[Federal Register Volume 65, Number 250 (Thursday, December 28, 2000)]
[Notices]
[Pages 82442-82444]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-33109]
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SOCIAL SECURITY ADMINISTRATION
Agency Information Collection Activities: Proposed Request and
Comment Request
The Social Security Administration (SSA) publishes a list of
information collection packages that will require clearance by the
Office of Management and Budget (OMB) in compliance with Pub. L. 104-13
effective October 1, 1995, The Paperwork Reduction Act of 1995. 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 on ways to minimize burden on
respondents, including the use of automated collection techniques or
other forms of information technology.
Written comments and recommendations regarding the information
collection(s) should be submitted to the SSA Reports Clearance Officer
and to the OMB Desk Officer at the following addresses:
(OMB), Attn: Desk Officer for SSA, New Executive Office Building,
Room 10230, 725 17th St., NW, Washington, DC 20503; (SSA), Social
Security Administration, DCFAM, Attn: Frederick W. Brickenkamp, 1-A-21
Operations Bldg., 6401 Security Blvd., Baltimore, MD 21235.
I. The information collections listed below will be submitted to
OMB within 60 days from the date of this notice. Your comments should
be submitted to SSA within 60 days from the date of this publication.
You can obtain a copy of the collection instruments by calling the SSA
Reports Clearance Officer at 410-965-4145, or by writing to him at the
address listed above.
1. Pre-1957 Military Service Federal Benefit Questionnaire--0960-
0120. Form SSA-2512 collects data used in the claims adjudication
process to grant gratuitous military wage credits, when applicable, and
solicits sufficient information to make a determination of eligibility.
The respondents are individuals who are applying for Social Security
benefits on the record of a wage earner with pre-1957 military service.
Number of Respondents: 12,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 2,000 hours.
2. Application for a Social Security Card--0960-0066. The
information collected on form SS-5 is needed to assign a Social
Security Number (SSN) and issue a card. SSA screens its records to make
sure applicants for original SSN cards don't already have SSNs before
assigning an original number. SSA also uses the information from the
SS-5 to insure that replacement SSN cards are issued to the correct
number holder. Use of SSNs enables SSA to keep an accurate record of
each individual's earnings for the payment of benefits and for
administrative purposes as an identifier for health-maintenance and
income-maintenance programs, such as the Retirement, Survivors and
Disability Insurance programs, the SSI program and other programs
administered by the Federal government including Black Lung, Medicare
and veterans compensation and pension programs. The Internal Revenue
Service uses the SSN as a taxpayer identification number for those
individuals who are eligible to be assigned an SSN. The respondents are
applicants for original, duplicate or corrected Social Security cards.
Number of Respondents: 17.6 million.
Frequency of Response: 1.
Average Burden Per Response: 8\1/2\-9 minutes.
Estimated Annual Burden: 2,501,667 hours.
3. Certificate of Responsibility for Welfare and Care of Child Not
in Applicant's Custody--0960-0019. SSA uses the information collected
on form SSA-781 to decide if ``in care'' requirements are met by non-
custodial parent(s), who is filing for benefits based on having a child
in care. The respondents are non-custodial wage earners whose
entitlement to benefits depends upon having an entitled child in care.
Number of Respondents: 14,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 2,333 hours.
4. Questionnaire for Children Claiming SSI Benefits--0960-0499. The
information collected on form SSA-3881 is used by SSA to evaluate
disability in children who apply for
[[Page 82443]]
Supplemental Security Income (SSI) payments. The respondents are
individuals who apply for SSI benefits for a disabled child.
Number of Respondents: 272,000.
Frequency of Response: 1.
Average Burden Per Response: 30 minutes.
Estimated Annual Burden: 136,000 hours.
II. The information collections listed below have been submitted to
OMB for clearance. Your comments on the information collections would
be most useful if received by OMB and SSA within 30 days from the date
of this publication. You can obtain a copy of the OMB clearance
packages by calling the SSA Reports Clearance Officer on (410) 965-
4145, or by writing to him at the address listed above.
1. Child Relationship Statement--0960-0116. SSA uses the
information collected on Form SSA-2519 to help determine the
entitlement of children to Social Security benefits under section
216(h)(3) of the Social Security Act (deemed child provision). The
respondents are persons providing information about the relationship
between the worker and his/her alleged biological child, in connection
with the child's application for benefits.
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 12,500 hours.
2. Request to Resolve Questionable Quarters of Coverage (QC);
Request for QC History Based on Relationship--0960-0575. Form SSA-512
is used by the States to request clarification from SSA on questionable
QCs information. The Personal Responsibility and Work Opportunity
Reconciliation Act states that aliens admitted for lawful residence who
have worked and earned 40 qualifying QCs for Social Security purposes
can generally receive State benefits. Form SSA-513 is used by States to
request QC information for an alien's spouse or child in cases where
the alien does not sign a consent form giving permission to access his/
her Social Security records. QCs can also be allocated to a spouse and/
or to a child under age 18, if needed, to obtain 40 qualifying QCs for
the alien. The respondents are State agencies that require QC
information in order to determine eligibility for benefits.
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SSA-512 SSA-513
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Number of Respondents........................... 200,000 350,000
Frequency of Response........................... 1 1
Average Burden Per Response (minute)............ 2 2
Estimated Annual Burden (hours)................. 6,667 11,667
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3. Affective Disorder Treatment Demonstration Project--0960-NEW
Background
There is substantial research evidence that affective disorders
(i.e., mental disorders that affect a person's mood, such as depression
and bipolar disorder) usually respond to treatment; there is also
evidence that many individuals with affective disorders do not receive
effective treatment. The cost of care is one of the reasons for the low
treatment rates of individuals with affective disorder. This may be
true for many beneficiaries, particularly those in the Medicare waiting
period. Therefore, SSA will test the hypothesis that providing access
to treatment will result in improved health status of Disability
Insurance (DI) beneficiaries with affective disorders, which might, in
turn, lead to increased labor force participation and self-sufficiency.
This outcome would benefit both participants and taxpayers.
The Demonstration Project
SSA plans to implement a 5-year demonstration project that will
test the effectiveness of providing better access to quality affective
disorders treatments for DI beneficiaries who have an affective
disorder as their primary reason for disability. Several forms and
survey instruments will be used during the demonstration to collect
information for screening program participants, beneficiary protection,
and program evaluation. Some of the data will be collected from
beneficiaries, and other data will be collected from the medical
service providers who treat beneficiaries during the study.
The respondents to this collection will be randomly selected DI
beneficiaries with an affective disorder and their health care
providers.
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Annual Average Estimated
number of Frequency burden per annual
respondents of response response burden
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Beneficiary:
Beneficiary telephone screening............................. 1,068 1 16 285
Authorization for release of medical information............ 855 1 5 71
Baseline survey............................................. 400 1 35 233
8-Month follow-up survey.................................... 380 1 32 203
16-Month follow-up survey................................... 361 1 32 193
24-Month follow-up survey................................... 343 1 32 183
32-Month follow-up survey................................... 326 1 35 190
Health Provider:
Copy medical records........................................ 667 1 20 222
Medical records questionnaire............................... 667 1 10 111
Treatment participation screen.............................. 200 1 15 50
Provider credentialing questionnaire........................ 150 1 15 38
Initial treatment plan...................................... 150 1 30 75
Quarterly progress report................................... 143 8 30 572
Total Respondents..................................... 5,708
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Total Annual Burden Hrs............................... ........... ........... ........... 2,426
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[[Page 82444]]
Dated: December 21, 2000.
Elizabeth A. Davidson,
Acting Reports Clearance Officer, Social Security Administration.
[FR Doc. 00-33109 Filed 12-27-00; 8:45 am]
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