[Federal Register Volume 62, Number 143 (Friday, July 25, 1997)]
[Notices]
[Page 40131]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-19570]
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SOCIAL SECURITY ADMINISTRATION
Agency Information Collection Activities: Request for Emergency
Review by the Office of Management and Budget
The Social Security Administration publishes a list of information
collection packages that will require clearance by OMB in compliance
with Public Law 104-13 effective October 1, 1995, The Paperwork
Reduction Act of 1995. The information collections listed below have
been submitted to OMB for emergency clearance. OMB approval has been
requested by July 31, 1997:
1. 0960-NEW. SSA will conduct tests of three prototype disability
forms, SSA-3368, SSA-3369 and SSA-3820. The information collected on
these forms will be used in the determination of disability by the
State Disability Determination Services. The SSA-3368 will be used to
develop medical evidence and to assess the alleged disability. The SSA-
3369 will be used to collect information about an individual's past
work history. The SSA-3820 will be used to obtain various types of
information about a child's condition, his/her treating sources and/or
other medical sources of evidence. The respondents are applicants for
disability benefits.
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SSA-3368 SSA-3369 SSA-3820
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Number of Respondents:................. 7,500 5,000 5,000
Frequency of Response:................. 1 1 1
Average Burden Per Response (minutes):. 30 30 30
Estimated Annual Burden (hours):....... 3,750 2,500 2,500
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2. Questionnaire for Children Claiming SSI Benefits--0960-0499. The
information collected on form SSA-3881 is used by the State Disability
Determination Services offices to evaluate disability in children who
apply for supplemental security income payments. The respondents are
individuals who apply for supplemental security income benefits for a
disabled child.
Number of Respondents: 978,000.
Frequency of Response: 1.
Average Burden Per Response: 20 minutes.
Estimated Annual Burden: 326,000 hours.
To receive a copy of the form or clearance packages, call the SSA
Reports Clearance Officer on (410) 965-4125 or write to him at the
address listed below. Written comments and recommendations regarding
the information collection(s) should be directed to the OMB Desk
Officer and SSA Reports Clearance Officer at the following addresses:
(OMB)
Office of Management and Budget, OIRA; Attn: Laura Oliven, New
Executive Office Building, Room 10230, 725 17th St., NW., Washington,
D.C. 20503
(SSA)
Social Security Administration, DCFAM; Attn: Nicholas E. Tagliareni,
6401 Security Blvd, 1-A-21 Operations Bldg., Baltimore, MD 21235
Dated: July 18, 1997.
Nicholas E. Tagliareni,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 97-19570 Filed 7-24-97; 8:45 am]
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