82 FR 12159 - Agency Information Collection Activities: Proposed Request
SOCIAL SECURITY ADMINISTRATION Federal Register Volume 82, Issue 38 (February 28, 2017)
Federal Register Volume 82, Issue 38 (February 28, 2017)
| Page Range | 12159-12161 | |
| FR Document | 2017-03850 |
[Federal Register Volume 82, Number 38 (Tuesday, February 28, 2017)] [Notices] [Pages 12159-12161] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2017-03850] ======================================================================= ----------------------------------------------------------------------- SOCIAL SECURITY ADMINISTRATION [Docket No: SSA-2017-0008] 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, Fax: 410-966-2830, Email address: [email protected]. Or you may submit your comments online through www.regulations.gov, referencing Docket ID Number [SSA-2017- 0008]. 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 May 1, 2017. Individuals can obtain copies of the collection instruments by writing to the above email address. 1. Statement Regarding Marriage--20 CFR 404.726--0960-0017. According to Section 216(h)(1)(A) of the Social Security Act (Act), SSA must apply state law when determining an individual's marital status. Some state laws recognize marriages without a ceremony (i.e., common- law marriages). In such cases, SSA provides the same spouse or widow(er) benefits to the common-law spouses as it does to ceremonially married spouses. To determine common-law spouses, SSA must elicit information from blood relatives or other persons who are knowledgeable about the alleged common-law relationship. SSA uses Form SSA-753, Statement Regarding Marriage, to collect information from third parties to verify the applicant's statements about intent, cohabitation, and holding out to the public as married, which are the basic tenets of a common-law marriage. SSA uses the information to determine if a valid marital relationship exists, and if the common-law spouse is entitled to Social Security spouse or widow(er) benefits. The respondents are third parties who can confirm or deny the alleged common-law marriage. Type of Request: Revision of an OMB-approved information collection. [[Page 12160]] ---------------------------------------------------------------------------------------------------------------- Average burden Estimated total Modality of completion Number of Frequency of per response annual burden respondents response (minutes) (hours) ---------------------------------------------------------------------------------------------------------------- SSA-753..................................... 40,000 1 9 6,000 ---------------------------------------------------------------------------------------------------------------- 2. Statement of Income and Resources--20 CFR 416.207, 146.301- 416.310, 416.704, and 416.708-0960-0124. SSA collects information about income and resources for Supplemental Security Income (SSI) claims and redeterminations on the SSA-8010-BK. SSA uses the information to make initial or continuing eligibility determinations for SSI claimants or recipients who are subject to deeming. The respondents are people whose income and resources SSA may deem (consider to be available) to SSI applicants or recipients. 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-8010-BK................................. 341,000 1 26 147,767 ---------------------------------------------------------------------------------------------------------------- 3. Claimant's Work Background--20 CFR 404.1512(a); 404.1520(a)(4); 404.1565(b); 416.912(a); 416.920(a)(4); 416.965(b)--0960-0300. Sections 205(a) and 1631(e) of the Act provide the Commissioner of Social Security with the authority to establish procedures for determining if a claimant is entitled to disability benefits. An administrative law judge (ALJ) may ask individuals to provide background information on Form HA-4633 about work they performed in the past 15 years. When a claimant requests a hearing before an ALJ to establish an entitlement to disability benefits, the ALJ may request that the claimant provide a work history to assist the ALJ in fully inquiring into statutory issues related to the disability. The ALJ uses the information collected from the claimants on Form HA-4633 to: (1) Identify the claimant's relevant work history; (2) decide if SSA requires expert vocational testimony and, if so, have a vocational expert available to testify during the hearing; and (3) provide a reference for the ALJ to discuss the claimant's work history. The ALJ makes the completed HA-4633 part of the documentary evidence of record. The respondents are claimants for disability benefits under Title II or Title XVI who requested a hearing before an ALJ after SSA denied their application for disability payments. Type of Request: Revision of an OMB-approved information collection. ---------------------------------------------------------------------------------------------------------------- Average Number of Frequency of burden per Estimated Modality of completion respondents response response total annual (minutes) burden (hours) ---------------------------------------------------------------------------------------------------------------- HA-4633 PDF/paper version....................... 20,000 1 15 5,000 Electronic Records Express...................... 180,000 1 15 45,000 --------------------------------------------------------------- Total....................................... 200,000 .............. .............. 50,000 ---------------------------------------------------------------------------------------------------------------- 4. Letter to Landlord Requesting Rental Information--20 CFR 416.1130(b)--0960-0454. SSA uses Form SSA-L5061 to obtain rental subsidy information, which enables SSA to determine and verify an income value for such subsidies. SSA uses this income value as part of determining eligibility for SSI and the correct amount of SSI payable to the claimant. SSA bases an individual's eligibility for SSI payments, in part, on the amount of countable income the individual receives. Income includes in-kind support and maintenance in the form of room or rent, such as a subsidized rental arrangement. SSA requires claimants to assist in obtaining this information to prevent a delay or overpayment with their SSI payments. We collect this information only if the SSI applicant or recipient is the parent or child of the landlord (respondent). For most respondents, we collect this information once per year or less, via telephone, or face-to-face personal interview. The claims representative records the information in our Modernized SSI Claims System (MSSICS), and we require verbal attestation in lieu of a wet signature. However, if the claims representative is unable to contact the respondent via the telephone or face-to-face, we print and mail a paper form to the respondent for completion. The respondent completes, signs, and returns the form to the claims representative. Upon receipt, the claims representative documents the information in MSSICS or, for non-MSSICS cases, faxes the form into the appropriate electronic folder and shreds the paper form. The respondents are landlords related to the SSI beneficiaries as a parent or child. Type of Request: Revision of an OMB-approved information collection. [[Page 12161]] ---------------------------------------------------------------------------------------------------------------- Average burden Estimated total Modality of completion Number of Frequency of per response annual burden respondents response (minutes) (hours) ---------------------------------------------------------------------------------------------------------------- SSA-L5061................................... 72,000 1 10 12,000 ---------------------------------------------------------------------------------------------------------------- 5. Request for Evidence From Doctor and Request for Evidence From Hospital--20 CFR 404 Subpart P and 20 CFR 416 Subpart I--0960-0722. Sections 223(d)(5) and 1614(a)(3)(H)(i) of the Act require claimants to furnish medical evidence of their disability when filing a disability claim. SSA uses Forms HA-66 and HA-67 to request evidence from medical sources, which claimants identify as having information relative to their impairments, or ability to do work-related activities. In addition to accepting manual paper responses, SSA sends a barcode with the HA-66 and HA-67, allowing respondents to fax the information directly into the electronic claims folder rather than submitting it manually. SSA uses the information to determine eligibility for benefits, and to pay medical sources for furnishing the information. The respondents are medical sources, doctors, and hospitals that evaluate the claimants. Type of Request: Revision of an OMB-approved information collection. ---------------------------------------------------------------------------------------------------------------- Average Number of Frequency of burden per Estimated Modality of completion respondents response response total annual (minutes) burden (hours) ---------------------------------------------------------------------------------------------------------------- HA-66--Paper Version............................ 3,060 22 15 16,830 HA-66--Electronic Version....................... 8,940 22 15 49,170 HA-67--Paper Version............................ 3,060 22 15 16,830 HA-67--Electronic Version....................... 8,940 22 15 49,170 --------------------------------------------------------------- Totals...................................... 24,000 .............. .............. 132,000 ---------------------------------------------------------------------------------------------------------------- Dated: February 23, 2017. Naomi R. Sipple, Reports Clearance Officer, Social Security Administration. [FR Doc. 2017-03850 Filed 2-27-17; 8:45 am] BILLING CODE 4191-02-P
![Federal Register / Vol. 82, No. 38 / Tuesday, February 28, 2017 / Notices 12159
Incident Period: 01/05/2017 through SMALL BUSINESS ADMINISTRATION SSA is soliciting comments on the
01/14/2017. accuracy of the agency’s burden
[Disaster Declaration #15043 and #15044]
Effective Date: 02/17/2017. estimate; the need for the information;
Georgia Disaster Number GA–00092 its practical utility; ways to enhance its
Physical Loan Application Deadline quality, utility, and clarity; and ways to
Date: 04/18/2017. AGENCY: U.S. Small Business minimize burden on respondents,
Economic Injury (EIDL) Loan Administration. including the use of automated
Application Deadline Date: 11/17/2017. ACTION: Amendment 2. collection techniques or other forms of
information technology. Mail, email, or
ADDRESSES: Submit completed loan SUMMARY: This is an amendment of the fax your comments and
applications to: U.S. Small Business Presidential declaration of a major recommendations on the information
Administration, Processing and disaster for Public Assistance Only for collection(s) to the OMB Desk Officer
Disbursement Center, 14925 Kingsport the State of Georgia (FEMA–4297–DR), and SSA Reports Clearance Officer at
Road, Fort Worth, TX 76155. dated 2/07/2017. the following addresses or fax numbers.
Incident: Severe Storms, Tornadoes, (OMB), Office of Management and
FOR FURTHER INFORMATION CONTACT: A. Straight-line Winds, and Flooding. Budget, Attn: Desk Officer for SSA, Fax:
Escobar, Office of Disaster Assistance, Incident Period: 1/21/2017 through 202–395–6974, Email address: OIRA_
U.S. Small Business Administration, 1/22/2017. Submission@omb.eop.gov, (SSA), Social
409 3rd Street SW., Suite 6050, Effective Date: 2/15/2017.
Physical Loan Application Deadline Security Administration, OLCA, Attn:
Washington, DC 20416. Reports Clearance Director, 3100 West
Date: 4/10/2017.
SUPPLEMENTARY INFORMATION: Notice is Economic Injury (EIDL) Loan High Rise, 6401 Security Blvd.,
hereby given that as a result of the Application Deadline Date: 11/07/2017. Baltimore, MD 21235, Fax: 410–966–
President’s major disaster declaration on 2830, Email address:
ADDRESSES: Submit completed loan
02/17/2017, Private Non-Profit OR.Reports.Clearance@ssa.gov. Or you
applications to: U.S. Small Business may submit your comments online
organizations that provide essential Administration, Processing and
services of governmental nature may file through www.regulations.gov,
Disbursement Center, 14925 Kingsport referencing Docket ID Number [SSA–
disaster loan applications at the address Road, Fort Worth, TX 76155. 2017–0008].
listed above or other locally announced FOR FURTHER INFORMATION CONTACT: A. The information collections below are
locations. Escobar, Office of Disaster Assistance, pending at SSA. SSA will submit them
The following areas have been U.S. Small Business Administration, to OMB within 60 days from the date of
determined to be adversely affected by 409 3rd Street SW., Suite 6050, this notice. To be sure we consider your
the disaster: Washington, DC 20416. comments, we must receive them no
SUPPLEMENTARY INFORMATION: The notice later than May 1, 2017. Individuals can
Primary Counties/Areas: of the President’s major disaster obtain copies of the collection
Carson City, Douglas, Lyon, Storey, declaration for Private Non-Profit instruments by writing to the above
Washoe organizations in the State of Georgia, email address.
And the PYRAMID Lake Paiute Tribe, dated 02/07/2017, is hereby amended to 1. Statement Regarding Marriage—20
the Reno-Sparks Indian Colony, and include the following areas as adversely CFR 404.726—0960–0017. According to
affected by the disaster. Section 216(h)(1)(A) of the Social
the Washoe Tribe of Nevada and
Primary Counties: Colquitt. Security Act (Act), SSA must apply state
California law when determining an individual’s
All other information in the original
The Interest Rates are: declaration remains unchanged. marital status. Some state laws
(Catalog of Federal Domestic Assistance
recognize marriages without a ceremony
Percent Number 59008) (i.e., common-law marriages). In such
cases, SSA provides the same spouse or
For Physical Damage: James E. Rivera, widow(er) benefits to the common-law
Non-Profit Organizations With Associate Administrator for Disaster spouses as it does to ceremonially
Credit Available Elsewhere ... 2.500 Assistance. married spouses. To determine
Non-Profit Organizations With- [FR Doc. 2017–03834 Filed 2–27–17; 8:45 am] common-law spouses, SSA must elicit
out Credit Available Else- BILLING CODE 8025–01–P information from blood relatives or
where ..................................... 2.500 other persons who are knowledgeable
For Economic Injury: about the alleged common-law
Non-Profit Organizations With- SOCIAL SECURITY ADMINISTRATION relationship. SSA uses Form SSA–753,
out Credit Available Else- Statement Regarding Marriage, to collect
where ..................................... 2.500 [Docket No: SSA–2017–0008]
information from third parties to verify
Agency Information Collection the applicant’s statements about intent,
The number assigned to this disaster cohabitation, and holding out to the
Activities: Proposed Request
for physical damage is 150536 and for public as married, which are the basic
economic injury is 150546. The Social Security Administration tenets of a common-law marriage. SSA
(SSA) publishes a list of information uses the information to determine if a
(Catalog of Federal Domestic Assistance
collection packages requiring clearance valid marital relationship exists, and if
mstockstill on DSK3G9T082PROD with NOTICES
Number 59008)
by the Office of Management and the common-law spouse is entitled to
James E. Rivera,
Budget (OMB) in compliance with Social Security spouse or widow(er)
Public Law 104–13, the Paperwork benefits. The respondents are third
Associate Administrator for Disaster Reduction Act of 1995, effective October parties who can confirm or deny the
Assistance.
1, 1995. This notice includes revisions alleged common-law marriage.
[FR Doc. 2017–03837 Filed 2–27–17; 8:45 am]
of OMB-approved information Type of Request: Revision of an OMB-
BILLING CODE 8025–01–P collections. approved information collection.
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![Federal Register / Vol. 82, No. 38 / Tuesday, February 28, 2017 / Notices 12161
Average Estimated total
Number of Frequency of burden per
Modality of completion annual burden
respondents response response (hours)
(minutes)
SSA–L5061 ...................................................................................................... 72,000 1 10 12,000
5. Request for Evidence From Doctor evidence from medical sources, which submitting it manually. SSA uses the
and Request for Evidence From claimants identify as having information information to determine eligibility for
Hospital—20 CFR 404 Subpart P and 20 relative to their impairments, or ability benefits, and to pay medical sources for
CFR 416 Subpart I—0960–0722. to do work-related activities. In addition furnishing the information. The
Sections 223(d)(5) and 1614(a)(3)(H)(i) to accepting manual paper responses, respondents are medical sources,
of the Act require claimants to furnish SSA sends a barcode with the HA–66 doctors, and hospitals that evaluate the
medical evidence of their disability and HA–67, allowing respondents to fax claimants.
when filing a disability claim. SSA uses the information directly into the Type of Request: Revision of an OMB-
Forms HA–66 and HA–67 to request electronic claims folder rather than approved information collection.
Average Estimated total
Number of Frequency of burden per
Modality of completion annual burden
respondents response response (hours)
(minutes)
HA–66—Paper Version ................................................................................... 3,060 22 15 16,830
HA–66—Electronic Version ............................................................................. 8,940 22 15 49,170
HA–67—Paper Version ................................................................................... 3,060 22 15 16,830
HA–67—Electronic Version ............................................................................. 8,940 22 15 49,170
Totals ........................................................................................................ 24,000 ........................ ........................ 132,000
Dated: February 23, 2017. display of the exhibit objects at the the authority vested in me by the Act of
Naomi R. Sipple, National Gallery of Art, Washington, October 19, 1965 (79 Stat. 985; 22 U.S.C.
Reports Clearance Officer, Social Security District of Columbia, from on or about 2459), E.O. 12047 of March 27, 1978, the
Administration. April 9, 2017, until on or about July 9, Foreign Affairs Reform and
[FR Doc. 2017–03850 Filed 2–27–17; 8:45 am] 2017, and at possible additional Restructuring Act of 1998 (112 Stat.
BILLING CODE 4191–02–P exhibitions or venues yet to be 2681, et seq.; 22 U.S.C. 6501 note, et
determined, is in the national interest. seq.), Delegation of Authority No. 234 of
I have ordered that Public Notice of October 1, 1999, Delegation of Authority
DEPARTMENT OF STATE these Determinations be published in No. 236–3 of August 28, 2000 (and, as
the Federal Register. appropriate, Delegation of Authority No.
[Public Notice: 9899]
FOR FURTHER INFORMATION CONTACT: For 257–1 of December 11, 2015), I hereby
Notice of Determinations; Culturally further information, including a list of determine that the objects to be
Significant Objects Imported for the imported objects, contact the Office included in the exhibition ‘‘Matisse in
Exhibition Determinations: ‘‘Frédéric of Public Diplomacy and Public Affairs the Studio,’’ imported from abroad for
Bazille and the Birth of Impressionism’’ in the Office of the Legal Adviser, U.S. temporary exhibition within the United
Exhibition Department of State (telephone: 202– States, are of cultural significance. The
632–6471; email: section2459@ objects are imported pursuant to loan
SUMMARY: Notice is hereby given of the state.gov). The mailing address is U.S.
following determinations: Pursuant to agreements with the foreign owners or
Department of State, L/PD, SA–5, Suite
the authority vested in me by the Act of custodians. I also determine that the
5H03, Washington, DC 20522–0505.
October 19, 1965 (79 Stat. 985; 22 U.S.C. exhibition or display of the exhibit
2459), E.O. 12047 of March 27, 1978, the Alyson Grunder, objects at the Museum of Fine Arts,
Foreign Affairs Reform and Deputy Assistant Secretary for Policy, Bureau Boston, Boston, Massachusetts, from on
Restructuring Act of 1998 (112 Stat. of Educational and Cultural Affairs, or about April 9, 2017, until on or about
2681, et seq.; 22 U.S.C. 6501 note, et Department of State. July 9, 2017, and at possible additional
seq.), Delegation of Authority No. 234 of [FR Doc. 2017–03863 Filed 2–27–17; 8:45 am] exhibitions or venues yet to be
October 1, 1999, Delegation of Authority BILLING CODE 4710–05–P determined, is in the national interest.
No. 236–3 of August 28, 2000 (and, as I have ordered that Public Notice of
appropriate, Delegation of Authority No. these Determinations be published in
257–1 of December 11, 2015), I hereby DEPARTMENT OF STATE
the Federal Register.
determine that the objects to be
included in the exhibition ‘‘Frédéric [Public Notice 9898] FOR FURTHER INFORMATION CONTACT: For
mstockstill on DSK3G9T082PROD with NOTICES
Bazille and the Birth of Impressionism,’’ further information, including a list of
Notice of Determinations; Culturally the imported objects, contact the Office
imported from abroad for temporary Significant Objects Imported for
exhibition within the United States, are of Public Diplomacy and Public Affairs
Exhibition Determinations: ‘‘Matisse in
of cultural significance. The objects are in the Office of the Legal Adviser, U.S.
the Studio’’ Exhibition
imported pursuant to loan agreements Department of State (telephone: 202–
with the foreign owners or custodians. SUMMARY: Notice is hereby given of the 632–6471; email: section2459@
I also determine that the exhibition or following determinations: Pursuant to state.gov). The mailing address is U.S.
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Document Created: 2017-02-27 23:53:31
Document Modified: 2017-02-27 23:53:31
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| Collection | Federal Register | |
| sudoc Class | AE 2.7: GS 4.107: AE 2.106: | |
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| Section | Notices | |
| FR Citation | 82 FR 12159 |
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