83 FR 26736 - Agency Information Collection Activities: Proposed Request and Comment Request
SOCIAL SECURITY ADMINISTRATION Federal Register Volume 83, Issue 111 (June 8, 2018)
Federal Register Volume 83, Issue 111 (June 8, 2018)
| Page Range | 26736-26739 | |
| FR Document | 2018-12395 |
[Federal Register Volume 83, Number 111 (Friday, June 8, 2018)] [Notices] [Pages 26736-26739] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2018-12395] ----------------------------------------------------------------------- SOCIAL SECURITY ADMINISTRATION [Docket No. SSA-2018-0024] 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 one extension, 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-2018-0024]. 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 7, 2018. Individuals can obtain copies of the collection instruments by writing to the above email address. 1. Employment Relationship Questionnaire--20 CFR 404.1007--0960- 0040. When SSA needs information to determine a worker's employment status for the purpose of maintaining a worker's earning records, the agency uses Form SSA-7160-F4 to determine the existence of an employer- employee relationship. We use the information to develop the employment relationship; specifically, to determine whether a beneficiary is self- employed or an employee. The respondents are individuals seeking to establish their status as employees, and their alleged employers. 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-7160-F4--Individuals........................ 8,000 1 25 3,333 SSA-7160-F4--Businesses......................... 7,200 1 25 3,000 SSA-7160-F4--State/Local Governemnt............. 800 1 25 333 --------------------------------------------------------------- [[Page 26737]] Total....................................... 16,000 .............. .............. 6,666 ---------------------------------------------------------------------------------------------------------------- 2. Application for Circuit Court Law--20 CFR 404.985 & 416.1458-- 0960-0581. Persons claiming an acquiescence ruling (AR) would change SSA's prior determination or decision must submit a written readjudication request with specific information. SSA reviews the information in the requests to determine if the issues stated in the AR pertain to the claimant's case, and if the claimant is entitled to readjudication. If readjudication is appropriate, SSA considers the issues the AR covers. Any new determination or decision is subject to administrative or judicial review as specified in the regulations, and the claimants must provide information to request readjudication. Respondents are claimants for Social Security benefits and Supplemental Security Income (SSI) payments who request readjudication. Type of Request: Extension of an OMB-approved information collection. ---------------------------------------------------------------------------------------------------------------- Estimated Number of Frequency of Average burden Total annual Modality of completion rspondents response per response burden (minutes) (hours) ---------------------------------------------------------------------------------------------------------------- AR-based Readjudication Requests................ 10,000 1 17 2,833 ---------------------------------------------------------------------------------------------------------------- II. SSA submitted the information collections below to OMB for clearance. Your comments regarding these 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 9, 2018. 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 and 20 CFR 404.601-404.603--0960-0012. Section 202(h) of the Social Security Act (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 claimant meets the eligibility and application criteria. The respondents are applicants for, and recipients of, Social Security Old Age, Survivors, and Disability Insurance (OASDI). Correction Notice: SSA is updating the burden information for this collection, so it differs from the information we published at 83 FR 12455, on 3/21/18. 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-7-F6--Modernized Claims System and Paper 168 1 15 42 Versions................................... ---------------------------------------------------------------------------------------------------------------- 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..................................... 31,827 1 5 2,652 ---------------------------------------------------------------------------------------------------------------- 3. Statement of Self-Employment Income--20 CFR 404.101, 404.110, 404.1096(a)(d)--0960-0046. To qualify for insured status, and collect Social Security benefits, self-employed individuals must demonstrate they earned the minimum amount of self-employment income (SEI) in a current year. SSA uses Form SSA-766, Statement of Self-Employment Income, to collect the information we need to determine if the individual earned at least the minimum amount of SEI needed for one or more quarters of coverage in the current year. Based on the information we obtain, we may credit additional quarters of coverage to give the individual insured status, expediting benefit payments. Respondents are self-employed individuals potentially eligible for Social Security benefits. Type of Request: Revision of an OMB-approved information collection. [[Page 26738]] ---------------------------------------------------------------------------------------------------------------- Average burden Estimated total Modality of completion Number of Frequency of per response annual burden respondents response (minutes) (hours) ---------------------------------------------------------------------------------------------------------------- SSA-766..................................... 2,500 1 5 208 ---------------------------------------------------------------------------------------------------------------- 4. Request for Workers' Compensation/Public Disability Benefit Information--20 CFR 404.408(e)--0960-0098. Claimants for Social Security disability payments who are also receiving Worker's Compensation/Public Disability Benefits (WC/PDB) must notify SSA about their WC/PDB, so the agency can reduce claimants' Social Security disability payments accordingly. If claimants provide necessary evidence, such as a copy of their award notice, benefit check, etc., that is sufficient verification. In cases where claimants cannot provide such evidence, SSA uses Form SSA-1709. The entity paying the WC/PDB benefits, its agent (such as an insurance carrier), or an administering public agency complete this form. The respondents are Federal, State, and local agencies, insurance carriers, and public or private self-insured companies administering WC/PDB benefits to disability claimants. 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-1709.................................... 120,000 1 15 30,000 ---------------------------------------------------------------------------------------------------------------- 5. Third Party Liability Information Statement--42 CFR 433.136- 433.139--0960-0323. To reduce Medicaid costs, Medicaid state agencies identify third party insurers liable for medical care or services for Medicaid beneficiaries. Regulations at 2 CFR 433.136-433.139 require Medicaid state agencies to obtain this information on Medicaid applications and redeterminations as a condition of Medicaid eligibility. States may enter into agreements with the Commissioner of Social Security to make Medicaid eligibility determinations for aged, blind, and disabled beneficiaries in those states. Applications for and redeterminations of SSI eligibility in jurisdictions with such agreements are applications and redeterminations of Medicaid eligibility. Under these agreements, SSA obtains third party liability information using Form SSA-8019-U2, and provides that information to the Medicaid state agencies. The Medicaid state agencies use the information to bill third parties liable for medical care, support, or services for a beneficiary to guarantee that Medicaid remains the payer of last resort. The respondents are SSI claimants and recipients. Type of Request: Revision of an OMB-approved information collection. ---------------------------------------------------------------------------------------------------------------- Average Estimated Number of Frequency of burden per total annual Modality of completion respondents response response burden (minutes) (hours) ---------------------------------------------------------------------------------------------------------------- SSA-8019-U2--Paper Version...................... 200 1 5 17 SSA-8019-U2--SSI Claims Sysetm Version.......... 49,621 1 5 4,135 --------------------------------------------------------------- Totals...................................... 49,821 .............. .............. 4,152 ---------------------------------------------------------------------------------------------------------------- 6. 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 26739]] 7. Authorization for the Social Security Administration to Obtain Account Records from a Financial Institution and Request for Records (Medicare)--20 CFR 418.3420--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. Type of Request: Revision of an OMB-approved information collection. ---------------------------------------------------------------------------------------------------------------- Average Estimated Number of Frequency of burden per total annual Modality of completion respondents response response burden (minutes) (hours) ---------------------------------------------------------------------------------------------------------------- SSA-4640--Medicare Part D Subsidy Applicants.... 5,000 1 1 83 SSA-4640--Financial Institutions................ 5,000 1 4 333 --------------------------------------------------------------- Total....................................... 10,000 .............. .............. 416 ---------------------------------------------------------------------------------------------------------------- Dated: June 4, 2018. Faye Lipsky, Reports Clearance Director, Social Security Administration. [FR Doc. 2018-12395 Filed 6-7-18; 8:45 am] BILLING CODE 4191-02-P
![26736 Federal Register / Vol. 83, No. 111 / Friday, June 8, 2018 / Notices
Average Estimated total
Number of Frequency of burden of
Modality of completion annual burden
respondents response response (hours)
(hours)
SSA–680 .......................................................................................................... 30 1 5 150
II. SSA submitted the information governing the Federal Government Security beneficiary who elected to have
collection below to OMB for clearance. Participation in the Automated Clearing payments sent to Canada. Form SSA–
Your comments regarding this House: (1) Allow SSA to send Social 1712 (or SSA–1712 CN), Notice of
information collection would be most Security payments to Canada; and (2) Reclamation-Canada Payment Made in
useful if OMB and SSA receive them 30 mandate the reclamation of funds paid the United States, is the cover sheet SSA
days from the date of this publication. erroneously to a Canadian bank, or prepares to request return of the
To be sure we consider your comments, financial institution, after the death of a payment. The respondents are Canadian
we must receive them no later than July Social Security beneficiary. SSA uses banks and financial institutions who
9, 2018. Individuals can obtain copies of Form SSA–1713, Notice of Reclamation erroneously received Social Security
the OMB clearance packages by writing Action, to determine if, how, and when payments.
to OR.Reports.Clearance@ssa.gov. the Canadian bank or financial
Statement of Reclamation Action—31 institution is going to return erroneous Type of Request: Revision of an OMB-
CFR 210—0960–0734. Regulations payments after the death of a Social approved information collection.
Average Estimated total
Number of Frequency of burden of
Modality of completion annual burden
respondents response response (hours)
(minutes)
SSA–1712 ........................................................................................................ 8 1 5 1
SSA–1713 ........................................................................................................ 7 1 5 1
Totals ........................................................................................................ 15 ........................ ........................ 2
Dated: June 4, 2018. estimate; the need for the information; I. The information collections below
Faye Lipsky, its practical utility; ways to enhance its are pending at SSA. SSA will submit
Reports Clearance Director, Social Security quality, utility, and clarity; and ways to them to OMB within 60 days from the
Administration. minimize burden on respondents, date of this notice. To be sure we
[FR Doc. 2018–12391 Filed 6–7–18; 8:45 am] including the use of automated consider your comments, we must
BILLING CODE 4191–02–P collection techniques or other forms of receive them no later than August 7,
information technology. Mail, email, or 2018. Individuals can obtain copies of
fax your comments and the collection instruments by writing to
SOCIAL SECURITY ADMINISTRATION recommendations on the information the above email address.
collection(s) to the OMB Desk Officer 1. Employment Relationship
[Docket No. SSA–2018–0024] and SSA Reports Clearance Officer at Questionnaire—20 CFR 404.1007—
Agency Information Collection the following addresses or fax numbers. 0960–0040. When SSA needs
Activities: Proposed Request and (OMB), Office of Management and information to determine a worker’s
Comment Request Budget, Attn: Desk Officer for SSA, employment status for the purpose of
Fax: 202–395–6974, Email address: maintaining a worker’s earning records,
The Social Security Administration OIRA_Submission@omb.eop.gov. the agency uses Form SSA–7160–F4 to
(SSA) publishes a list of information determine the existence of an employer-
collection packages requiring clearance (SSA), Social Security Administration, employee relationship. We use the
by the Office of Management and OLCA, Attn: Reports Clearance information to develop the employment
Budget (OMB) in compliance with Director, 3100 West High Rise, 6401 relationship; specifically, to determine
Public Law 104–13, the Paperwork Security Blvd., Baltimore, MD 21235, whether a beneficiary is self-employed
Reduction Act of 1995, effective October Fax: 410–966–2830, Email address: or an employee. The respondents are
1, 1995. This notice includes revisions, OR.Reports.Clearance@ssa.gov. individuals seeking to establish their
and one extension, of OMB-approved Or you may submit your comments status as employees, and their alleged
information collections. online through www.regulations.gov, employers.
SSA is soliciting comments on the referencing Docket ID Number [SSA– Type of Request: Revision of an OMB-
accuracy of the agency’s burden 2018–0024]. approved information collection.
Average Estimated total
Number of Frequency of burden per
amozie on DSK3GDR082PROD with NOTICES1
Modality of completion annual burden
respondents response response (hours)
(minutes)
SSA–7160–F4—Individuals ............................................................................. 8,000 1 25 3,333
SSA–7160–F4—Businesses ............................................................................ 7,200 1 25 3,000
SSA–7160–F4—State/Local Governemnt ....................................................... 800 1 25 333
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![Federal Register / Vol. 83, No. 111 / Friday, June 8, 2018 / Notices 26739
7. Authorization for the Social resources. The MMA mandates that the or continue to qualify, for the subsidy.
Security Administration to Obtain Government provide subsidies for those SSA uses Form SSA–4640 to: (1) Obtain
Account Records from a Financial individuals who qualify for the the individual’s consent to verify
Institution and Request for Records program, and who meet eligibility balances of financial institution (FI)
(Medicare)—20 CFR 418.3420—0960– criteria for help with premium, accounts; and (2) obtain verification of
0729. The Medicare Prescription Drug, deductible, or co-payment costs. SSA such balances from the FI. Respondents
Improvement, and Modernization Act of uses the SSA–4640, Authorization for are Medicare Part D program subsidy
2003 (MMA) established the Medicare the Social Security Administration to applicants or claimants, and their
Part D program for voluntary Obtain Account Records from a financial institutions.
prescription drug coverage of premium, Financial Institution and Request for
deductible, and copayment costs for Records (Medicare), to determine if Type of Request: Revision of an OMB-
individuals with limited income and subsidy applicants or recipients qualify, approved information collection.
Average Estimated total
Number of Frequency of burden per
Modality of completion annual burden
respondents response response (hours)
(minutes)
SSA–4640—Medicare Part D Subsidy Applicants .......................................... 5,000 1 1 83
SSA–4640—Financial Institutions ................................................................... 5,000 1 4 333
Total .......................................................................................................... 10,000 ........................ ........................ 416
Dated: June 4, 2018. has elapsed, whichever is later. The the SVB portion is 806(b) of the Act (42
Faye Lipsky, matching program will be in effect for U.S.C. 1006(b)).
Reports Clearance Director, Social Security a period of 18 months. Purpose(s): The purpose of this
Administration. ADDRESSES: Interested parties may matching program is to set forth the
[FR Doc. 2018–12395 Filed 6–7–18; 8:45 am] comment on this notice by either terms, safeguards, and procedures under
BILLING CODE 4191–02–P telefaxing to (410) 966–0869, writing to which RRB, as the source agency, will
Mary Ann Zimmerman, Acting disclose RRB annuity payment data to
Executive Director, Office of Privacy
SOCIAL SECURITY ADMINISTRATION SSA, the recipient agency. SSA will use
and Disclosure, Office of the General
the information to verify SSI and SVB
Counsel, Social Security
[Docket No. SSA 2017–0059]
Administration, G–401WHR Building, eligibility and benefit payment amounts.
6401 Security Boulevard, Baltimore, MD SSA will also record the railroad
Privacy Act of 1974; Matching Program annuity amounts RRB paid to SSI and
21235–6401, or email at
AGENCY: Social Security Administration Mary.Ann.Zimmerman@ssa.gov. All SVB recipients in the SSR.
(SSA). comments received will be available for Categories of Individuals: The
ACTION:Notice of a new matching public inspection by contacting Ms. individuals whose information is
program. Zimmerman at this street address. involved in this matching program are
FOR FURTHER INFORMATION CONTACT: applicants for and recipients of SSI
SUMMARY: In accordance with the Interested parties may submit general payments and SVB benefits.
provisions of the Privacy Act, as questions about the matching program
amended, this notice announces a new Categories of Records: SSA will match
to Mary Ann Zimmerman, Acting
matching program with the Railroad the Social Security number, name, date
Executive Director, Office of Privacy
Retirement Board (RRB). This matching of birth, and RRB claim number on the
and Disclosure, Office of the General
agreement sets forth the terms, Counsel, by any of the means shown RRB file and the SSR.
safeguards, and procedures under which above. System(s) of Records: RRB will
RRB, as the source agency, will disclose provide SSA with an electronic data file
RRB annuity payment data to SSA, the Mary Ann Zimmerman,
containing annuity payment data from
recipient agency. SSA will use the Acting Executive Director, Office of Privacy
RRB’s system of records, RRB–22
information to verify Supplemental and Disclosure, Office of the General Counsel.
Railroad Retirement, Survivor, and
Security Income (SSI) and Special Participating Agencies: SSA and RRB. Pensioner Benefits System, last
Veterans Benefits (SVB) eligibility and Authority for Conducting the published on May 15, 2015 (80 FR
benefit payment amounts. SSA will also Matching Program: The legal authority
record the railroad annuity amounts 28018). SSA will match RRB’s data with
for this agreement is executed in data maintained in the SSR,
RRB paid to SSI and SVB recipients in compliance with the Privacy Act of
the Supplemental Security Income Supplemental Security Income Record
1974, as amended by the Computer
Record (SSR). and Special Veterans Benefits, SSA/
Matching and Privacy Protection Act of
OITPBS, 60–0103, published on January
DATES: The deadline to submit 1988, the regulations and guidance
amozie on DSK3GDR082PROD with NOTICES1
comments on the proposed matching promulgated thereunder. Legal authority 11, 2006 (71 FR 1830) and December 10,
program is 30 days from the date of for the disclosure under this agreement 2007 (72 FR 69723). SVB data also
publication in the Federal Register. The for the SSI portion are 1631(e)(1)(A) and resides on the SSR.
matching program will be applicable on (B) and 1631(f) of the Social Security [FR Doc. 2018–12314 Filed 6–7–18; 8:45 am]
September 2, 2018 and will expire on Act (Act) (42 U.S.C. 1383(e)(1)(A) and BILLING CODE 4191–02–P
March 1, 2020, or once a minimum of (B) and 1383(f)). The legal authority for
30 days after publication of this notice the disclosure under this agreement for
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Document Created: 2018-06-08 01:22:40
Document Modified: 2018-06-08 01:22:40
| 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 | 83 FR 26736 |
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