81 FR 39990 - Agency Information Collection Activities: Proposed Request and Comment Request
SOCIAL SECURITY ADMINISTRATION Federal Register Volume 81, Issue 118 (June 20, 2016)
Federal Register Volume 81, Issue 118 (June 20, 2016)
| Page Range | 39990-39992 | |
| FR Document | 2016-14443 |
[Federal Register Volume 81, Number 118 (Monday, June 20, 2016)] [Notices] [Pages 39990-39992] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2016-14443] ======================================================================= ----------------------------------------------------------------------- SOCIAL SECURITY ADMINISTRATION [Docket No: SSA-2016-0027] 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 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-2016-0027]. 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 August 19, 2016. Individuals can obtain copies of the collection instruments by writing to the above email address. 1. Request for Earnings and Benefit Estimate Statement--20 CFR 404.810--0960-0466. Section 205(c)(2)(A) of the Social Security Act (Act) requires the Commissioner of SSA establish and maintain records of wages paid to, and amounts of self-employment income derived by, each individual as well as the periods in which such wages were paid and such income derived. An individual may complete and mail Form SSA- 7004 to SSA's Data Operations Center in Wilkes-Barre, PA, to obtain a Statement of Earnings or Quarters of Coverage. SSA uses the information Form SSA-7004 collects to identify respondent's Social Security earnings records; extract posted earnings information; calculate potential benefit estimates; produce the resulting Social Security statements; and mail them to the requesters. The respondents are Social Security number holders requesting information about their Social Security earnings records and estimates of their potential 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-7004.................................... 40,090 1 5 3,341 ---------------------------------------------------------------------------------------------------------------- 2. National Beneficiary Survey--0960-0800. SSA is continuing the National Beneficiary Survey (NBS), a survey which gathers data from Supplemental Security Income (SSI) recipients and Social Security Disability Insurance (SSDI) beneficiaries about their characteristics, their well-being, and other factors that promote or hinder employment. In particular, the survey seeks to uncover important information about the factors promoting beneficiary self-sufficiency and, conversely, factors impeding beneficiary efforts to maintain employment. We use this data to improve the administration and effectiveness of the SSDI and SSI programs. These results are valuable as SSA and other policymakers continue efforts to improve programs and services that help SSDI beneficiaries and SSI recipients become more self-sufficient. Background SSDI and SSI programs provide a crucial and necessary safety net for working-age people with disabilities. By improving employment outcomes for SSDI beneficiaries and SSI recipients, SSA supports the effort to reduce the reliance of people with disabilities on these programs. SSA conducted the prior NBS in 2004, 2005, 2006, and 2010, which was an important first step in understanding the work interest and experiences of SSI recipients and SSDI beneficiaries, and in gaining information about their impairments, health, living arrangements, family structure, pre-disability occupation, and use of non-SSA programs (e.g., the Supplemental Nutrition Assistance Program). The prior NBS data is available to researchers and the public. The National Beneficiary Survey (NBS) The primary purpose of the new NBS-General Waves is to assess beneficiary well-being and interest in work, learn about beneficiary work experiences (successful and unsuccessful), and identify factors that promote or restrict long-term work success. Information collected in the survey includes factors such as health; living arrangements; family structure; current occupation; use of non-SSA programs; knowledge of SSDI and SSI work incentive programs; obstacles to work; and beneficiary interest and motivation to return to work. We propose to conduct the first wave of the NBS-General Waves in 2015. We will further conduct subsequent rounds in 2017 (round 2) and 2019 (round 3). The information we will collect is not available from SSA administrative data or other sources. In the NBS-General Waves, the sample design is similar to what we used for the prior NBS. Enhancement of the prior questionnaire includes additional questions on the factors that promote or hinder employment success. In 2015 we conducted semi- structured qualitative interviews to provide SSA an in-depth understanding of factors that aid or inhibit individuals in their efforts to obtain and retain employment and advance in the workplace. We use the qualitative data to add context and [[Page 39991]] understanding when interpreting survey results, and to inform the sample and survey design of rounds 2 and 3. Respondent participation in the NBS is voluntary and the decision to participate or not has no impact on current or future receipt of payments or benefits. Respondents are current SSDI beneficiaries and SSI recipients. Type of Request: Revision of an OMB-approved information collection. ---------------------------------------------------------------------------------------------------------------- Average Estimated Number of Frequency of burden per total annual Administration year respondents response response burden (hours) (hours) ---------------------------------------------------------------------------------------------------------------- 2017 ---------------------------------------------------------------------------------------------------------------- Cross-Sectional Samples: Representative Beneficiary Sample........... 4,000 1 50 3,333 Successful Workers.......................... 4,500 1 70 5,250 --------------------------------------------------------------- Subtotal................................ .............. .............. .............. 8,583 ---------------------------------------------------------------------------------------------------------------- 2019 ---------------------------------------------------------------------------------------------------------------- Cross-Sectional Samples: Representative Beneficiary Sample........... 4,000 1 50 3,333 Successful Workers.......................... 3,000 1 70 3,500 Longitudinal Samples: Successful Workers.......................... 2,250 1 70 2,625 --------------------------------------------------------------- Subtotal................................ .............. .............. .............. 9,458 --------------------------------------------------------------- Total Burden........................ 17,750 .............. .............. 18,041 ---------------------------------------------------------------------------------------------------------------- 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 July 20, 2016. Individuals can obtain copies of the OMB clearance package by writing to [email protected]. 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 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. ---------------------------------------------------------------------------------------------------------------- Estimated Number of Frequency of Average burden total annual Modality of completion respondents response per response burden (minutes) (hours) ---------------------------------------------------------------------------------------------------------------- MCS............................................. 662,084 1 9 99,313 Paper........................................... 8,164 1 10 1,361 --------------------------------------------------------------- Total....................................... 670,248 .............. .............. 100,674 ---------------------------------------------------------------------------------------------------------------- 2. Representative Payee Evaluation Report--20 CFR 404.2065 & 416.665--0960-0069. Sections 205(j) and 1631(a)(2) of the Social Security Act (Act) state SSA may appoint a representative payee to receive Title II benefits or Title XVI payments on behalf of individuals unable to manage or direct the management of those funds themselves. SSA requires appointed representative payees to report once each year on how they used or conserved those funds. When a representative payee fails to adequately report to SSA as required, SSA conducts a face-to-face interview with the payee and completes Form SSA-624, Representative Payee Evaluation Report, to determine the continued suitability of the representative payee to serve as a payee. The respondents are individuals or organizations serving as representative payees for individuals receiving Title II benefits or Title XVI payments, and who fail to comply with SSA's statutory annual reporting requirement. 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-624..................................... 267,000 1 30 133,500 ---------------------------------------------------------------------------------------------------------------- [[Page 39992]] 3. 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 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. ---------------------------------------------------------------------------------------------------------------- Estimated Number of Frequency of Average burden total annual Modality of completion respondents response per response burden (minutes) (hours) ---------------------------------------------------------------------------------------------------------------- SSA-4814-F5..................................... 18,750 1 8 2,500 SSA-4815-F6..................................... 120 1 10 20 --------------------------------------------------------------- Totals...................................... 18,870 .............. .............. 2,520 ---------------------------------------------------------------------------------------------------------------- 4. 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. ---------------------------------------------------------------------------------------------------------------- Average burden Estimated total Modality of completion Number of Frequency of per response annual burden respondents response (minutes) (hours) ---------------------------------------------------------------------------------------------------------------- SSA-437..................................... 255 1 60 255 ---------------------------------------------------------------------------------------------------------------- 5. Statement for Determining Continuing Entitlement for Special Veterans Benefits (SVB)--0960-0782. SSA regularly reviews individuals' claims for Special Veterans Benefits (SVB) to determine their continued eligibility and correct payment amounts. Individuals living outside the United States receiving SVB must report to SSA any changes that may affect their benefits, such as: (1) A change in mailing address or residence; (2) an increase or decrease in a pension, annuity, or other recurring benefit; (3) a return or visit to the United States for a calendar month or longer; or (4) an inability to manage benefits. SSA uses Form SSA-2010, to collect this information. Respondents are beneficiaries living outside the United States collecting SVB. 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-2010.................................... 1,799 1 20 600 ---------------------------------------------------------------------------------------------------------------- Dated: June 14, 2016. Naomi R. Sipple, Reports Clearance Officer, Social Security Administration. [FR Doc. 2016-14443 Filed 6-17-16; 8:45 am] BILLING CODE 4191-02-P
![39990 Federal Register / Vol. 81, No. 118 / Monday, June 20, 2016 / Notices
For the Commission, by the Division of minimize burden on respondents, the collection instruments by writing to
Trading and Markets, pursuant to delegated including the use of automated the above email address.
authority.21 collection techniques or other forms of
Brent J. Fields,
1. Request for Earnings and Benefit
information technology. Mail, email, or Estimate Statement—20 CFR 404.810—
Secretary. fax your comments and 0960–0466. Section 205(c)(2)(A) of the
[FR Doc. 2016–14499 Filed 6–17–16; 8:45 am] recommendations on the information Social Security Act (Act) requires the
BILLING CODE 8011–01–P collection(s) to the OMB Desk Officer Commissioner of SSA establish and
and SSA Reports Clearance Officer at maintain records of wages paid to, and
the following addresses or fax numbers. amounts of self-employment income
SOCIAL SECURITY ADMINISTRATION (OMB) Office of Management and derived by, each individual as well as
[Docket No: SSA–2016–0027] Budget, Attn: Desk Officer for SSA, the periods in which such wages were
Fax: 202–395–6974, Email address: paid and such income derived. An
Agency Information Collection OIRA_Submission@omb.eop.gov. individual may complete and mail Form
Activities: Proposed Request and (SSA) Social Security Administration, SSA–7004 to SSA’s Data Operations
Comment Request OLCA, Attn: Reports Clearance Center in Wilkes-Barre, PA, to obtain a
Director, 3100 West High Rise, 6401 Statement of Earnings or Quarters of
The Social Security Administration
Security Blvd., Baltimore, MD 21235, Coverage. SSA uses the information
(SSA) publishes a list of information
Fax: 410–966–2830, Email address: Form SSA–7004 collects to identify
collection packages requiring clearance
OR.Reports.Clearance@ssa.gov, or you respondent’s Social Security earnings
by the Office of Management and
Budget (OMB) in compliance with may submit your comments online records; extract posted earnings
Public Law 104–13, the Paperwork through www.regulations.gov, information; calculate potential benefit
Reduction Act of 1995, effective October referencing Docket ID Number [SSA– estimates; produce the resulting Social
1, 1995. This notice includes revisions 2016–0027]. Security statements; and mail them to
of OMB-approved information I. The information collections below the requesters. The respondents are
collections. are pending at SSA. SSA will submit Social Security number holders
SSA is soliciting comments on the them to OMB within 60 days from the requesting information about their
accuracy of the agency’s burden date of this notice. To be sure we Social Security earnings records and
estimate; the need for the information; consider your comments, we must estimates of their potential benefits.
its practical utility; ways to enhance its receive them no later than August 19, Type of Request: Revision of an OMB-
quality, utility, and clarity; and ways to 2016. Individuals can obtain copies of approved information collection.
Average Estimated total
Number of Frequency of burden per
Modality of completion annual burden
respondents response response (hours)
(minutes)
SSA–7004 ........................................................................................................ 40,090 1 5 3,341
2. National Beneficiary Survey— improving employment outcomes for such as health; living arrangements;
0960–0800. SSA is continuing the SSDI beneficiaries and SSI recipients, family structure; current occupation;
National Beneficiary Survey (NBS), a SSA supports the effort to reduce the use of non-SSA programs; knowledge of
survey which gathers data from reliance of people with disabilities on SSDI and SSI work incentive programs;
Supplemental Security Income (SSI) these programs. SSA conducted the obstacles to work; and beneficiary
recipients and Social Security Disability prior NBS in 2004, 2005, 2006, and interest and motivation to return to
Insurance (SSDI) beneficiaries about 2010, which was an important first step work.
their characteristics, their well-being, in understanding the work interest and We propose to conduct the first wave
and other factors that promote or hinder experiences of SSI recipients and SSDI of the NBS-General Waves in 2015. We
employment. In particular, the survey beneficiaries, and in gaining will further conduct subsequent rounds
seeks to uncover important information information about their impairments, in 2017 (round 2) and 2019 (round 3).
about the factors promoting beneficiary health, living arrangements, family The information we will collect is not
self-sufficiency and, conversely, factors structure, pre-disability occupation, and available from SSA administrative data
impeding beneficiary efforts to maintain use of non-SSA programs (e.g., the or other sources. In the NBS-General
employment. We use this data to Supplemental Nutrition Assistance Waves, the sample design is similar to
improve the administration and Program). The prior NBS data is what we used for the prior NBS.
effectiveness of the SSDI and SSI available to researchers and the public. Enhancement of the prior questionnaire
programs. These results are valuable as includes additional questions on the
SSA and other policymakers continue The National Beneficiary Survey (NBS)
factors that promote or hinder
efforts to improve programs and services The primary purpose of the new NBS- employment success. In 2015 we
that help SSDI beneficiaries and SSI
asabaliauskas on DSK3SPTVN1PROD with NOTICES
General Waves is to assess beneficiary conducted semi-structured qualitative
recipients become more self-sufficient. well-being and interest in work, learn interviews to provide SSA an in-depth
Background about beneficiary work experiences understanding of factors that aid or
(successful and unsuccessful), and inhibit individuals in their efforts to
SSDI and SSI programs provide a identify factors that promote or restrict obtain and retain employment and
crucial and necessary safety net for long-term work success. Information advance in the workplace. We use the
working-age people with disabilities. By collected in the survey includes factors qualitative data to add context and
21 17 CFR 200.30–3(f)(2)(i) & 200.30–3(f)(3).
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![39992 Federal Register / Vol. 81, No. 118 / Monday, June 20, 2016 / Notices
3. Medical Report on Adult with gather information to make a infection, who is applying for SSI
Allegation of Human Immunodeficiency determination about an applicant’s disability benefits, meets the
Virus Infection; Medical Report on claim for SSI payments; this procedure requirements for PD. The respondents
Child with Allegation of Human is the Presumptive Disability (PD). SSA are the medical sources of the
Immunodeficiency Virus Infection—20 uses Forms SSA–4814–F5 and SSA– applicants for SSI disability payments.
CFR 416.933–20 CFR 416.934—0960– 4815–F6 to collect information
Type of Request: Revision of an OMB-
0500. Section 1631(e)(i) of the Act necessary to determine if an individual
authorizes the Commissioner of SSA to with human immunodeficiency virus approved information collection.
Average bur- Estimated total
Number of re- Frequency of den per re-
Modality of completion annual burden
spondents response sponse (hours)
(minutes)
SSA–4814–F5 .................................................................................................. 18,750 1 8 2,500
SSA–4815–F6 .................................................................................................. 120 1 10 20
Totals ........................................................................................................ 18,870 ........................ ........................ 2,520
4. Complaint Form for Allegations of proceeding under this administrative discrimination; and (5) establish other
Discrimination in Programs or Activities complaint process in connection with relevant information that would assist
Conducted by the Social Security an SSA program or activity. Individuals in the investigation and resolution of
Administration—0960–0585. SSA uses who believe SSA discriminated against the complaint. Respondents are
Form SSA–437 to investigate and them on any of the above bases may file individuals who believe an SSA
formally resolve complaints of a written complaint of discrimination. program or activity, or SSA employees,
discrimination based on disability, race, SSA uses the information to: (1) Identify contractors or agents discriminated
color, national origin (including limited the complaint; (2) identify the alleged against them.
English language proficiency), sex discriminatory act; (3) establish the date
(including sexual orientation and of such alleged action; (4) establish the Type of Request: Revision on an
gender identity), age, religion, or identity of any individual(s) with OMB-approved information collection.
retaliation for having participated in a information about the alleged
Average Estimated total
Number of Frequency of burden per
Modality of completion annual burden
respondents response response (hours)
(minutes)
SSA–437 .......................................................................................................... 255 1 60 255
5. Statement for Determining States receiving SVB must report to SSA inability to manage benefits. SSA uses
Continuing Entitlement for Special any changes that may affect their Form SSA–2010, to collect this
Veterans Benefits (SVB)—0960–0782. benefits, such as: (1) A change in information. Respondents are
SSA regularly reviews individuals’ mailing address or residence; (2) an beneficiaries living outside the United
claims for Special Veterans Benefits increase or decrease in a pension, States collecting SVB.
(SVB) to determine their continued annuity, or other recurring benefit; (3) a
Type of Request: Revision of an OMB-
eligibility and correct payment amounts. return or visit to the United States for
Individuals living outside the United a calendar month or longer; or (4) an approved information collection.
Average Estimated total
Number of Frequency of burden per
Modality of completion annual burden
respondents response response (hours)
(minutes)
SSA–2010 ........................................................................................................ 1,799 1 20 600
Dated: June 14, 2016. DEPARTMENT OF STATE Budget (OMB) approval for the
Naomi R. Sipple, information collection described below.
[Public Notice 9610]
Reports Clearance Officer, Social Security In accordance with the Paperwork
Administration. 60-Day Notice of Proposed Information Reduction Act of 1995, we are
asabaliauskas on DSK3SPTVN1PROD with NOTICES
[FR Doc. 2016–14443 Filed 6–17–16; 8:45 am] Collection: Statement of Material requesting comments on this collection
BILLING CODE 4191–02–P Change, Merger, Acquisition, or from all interested individuals and
Divestment of a Registered Party organizations. The purpose of this
notice is to allow 60 days for public
Notice of request for public
ACTION: comment preceding submission of the
comment. collection to OMB.
SUMMARY: The Department of State is
seeking Office of Management and
VerDate Sep<11>2014 17:05 Jun 17, 2016 Jkt 238001 PO 00000 Frm 00106 Fmt 4703 Sfmt 4703 E:\FR\FM\20JNN1.SGM 20JNN1](https://thefederalregister.org/doc/81_FR_40108/page/3.svg)
Document Created: 2016-06-18 00:09:09
Document Modified: 2016-06-18 00:09:09
| 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 | 81 FR 39990 |
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