[Federal Register Volume 81, Number 64 (Monday, April 4, 2016)]
[Notices]
[Pages 19283-19284]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-07584]
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SOCIAL SECURITY ADMINISTRATION
[Docket No: SSA-2016-0010]
Agency Information Collection Activities: Proposed 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.
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,
[[Page 19284]]
Fax: 410-966-2830, Email address: [email protected].
Or you may submit your comments online through www.regulations.gov,
referencing Docket ID Number [SSA-2016-0010].
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 June
3, 2016. Individuals can obtain copies of the collection instruments by
writing to the above email address.
1. Application for Lump Sum Death Payment--20 CFR 404.390-404.392--
0960-0013. SSA uses Form SSA-8-F4 to collect information needed to
authorize payment of the lump sum death payment (LSDP) to a widow,
widower, or children as defined in Section 202(i) of the Social
Security Act (Act). Respondents complete the application for this one-
time payment via paper form, telephone, or an in-person interview with
SSA employees. Respondents are applicants for the LSDP.
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)
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Modernized Claims System........................ 662,084 1 9 99,313
Paper........................................... 8,164 1 10 1,361
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Total....................................... 670,248 .............. .............. 100,674
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Medical Report on Adult with Allegation of Human Immunodeficiency
Virus Infection; Medical Report on Child with Allegation of Human
Immunodeficiency Virus Infection--20 CFR 416.933-20 CFR 416.934--0960-
0500. Section 1631(e)(i) of the Act authorizes the Commissioner of SSA
to gather information to make a determination about an applicant's
claim for Supplemental Security Income (SSI) payments; this procedure
is the Presumptive Disability (PD). SSA uses Forms SSA-4814-F5 and SSA-
4815-F6 to collect information necessary to determine if an individual
with human immunodeficiency virus infection, who is applying for SSI
disability benefits, meets the requirements for PD. The respondents are
the medical sources of the applicants for SSI disability payments.
Type of Request: Revision of an OMB-approved information
collection.
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Total
Number of Frequency of Average burden estimated
Modality of completion respondents response per response total annual
(minutes) burden (hours)
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SSA-4814-F5..................................... 18,750 1 8 2,500
SSA-4815-F6..................................... 120 1 10 20
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Totals...................................... 18,870 .............. .............. 2,520
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3. Complaint Form for Allegations of Discrimination in Programs or
Activities Conducted by the Social Security Administration--0960-0585.
SSA uses Form SSA-437 to investigate and formally resolve complaints of
discrimination based on disability, race, color, national origin
(including limited English language proficiency), sex (including sexual
orientation and gender identity), age, religion, or retaliation for
having participated in a proceeding under this administrative complaint
process in connection with an SSA program or activity. Individuals who
believe SSA discriminated against them on any of the above bases may
file a written complaint of discrimination. SSA uses the information to
(1) identify the complaint; (2) identify the alleged discriminatory
act; (3) establish the date of such alleged action; (4) establish the
identity of any individual(s) with information about the alleged
discrimination; and (5) establish other relevant information that would
assist in the investigation and resolution of the complaint.
Respondents are individuals who believe an SSA program or activity, or
SSA employees, contractors or agents discriminated against them.
Type of Request: Revision on an OMB-approved information
collection.
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Average burden
Modality of collection Number of Frequency of per response Total annual
respondents response (minutes) burden (hours)
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SSA-437..................................... 255 1 60 255
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Dated: March 28, 2016.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2016-07584 Filed 4-1-16; 8:45 am]
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