80 FR 30316 - Agency Information Collection Activities: Proposed Request and Comment Request
SOCIAL SECURITY ADMINISTRATION Federal Register Volume 80, Issue 101 (May 27, 2015)
Federal Register Volume 80, Issue 101 (May 27, 2015)
| Page Range | 30316-30318 | |
| FR Document | 2015-12671 |
[Federal Register Volume 80, Number 101 (Wednesday, May 27, 2015)] [Notices] [Pages 30316-30318] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2015-12671] ======================================================================= ----------------------------------------------------------------------- SOCIAL SECURITY ADMINISTRATION [Docket No: SSA-2015-0029] Agency Information Collection Activities: Proposed Request and Comment 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 and extensions 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, Fax: 410-966-2830, Email address: [email protected]. Or you may submit your comments online through www.regulations.gov, referencing Docket ID Number [SSA-2015-0029]. I. 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 July 27, 2015. Individuals can obtain copies of the collection instruments by writing to the above email address. 1. Statement of Employer--20 CFR 404.801-404.803--0960-0030. When workers report they were paid wages but cannot provide proof of those earnings, and the wages do not appear in SSA's records of earnings, SSA uses Form SSA-7011-F4 to document the alleged wages. Specifically, the agency uses the form to resolve discrepancies in the individual's Social Security earnings record and to process claims for Social Security benefits. We only send Form SSA-7011-F4 to employers if we are unable able to locate the earnings information within our own records. The respondents are employers who can verify wage allegations made by wage earners. Type of Request: Revision of an OMB-approved information collection. ---------------------------------------------------------------------------------------------------------------- Average burden Estimated total Modality of completion Number of Frequency of per response annual burden respondents response (minutes) (hours) ---------------------------------------------------------------------------------------------------------------- SSA-7011-F4................................. 500 1 20 167 ---------------------------------------------------------------------------------------------------------------- 2. Function Report Adult-Third Party--20 CFR 404.1512 & 416.912-- 0960-0635. Individuals receiving or applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) provide SSA with medical evidence and other proof SSA requires to prove their disability. SSA, and Disability Determination Services (DDS) on our behalf, collect this information using Form SSA-3380-BK. We use the information to document how claimant's disabilities affect their ability to function, and to determine eligibility for SSI and SSDI claims. The respondents are third parties familiar with the functional limitations (or lack thereof) of claimants who apply for SSI and SSDI benefits. Type of Request: Revision of an OMB approved information collection. ---------------------------------------------------------------------------------------------------------------- Average burden Estimated total Modality of completion Number of Frequency of per response annual burden respondents response (minutes) (hours) ---------------------------------------------------------------------------------------------------------------- SSA-3380-BK................................. 780,000 1 61 793,000 ---------------------------------------------------------------------------------------------------------------- II. SSA submitted the information collections below to OMB for clearance. Your comments regarding the information collections would be most useful if OMB and SSA receive them 30 days from the date of this publication. To be sure we consider your comments, we must receive them no later than June 26, 2015. Individuals can obtain copies of the OMB clearance packages by writing to [email protected]. 1. Application for Parent's Insurance Benefits--20 CFR 404.370- 404.374, 20 CFR 404.601-404.603--0960-0012. Section 202(h) of the Social Security Act establishes the conditions of eligibility a claimant must meet to receive monthly benefits as a parent of a deceased worker. SSA uses information from Form SSA-7-F6 to determine if the [[Page 30317]] claimant meets the eligibility and application criteria. The respondents are applicants for, and recipients of, Social Security Old Age, Survivors, and Disability Insurance (OASDI). Type of Request: Revision of an OMB-approved information collection. ---------------------------------------------------------------------------------------------------------------- Average burden Estimated total Modality of completion Number of Frequency of per response annual burden respondents response (minutes) (hours) ---------------------------------------------------------------------------------------------------------------- Modernized Claims System (MCS).............. 153 1 15 38 MCS/Signature Proxy......................... 158 1 14 37 Paper Form.................................. 4 1 15 1 ------------------------------------------------------------------- Total................................... 315 ............... ............... 76 ---------------------------------------------------------------------------------------------------------------- 2. Request for Withdrawal of Application--20 CFR 404.640--0960- 0015. Form SSA-521 documents the information SSA needs to process the withdrawal of an application for benefits. A paper SSA-521 is our preferred instrument for executing a withdrawal request; however, any written request for withdrawal signed by the claimant or a proper applicant on the claimant's behalf will suffice. Individuals who wish to withdraw their applications for benefits complete Form SSA-521, or sign the completed form for each request to withdraw. SSA uses the information from the SSA-521 to process the request for withdrawal. The respondents are applicants for Retirement, Survivors, Disability, and Health Insurance benefits. Type of Request: Revision of an OMB-approved information collection. ---------------------------------------------------------------------------------------------------------------- Average burden Estimated total Modality of completion Number of Frequency of per response annual burden respondents response (minutes) (hours) ---------------------------------------------------------------------------------------------------------------- SSA-521..................................... 39,000 1 5 3,250 ---------------------------------------------------------------------------------------------------------------- 3. Claimant's Medication--20 CFR 404.1512, 416.912--0960-0289. In cases where claimants request a hearing after denial of their disability claim for Social Security, SSA uses Form HA-4632 to request information from the claimant regarding the medications they use. This information helps the administrative law judge overseeing the case to fully investigate: (1) The claimant's medical treatment and (2) the effects of the medications on the claimant's medical impairments and functional capacity. The respondents are applicants (or their representatives) for OASDI benefits or SSI payments who request a hearing to contest an agency denial of their claim. Type of Request: Revision of an OMB-approved information collection. ---------------------------------------------------------------------------------------------------------------- Average burden Estimated total Modality of completion Number of Frequency of per response annual burden respondents response (minutes) (hours) ---------------------------------------------------------------------------------------------------------------- HA-4632 (paper)............................. 20,000 1 15 5,000 Electronic Records Express.................. 180,000 1 15 45,000 ------------------------------------------------------------------- Total................................... 200,000 ............... ............... 50,000 ---------------------------------------------------------------------------------------------------------------- 4. Permanent Residence in the United States Under Color of Law (PRUCOL)--20 CFR 416.1615 and 416.1618--0960-0451. As per 20 CFR 416.1415 and 416.1618 of the Code of Federal Regulations, SSA requires claimants or recipients to submit evidence of their alien status when they apply for SSI payments, and periodically thereafter as part of the eligibility determination process for SSI. When SSA cannot verify evidence of alien status through the regular claimant interview process, SSA verifies the validity of the evidence of PRUCOL for grandfathered nonqualified aliens with the Department of Homeland Security (DHS), and determines if the individual qualifies for PRUCOL status based on the DHS response. SSA does not maintain any forms or applications for respondents to use, rather, the regulations listed in 20 CFR 416.1615 and 416.1618 specify the information respondents need to submit to SSA to show evidence of PRUCOL. Without this information, SSA is unable to determine whether the PRUCOL individual is eligible for SSI payments. Respondents are qualified and unqualified aliens who apply for SSI payments under PRUCOL. Type of Request: Extension of an OMB-approved information collection. ---------------------------------------------------------------------------------------------------------------- Average burden Estimated total Modality of completion Number of Frequency of per response annual burden respondents response (minutes) (hours) ---------------------------------------------------------------------------------------------------------------- Personal or Telephone Interview............. 1,049 1 5 87 ---------------------------------------------------------------------------------------------------------------- [[Page 30318]] 5. Authorization for the Social Security Administration to Obtain Account Records from a Financial Institution and Request for Records (Medicare)--0960-0729. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) established the Medicare Part D program for voluntary prescription drug coverage of premium, deductible, and copayment costs for individuals with limited income and resources. The MMA mandates that the Government provide subsidies for those individuals who qualify for the program, and who meet eligibility criteria for help with premium, deductible, or co-payment costs. SSA uses the SSA-4640, Authorization for the Social Security Administration to Obtain Account Records from a Financial Institution and Request for Records (Medicare) to determine if subsidy applicants or recipients qualify, or continue to qualify, for the subsidy. SSA uses Form SSA- 4640 to: (1) Obtain the individual's consent to verify balances of financial institution (FI) accounts; and (2) obtain verification of such balances from the FI. Respondents are Medicare Part D program subsidy applicants or claimants, and their financial institutions. This is a correction notice. SSA published this information collection as a revision on March 9, 2015 at 80 FR 12542. Since we are not revising the Privacy Act Statement, this is now an extension of an OMB-approved information collection. Type of Request: Extension of an OMB-approved information collection. ---------------------------------------------------------------------------------------------------------------- Average burden Estimated total Modality of completion Number of Frequency of per response annual burden respondents response (minutes) (hours) ---------------------------------------------------------------------------------------------------------------- Medicare Part D Subsidy Applicants.......... 5,000 1 1 83 Financial Institutions...................... 5,000 1 4 333 ------------------------------------------------------------------- Total................................... 10,000 ............... ............... 416 ---------------------------------------------------------------------------------------------------------------- Dated: May 20, 2015. Faye I. Lipsky, Reports Clearance Officer, Social Security Administration. [FR Doc. 2015-12671 Filed 5-26-15; 8:45 am] BILLING CODE 4191-02-P
![30316 Federal Register / Vol. 80, No. 101 / Wednesday, May 27, 2015 / Notices
disaster loan applications at the address SOCIAL SECURITY ADMINISTRATION Director, 3100 West High Rise, 6401
listed above or other locally announced Security Blvd., Baltimore, MD 21235,
[Docket No: SSA–2015–0029] Fax: 410–966–2830, Email address:
locations.
The following areas have been OR.Reports.Clearance@ssa.gov.
Agency Information Collection
determined to be adversely affected by Activities: Proposed Request and Or you may submit your comments
the disaster: Comment Request online through www.regulations.gov,
referencing Docket ID Number [SSA–
Primary Counties: Braxton, Brooke, The Social Security Administration 2015–0029].
Doddridge, Gilmer, Jackson, Lewis, (SSA) publishes a list of information I. The information collections below
Marshall, Ohio, Pleasants, Ritchie, collection packages requiring clearance are pending at SSA. SSA will submit
Tyler, Wetzel. by the Office of Management and them to OMB within 60 days from the
Budget (OMB) in compliance with date of this notice. To be sure we
The Interest Rates are: Public Law 104–13, the Paperwork consider your comments, we must
Reduction Act of 1995, effective October receive them no later than July 27, 2015.
Percent
1, 1995. This notice includes revisions Individuals can obtain copies of the
For Physical Damage: and extensions of OMB-approved collection instruments by writing to the
Non-Profit Organizations With information collections. above email address.
Credit Available Elsewhere ..... 2.625 SSA is soliciting comments on the 1. Statement of Employer—20 CFR
Non-Profit Organizations Without accuracy of the agency’s burden 404.801–404.803—0960–0030. When
Credit Available Elsewhere ..... 2.625 estimate; the need for the information; workers report they were paid wages but
For Economic Injury: its practical utility; ways to enhance its cannot provide proof of those earnings,
Non-Profit Organizations Without quality, utility, and clarity; and ways to and the wages do not appear in SSA’s
Credit Available Elsewhere ..... 2.625 minimize burden on respondents, records of earnings, SSA uses Form
including the use of automated SSA–7011–F4 to document the alleged
The number assigned to this disaster collection techniques or other forms of wages. Specifically, the agency uses the
for physical damage is 14321B and for information technology. Mail, email, or form to resolve discrepancies in the
economic injury is 14322B. fax your comments and individual’s Social Security earnings
recommendations on the information record and to process claims for Social
(Catalog of Federal Domestic Assistance collection(s) to the OMB Desk Officer Security benefits. We only send Form
Numbers 59002 and 59008) and SSA Reports Clearance Officer at SSA–7011–F4 to employers if we are
James E. Rivera, the following addresses or fax numbers. unable able to locate the earnings
Associate Administrator for Disaster (OMB), Office of Management and information within our own records.
Assistance. Budget, Attn: Desk Officer for SSA, The respondents are employers who can
[FR Doc. 2015–12680 Filed 5–26–15; 8:45 am] Fax: 202–395–6974, Email address: verify wage allegations made by wage
OIRA_Submission@omb.eop.gov. earners.
BILLING CODE 8025–01–P
(SSA), Social Security Administration, Type of Request: Revision of an OMB-
OLCA, Attn: Reports Clearance approved information collection.
Average Estimated total
Number of Frequency of burden per
Modality of completion annual burden
respondents response response (hours)
(minutes)
SSA–7011–F4 .................................................................................................. 500 1 20 167
2. Function Report Adult-Third requires to prove their disability. SSA, eligibility for SSI and SSDI claims. The
Party—20 CFR 404.1512 & 416.912— and Disability Determination Services respondents are third parties familiar
0960–0635. Individuals receiving or (DDS) on our behalf, collect this with the functional limitations (or lack
applying for Social Security Disability information using Form SSA–3380–BK. thereof) of claimants who apply for SSI
Insurance (SSDI) or Supplemental We use the information to document and SSDI benefits.
Security Income (SSI) provide SSA with how claimant’s disabilities affect their Type of Request: Revision of an OMB
medical evidence and other proof SSA ability to function, and to determine approved information collection.
Average Estimated total
Number of Frequency of burden per
Modality of completion annual burden
respondents response response (hours)
(minutes)
SSA–3380–BK ................................................................................................. 780,000 1 61 793,000
mstockstill on DSK4VPTVN1PROD with NOTICES
II. SSA submitted the information we must receive them no later than June CFR 404.601–404.603—0960–0012.
collections below to OMB for clearance. 26, 2015. Individuals can obtain copies Section 202(h) of the Social Security Act
Your comments regarding the of the OMB clearance packages by establishes the conditions of eligibility a
information collections would be most writing to OR.Reports.Clearance@ claimant must meet to receive monthly
useful if OMB and SSA receive them 30 ssa.gov. benefits as a parent of a deceased
days from the date of this publication. 1. Application for Parent’s Insurance worker. SSA uses information from
To be sure we consider your comments, Benefits—20 CFR 404.370–404.374, 20 Form SSA–7–F6 to determine if the
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![30318 Federal Register / Vol. 80, No. 101 / Wednesday, May 27, 2015 / Notices
5. Authorization for the Social qualify for the program, and who meet of such balances from the FI.
Security Administration to Obtain eligibility criteria for help with Respondents are Medicare Part D
Account Records from a Financial premium, deductible, or co-payment program subsidy applicants or
Institution and Request for Records costs. SSA uses the SSA–4640, claimants, and their financial
(Medicare)—0960–0729. The Medicare Authorization for the Social Security institutions.
Prescription Drug, Improvement, and Administration to Obtain Account This is a correction notice. SSA
Modernization Act of 2003 (MMA) Records from a Financial Institution and
published this information collection as
established the Medicare Part D program Request for Records (Medicare) to
a revision on March 9, 2015 at 80 FR
for voluntary prescription drug coverage determine if subsidy applicants or
12542. Since we are not revising the
of premium, deductible, and copayment recipients qualify, or continue to
Privacy Act Statement, this is now an
qualify, for the subsidy. SSA uses Form
costs for individuals with limited extension of an OMB-approved
SSA–4640 to:
income and resources. The MMA (1) Obtain the individual’s consent to information collection.
mandates that the Government provide verify balances of financial institution Type of Request: Extension of an
subsidies for those individuals who (FI) accounts; and (2) obtain verification OMB-approved information collection.
Average Estimated total
Number of Frequency of burden per
Modality of completion annual burden
respondents response response (hours)
(minutes)
Medicare Part D Subsidy Applicants ............................................................... 5,000 1 1 83
Financial Institutions ........................................................................................ 5,000 1 4 333
Total .......................................................................................................... 10,000 ........................ ........................ 416
Dated: May 20, 2015. either: (1) That the harvesting nation has catch shrimp using other methods that
Faye I. Lipsky, adopted a program governing the do not threaten sea turtles. Use of such
Reports Clearance Officer, Social Security incidental capture of sea turtles in its small-scale technology does not
Administration. commercial shrimp fishery comparable adversely affect sea turtles. The 10
[FR Doc. 2015–12671 Filed 5–26–15; 8:45 am] to the program in effect in the United nations and one economy are: The
BILLING CODE 4191–02–P States and has an incidental take rate Bahamas, Belize, China, the Dominican
comparable to that of the United States; Republic, Fiji, Hong Kong, Jamaica,
or (2) that the fishing environment in Oman, Peru, Sri Lanka, and Venezuela.
DEPARTMENT OF STATE the harvesting nation does not pose a The Department of State has
threat of the incidental taking of sea communicated the certifications under
[Public Notice: 9147] Section 609 to the Office of Field
turtles. The President has delegated the
authority to make this certification to Operations of U.S. Customs and Border
Certifications Pursuant to Section 609
the Department of State (‘‘the Protection.
of Public Law 101–162 All DS–2031 forms accompanying
Department’’). Revised State Department
SUMMARY: On April 27, 2015, the guidelines for making the required shrimp imports from uncertified nations
Department of State certified, pursuant certifications were published in the must be originals and signed by the
to Section 609 of Public Law 101–162, Federal Register on July 2, 1999 (Vol. competent domestic fisheries authority.
that 14 nations have adopted programs 64, No. 130, Public Notice 3086). Shrimp harvested with turtle excluder
to reduce the incidental capture of sea devices (TEDs) in an uncertified nation
turtles in their shrimp fisheries On April 27, 2015, the Department may, under specific circumstances, be
comparable to the program in effect in certified 14 nations on the basis that eligible for importation into the United
the United States. The Department also their sea turtle protection programs are States under the DS–2031 section
certified that the fishing environments comparable to that of the United States: 7(A)(2) provision for ‘‘shrimp harvested
in 26 other countries and one economy Colombia, Costa Rica, Ecuador, El by commercial shrimp trawl vessels
do not pose a threat of the incidental Salvador, Gabon, Guatemala, Guyana, using TEDs comparable in effectiveness
taking of sea turtles protected under Honduras, Mexico, Nicaragua, Nigeria, to those required in the United States.’’
Section 609. Pakistan, Panama, and Suriname. The Use of this provision requires that the
Department also certified 26 shrimp Department of State determine in
DATES: Effective on Publication.
harvesting nations and one economy as advance that the government of the
FOR FURTHER INFORMATION CONTACT: having fishing environments that do not harvesting nation has put in place
Stephen J. Wilger, Office of Marine pose a danger to sea turtles. Sixteen adequate procedures to monitor the use
Conservation, Bureau of Oceans and nations have shrimping grounds only in of TEDS in the specific fishery in
International Environmental and cold waters where the risk of taking sea question and to ensure the accurate
Scientific Affairs, Department of State, turtles is negligible. They are: completion of the DS–2031 forms. At
Washington, DC 20520–7818; telephone: Argentina, Belgium, Canada, Chile, this time, the Department has made
(202) 647–3263; email: wilgersj2@
mstockstill on DSK4VPTVN1PROD with NOTICES
Denmark, Finland, Germany, Iceland, such a determination only with respect
state.gov. Ireland, the Netherlands, New Zealand, to specific and limited fisheries in
SUPPLEMENTARY INFORMATION: Section Norway, Russia, Sweden, the United Australia and France. Thus, the
609 of Public Law 101–162 (‘‘Section Kingdom, and Uruguay. Ten nations importation of TED-caught shrimp from
609’’) prohibits imports of certain and one economy only harvest shrimp any other uncertified nation will not be
categories of shrimp unless the using small boats with crews of less allowed. For Australia, shrimp
President certifies to the Congress by than five that use manual rather than harvested in the Exmouth Gulf Prawn
May 1, 1991, and annually thereafter, mechanical means to retrieve nets, or Fishery, the Northern Prawn Fishery,
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Document Created: 2015-12-15 15:35:58
Document Modified: 2015-12-15 15:35:58
| Category | Regulatory Information | |
| Collection | Federal Register | |
| sudoc Class | AE 2.7: GS 4.107: AE 2.106: | |
| Publisher | Office of the Federal Register, National Archives and Records Administration | |
| Section | Notices | |
| FR Citation | 80 FR 30316 |
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