Agency Forms Submitted to the Office of Management and Budget for Clearance

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 will require submission to

the Office of Management and Budget (OMB) for clearance in compliance

with P.L. 96-511, as amended (P.L. 104-13 effective October 1, 1995),

The Paperwork Reduction Act. Since the last list was published in the

Federal Register on September 22, 1995, the following information

collections have been proposed or will require extension of the current

OMB approvals.

(Call the Reports Clearance Officer on (410) 965-4142 for a copy of the

form(s)

[[Page 52446]]

or package(s), or write to her at the address listed after the

information collections.)

SSA Reports Clearance Officer: Charlotte S. Whitenight.

1. Request To Be Selected As Payee--0960-0014. The information

collected on form SSA-11-BK is used by the Social Security

Administration to help determine the proper payee for a person who

cannot receive his or her own Social Security benefits. The respondents

will be individuals who apply to receive Social Security benefits on

behalf of someone else.

Number of Respondents: 605,000

Frequency of Response: 1

Average Burden Per Response: 10.5 minutes

Estimated Annual Burden: 105,875 hours

2. Disability Update Report--0960-0511. The information on form

SSA-455 is used by the Social Security Administration to determine if a

full medical continuing disability review (CDR) should be conducted.

The respondents will be Social Security disability insurance

beneficiaries who are scheduled to receive a CDR.

Number of Respondents: 431,200

Frequency of Response: 1

Average Burden Per Response: 15 minutes

Estimated Annual Burden: 107,800 hours

3. Statement Regarding Marriage--0960-0017. The information

collected via form SSA-753 is used by the Social Security

Administration to make determinations regarding entitlement to spouse's

benefits when a common law marriage is alleged. The respondents are

third parties who can supply evidence concerning the existence of a

common law marriage.

Number of Respondents: 40,000

Frequency of Response: 1

Average Burden Per Response: 9 minutes

Estimated Annual Burden: 6,000 hours

4. State Contribution Return--0960-0041. The information on form

SSA-3961 is used by the Social Security Administration to identify and

account for all contributions due and paid by the states (or interstate

instrumentalities) under Section 218 of the Social Security Act. The

respondents are state agencies.

Number of Respondents: 117

Frequency of Response: on occasion

Average Burden Per Response: 3 minutes

Estimated Annual Burden: 500 hours

5. Statement of Death by Funeral Director--0960-0142. The

information collected on the SSA-721 is used by the Social Security

Administration to verify the death of an individual insured under the

Social Security Act and to determine if there is a survivor eligible

for a lump sum death payment. The respondents will be funeral directors

with knowledge of the death of a person insured for Social Security

benefits.

Number of Respondents: 900,000

Frequency of Response: 1

Average Burden Per Response: 3.5 minutes

Estimated Annual Burden: 52,500 hours

6. Annual Report of Earnings (long and short forms)--0960-0057. The

information on forms SSA-777 and SSA-7770 is used by the Social

Security Administration to determine the amount of yearly earnings of

beneficiaries so that the proper benefit amounts are paid to them. The

respondents will be beneficiaries under age 70 who have earned over the

exempt amount for the year and still received benefits.

Number of Respondents: (SSA-777)-200,000; (SSA-7770)-1,000,000

------------------------------------------------------------------------

SSA-777 SSA-7770

------------------------------------------------------------------------

Frequency of Response........... 1................... 1

Average Burden Per Response..... 17 minutes.......... 8 minutes.

Estimated Annual Burden......... (1)190,000 hours

(total for both

forms).

------------------------------------------------------------------------

7. Public Information Campaigns and News Releases-0960-0544. The

purpose of the public information campaigns and new releases is to

better inform the public about the programs and activities of the

Social Security Administration (SSA). The information is used by SSA to

determine media interest in airing and printing the public information

materials and news releases and to determine which materials are used,

how often, its effectiveness, and the need for more local

announcements. The respondents are newspapers and public broadcasting

systems such as television, cable, and radio stations.

Number of Respondents: TV--500, Newspaper-500, Radio--1,500, Cable--148

Frequency of Response: Public Service Announcements--4, News Releases--

Educational Tapes--2

Average Burden Per Response: 1 minute (solicitation card), 2 minutes

(business reply card)

Estimated Annual Burden: 298 hours

8. Work Reintegration Study--0960-0543. The information on the two

forms used in this study will aid the Social Security Administration in

determining what steps it can take to help beneficiaries who are

disabled due to a back condition to return to work.

Number of Respondents: 1,500

Frequency of Response: 1

Average Burden Per Response: 1 hour

Estimated Annual Burden: 1,500 hours

Social Security Administration

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:

Charlotte S. Whitenight, 6401 Security Blvd., 1-B-22 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 following information collections, which were published in the

Federal Register on August 4, 1995, have been submitted to OMB:

1. Notice Regarding Substitution of Party Upon Death of Claimant--

Reconsideration of Disability Cessation--OMB Control No. 0960-0351. The

information on form SSA-770 is used by the Social Security

Administration to obtain information from substitute parties regarding

their intention to pursue the appeals process on behalf of an

individual who died. The respondents are such parties.

Number of Respondents: 1,200

Frequency of Response: 1

Average Burden Per Response: 5 minutes

Estimated Annual Burden: 100 hours

[[Page 52447]]

2. Disability Determination and Transmittal--OMB Control No. 0960-

0437. The information on form SSA-831 will be used by the State

disability determination services to document whether an individual who

applies for disability benefits is eligible for those benefits based on

his or her alleged disability. It is also used by SSA for program

management and evaluation. The respondents are state agency employees

who make disability determinations for SSA.

Number of Respondents: 3,525,600

Frequency of Response: 1

Average Burden Per Response: 15 minutes

Estimated Annual Burden: 881,400

3. Cessation or Continuance of Disability or Blindness

Determination and Transmittal--Title XVI--OMB Control No. 0960-0443.

The information on form SSA-832 is used by State disability

determination services to document determinations as to whether an

individual's disability benefits should be terminated or continued on

the basis of his/her impairment. The respondents are state disability

determination services adjudicating Title XVI disability claims.

Number of Respondents: 53,700

Frequency of Response: 1

Average Burden Per Response: 30 minutes

Estimated Annual Burden: 26,850 hours

4. Cessation or Continuance of Disability or Blindness

Determination and Transmittal--Title II--OMB Control No. 0960-0442. The

information on form SSA-833 is used by State disability determination

services to prepare determinations of whether individuals receiving

Title II disability or blindness benefits continue to be unable to

engage in substantial gainful work by reason of their impairments and

are still eligible for benefit payments. It is also used to collect

data for program evaluation and program management.

Number of Respondents: 268,700

Frequency of Response: 1

Average Burden Per Response: 30 minutes

Estimated Annual Burden: 134,350 hours

Social Security Administration

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: Charlotte S.

Whitenight, 6401 Security Blvd, 1-A-21 Operations Bldg., Baltimore, MD

21235

Dated: October 2, 1995.

Charlotte Whitenight,

Reports Clearance Officer, Social Security Administration.

[FR Doc. 95-24880 Filed 10-5-95; 8:45 am]

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