on the worker for at least one-half of their support. Number of Respondents: 1,400. Frequency of Response: 1. Average Burden Per Response: 15 minutes. Estimated Annual Burden: 350 hours. 6. Permanent Residence in the U.S.--0960-451. The information collected by the Social Security Administration is used to determine if aliens meet the statutory and regulatory requirements for eligibility to SSI benefits. The respondents are aliens who are apply for and are recipients of SSI payments. Number of Respondents: 271,800. Frequency of Response: 1. Average Burden Per Response: 5 minutes. Estimated Annual Burden: 22,650 hours. Written comments and recommendations regarding these information collections should be sent within 60 days from the date of this publication, directly to the SSA Reports Clearance Officer at the following address: Social Security Administration, DCFAM, Attn: Judith T. Hasche, 6401 Security Blvd., 1-A-21 Operations Bldg., Baltimore, MD 21235. In addition to your comments on the accuracy of the agency's burden estimate, we are soliciting comments on the need for the information; its practical utility; ways to enhance its quality, utility and clarity; and on ways to minimize burden on respondents, including the use of automated collection techniques or other forms of information technology. The information collections listed below, which were published in the Federal Register on March 29 and April 5, 1996, have been submitted to OMB. 1. Videoconference Evaluation Recontact Survey--0960-NEW. The purpose of the survey is to obtain public reaction to conducting business using videoconferencing technology. The information will be used by the Social Security Administration to determine the effectiveness of using videoconferencing for conducting claims and hearing interviews. The respondents are applicants for Social Security disability benefits and Supplemental Security Income disability benefits. Number of Respondents: 400. Frequency of Response: 1. Average Burden Per Response: 15 minutes. Estimated Annual Burden: 100 hours. 2. Application for a Social Security Card--0960-0066. The information collected on form SS-5 is used by the Social Security Administration to assign Social Security Numbers so that individuals may obtain employment, report earnings, open back accounts, pay taxes, apply for benefits, and for other purposes. The respondents are individuals who apply for Social Security Numbers. Number of Respondents: 20,000,000. Frequency of Response: 1. Average Burden Per Response: 8 minutes. Estimated Annual Burden: 2,666,667 hours. 3. Statement Regarding Date of Birth and Citizenship--0960-0016. The information collected on form SSA-702 is used by the Social Security Administration in conjunction with other evidence to establish a claimant's age or citizenship when better proofs are not available. The respondents are individuals who have knowledge of the birth and citizenship of an applicant. Number of Respondents: 18,000. Frequency of Response: 1. Average Burden Per Response: 10 minutes. Estimated Annual Burden: 3,000. 4. Application for Mother's or Father's Insurance Benefits--0960- 0003. The information collected on form SSA-5 is used by the Social Security Administration to determine an applicant's eligibility to mother's or father's insurance benefits. The respondents are individuals who wish to file an application for such benefits. Number of Respondents: 180,000. Frequency of Response: 1. Average Burden Per Response: 15 minutes. Estimated Annual Burden: 45,000 hours. 5. Marriage Certification--0960-0009. The information collected on form SSA-3 is needed to provide evidence of an alleged marriage. Social Security uses the information to update records of marital status of an individual. The respondents are persons who apply for Social Security benefits and allege a current marriage. Number of Respondents: 200,000. Frequency of Response: 1. Average Burden Per Response: 5 minutes. Estimated Annual Burden: 16,667 hours. 6. Report on Individual with Childhood Impairment--0960-0084. The information collected on form SSA-1323 is used to determine the dates and results of psychometric testing and how the impairment affects the individual's progress in school. The respondents are public and private school officials and agencies which provide medical treatment to the applicant or claimant for benefits. Number of Responses: 7,000. Average Burden Per Response: 20 minutes. Estimated Annual Burden: 2,333. 7. Report on Individual with Mental Impairment--0960-0058. The information collected on form SSA-824 is used to determine a claimant's physical and mental status prior to making a disability determination. The respondents are treating physicians, medical directors, medical record libraries, and other health professionals. Number of Responses: 50,000. Frequency of Response: 1. Average Burden Per Response: 36 minutes. Estimated Annual Burden: 30,000. 8. Claimant's Recent Medical Treatment--0960-0292. The information collected on form HA-4631 [[Page 27382]] is used by the Social Security Administration to provide an updated medical history for a disability claimant who requests a hearing. The respondents are claimants for disability benefits who have requested a hearing and do not have updated medical evidence in file. Number of Respondents: 211,006. Frequency of Response: 1. Average Burden Per Response: 10 minutes. Estimated Annual Burden: 35,168. 9. Request for Review of Hearing Decision/Order--0960-0277. The information collected on form HA-520 is needed in order to afford claimants their statutory right under the Social Security Act to request review of a hearing decision. The data will be used to determine the course of action appropriate to resolve each issue. The respondents are claimants denied benefits or dissatisfied with a decision made regarding their claim. Number of Respondents: 87,632. Frequency of Response: 1. Average Burden Per Response: 10 minutes. Estimated Annual Burden: 14,605. 10. Claimant's Work Background--0960-0300. The information collected on form HA-4633 is used by the Social Security Administration in cases in which claimants for disability benefits have requested a hearing on the decision regarding their claim. A completed form provides an updated summary of a claimant's past relevant work and helps the Administrative Law Judge to better decide whether or not the claimant is disabled. The respondents are claimants who have requested a hearing and whose relevant work background is not in file. Number of Respondents: 200,958. Frequency of Response: 1. Average Burden Per Response: 15 minutes. Estimated Annual Burden: 50,240. 11. Medical Use Report, 20 CFR 416.268--0960-0552. The information required by this regulation is used by the Social Security Administration to determine if an individual is entitled to special Supplemental Security Income (SSI) payments. The respondents are SSI recipients whose payments were stopped based on earnings. Number of Respondents: 25,000. Frequency of Response: 1. Average Burden Per Response: 3 minutes. Estimated Annual Burden: 1,250 hours. Written comments and recommendations regarding these information collections should be sent within 30 days of the date of this publication. Comments may be directed to OMB and SSA at the following addresses: (OMB), Office of Management and Budget, OIRA, Attn: Laura Oliven, New Executive Office Building, Room 10230, Washington, D.C. 20503 (SSA), Social Security Administration, DCFAM, Attn: Judith T. Hasche, 6401 Security Blvd, 1-A-21 Operations Bldg., Baltimore, MD 21235 Dated: May 23, 1996. Judith T. Hasche, Reports Clearance Officer, Social Security Administration. [FR Doc. 96-13595 Filed 5-30-96; 8:45 am] BILLING CODE 4190-29-U