Notice2021-14167
Agency Information Collection Activities: Proposed Request
Primary source
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Published
July 2, 2021
Issuing agencies
Social Security Administration
Full Text
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<title>Federal Register, Volume 86 Issue 125 (Friday, July 2, 2021)</title>
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[Federal Register Volume 86, Number 125 (Friday, July 2, 2021)]
[Notices]
[Pages 35371-35374]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2021-14167]
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SOCIAL SECURITY ADMINISTRATION
[Docket No: SSA-2021-0016]
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, and an 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.
Comments: <a href="https://www.reginfo.gov/public/do/PRAMain">https://www.reginfo.gov/public/do/PRAMain</a>. Submit your
comments online referencing Docket ID Number [SSA-2021-0016].
(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: <a href="/cdn-cgi/l/email-protection#dc938ef28eb9acb3aea8aff29fb0b9bdaebdb2bfb99cafafbdf2bbb3aa"><span class="__cf_email__" data-cfemail="024d502c5067726d7076712c416e676370636c6167427171632c656d74">[email protected]</span></a>.
Or you may submit your comments online through <a href="https://www.reginfo.gov/public/do/PRAMain">https://www.reginfo.gov/public/do/PRAMain</a>, referencing Docket ID Number [SSA-
2021-0016].
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 31, 2021. Individuals can obtain copies of the collection
instruments by writing to the above email address.
1. Request for Withdrawal of Application--20 CFR 404.640--0960-
0015. Form SSA-521, Request for Withdrawal of Application, allows
claimants to specify which application they want to withdraw and the
reason for the withdrawal. Form SSA-521 is our preferred instrument for
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 Form 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.
[[Page 35372]]
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Average
Average burden Estimated theoretical Total annual
Modality of completion Number of Frequency of per response total annual hourly cost opportunity
respondents response (minutes) burden (hours) amount cost (dollars)
(dollars) * **
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Respondents applying for or receiving Retirement, 60,753 1 5 5,063 * $10.95 ** $55,440
Survivors, or Health Insurance benefits................
Respondents applying for or receiving Disability 14,374 1 5 1,198 * 10.95 ** 13,118
benefits...............................................
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Totals.............................................. 75,127 .............. .............. 6,261 .............. ** 68,558
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* We based this figure on the average DI payments based on SSA's current FY 2021 data (<a href="https://www.ssa.gov/legislation/2021FactSheet.pdf">https://www.ssa.gov/legislation/2021FactSheet.pdf</a>).
** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; rather,
these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual charge to
respondents to complete the application.
2. Statement of Employer--20 CFR 404.801-404.803--0960-0030. When
workers report they were paid wages but cannot provide proof of those
earnings, and the wages do not appear in SSA's records of earnings, SSA
uses Form SSA-7011-F4, Statement of Employer, to document the alleged
wages. Specifically, the agency uses the form to resolve discrepancies
in the individual's Social Security earnings record and to process
claims for Social Security benefits. We only send Form SSA-7011-F4 to
employers if we are unable able to locate the earnings information
within our own records. The respondents are employers who can verify
wage allegations made by wage earners.
Type of Request: Revision of an OMB-approved information
collection.
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Average
Average burden Estimated total theoretical Total annual
Modality of completion Number of Frequency of per response annual burden hourly cost opportunity
respondents response (minutes) (hours) amount cost (dollars)
(dollars) * **
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SSA-7011-F4....................................... 500 1 30 250 * $27.07 ** $6,768
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* We based this figure on average U.S. worker's hourly wages, as reported by Bureau of Labor Statistics data (<a href="https://www.bls.gov/oes/current/oes_nat.htm#00-0000">https://www.bls.gov/oes/current/oes_nat.htm#00-0000</a>).
** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; rather,
these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual charge to
respondents to complete the application.
3. Statement of Care and Responsibility for Beneficiary--20 CFR
404.2020, 404.2025, 408.620, 408.625, 416.620, and 416.625--0960-0109.
SSA uses the information from Form SSA-788, Statement of Care and
Responsibility for Beneficiary, to verify payee applicants' statements
of concern, and to identify other potential payees. SSA is concerned
with selecting the most qualified representative payee who will use
Social Security benefits in the beneficiary's best interest. SSA
considers factors such as the payee applicant's capacity to perform
payee duties; awareness of the beneficiary's situation and needs;
demonstration of past, and current concern for the beneficiary's well-
being If the payee applicant does not have custody of the beneficiary,
SSA obtains information from the custodian for evaluation against
information the applicant provides. Respondents are individuals who
have custody of the beneficiary in cases where someone else has filed
to be the beneficiary's representative payee.
Type of Request: Revision of an OMB-approved information
collection.
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Average
Average burden Estimated total theoretical Total annual
Modality of completion Number of Frequency of per response annual burden hourly cost opportunity
respondents response (minutes) (hours) amount cost (dollars)
(dollars) * **
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SSA-788........................................... 134,000 1 10 22,333 * $27.07 ** $604,554
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* We based this figures on average U.S. citizen's hourly salary, as reported by Bureau of Labor Statistics data (<a href="https://www.bls.gov/oes/current/oes_nat.htm#00-00000">https://www.bls.gov/oes/current/oes_nat.htm#00-00000</a>).
** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; rather,
these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual charge to
respondents to complete the application.
4. 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 42 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 Supplemental Security Income (SSI) eligibility in
jurisdictions with such agreements are applications and
redeterminations of Medicaid eligibility.
[[Page 35373]]
Under these agreements, SSA obtains third party liability
information using Form SSA-8019-U2, Third Party Liability Information
Statement, 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.
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Average wait
Average time in field Total annual
Number of Frequency of Average burden Estimated theoretical office or for opportunity
Modality of completion respondents response per response total annual hourly cost teleservice cost (dollars)
(minutes) burden (hours) amount centers ***
(dollars) * (minutes) **
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SSA-8019-U2 (Paper)..................... 200 1 6 20 * $19.01 .............. *** $380
SSI Claims System (Intranet)............ 35,257 1 6 3,526 * 19.01 ** 21 *** 301,613
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Totals.............................. 35,457 .............. .............. 3,546 .............. .............. *** 301,993
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* We based this figure on averaging both the average DI payments based on SSA's current FY 2021 data (<a href="https://www.ssa.gov/legislation/2021FactSheet.pdf">https://www.ssa.gov/legislation/2021FactSheet.pdf</a>), and the average U.S. worker's hourly wages, as reported by Bureau of Labor Statistics data (<a href="https://www.bls.gov/oes/current/oes_nat.htm">https://www.bls.gov/oes/current/oes_nat.htm</a>).
** We based this figure on averaging both the average FY 2021 wait times for field offices and teleservice centers, based on SSA's current management
information data.
*** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; rather,
these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual charge to
respondents to complete the application.
5. Certificate of Election for Reduced Spouse's Benefits--20 CFR
404.421--0960-0398. SSA cannot pay reduced Social Security benefits to
an already entitled spouse unless the spouse elects to receive reduced
benefits and is (1) at least age 62, but under full retirement age; and
(2) no longer caring for a child. In this situation, spouses who decide
to elect reduced benefits must file Form SSA-25, Certificate of
Election for Reduced Spouse's Benefits. SSA uses the information to pay
qualified spouses who elect to receive reduced benefits. Respondents
are entitled spouses seeking reduced Social Security benefits.
Type of Request: Revision of an OMB approved information
collection.
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Average
Average burden Estimated total theoretical Total annual
Modality of completion Number of Frequency of per response annual burden hourly cost opportunity
respondents response (minutes) (hours) amount cost (dollars)
(dollars) * **
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SSA-25............................................ 30,000 1 13 6,500 * $27.07 ** $175,955
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* We based this figures on average U.S. citizen's hourly salary, as reported by Bureau of Labor Statistics data (<a href="https://www.bls.gov/oes/current/oes_nat.htm#00-00000">https://www.bls.gov/oes/current/oes_nat.htm#00-00000</a>).
** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; rather,
these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual charge to
respondents to complete the application.
6. Permanent Residence in the United States Under Color of Law
(PRUCOL)--20 CFR 416.1615 and 416.1618--0960-0451. Under 20 CFR
416.1415 and 416.1618, 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) using the DHS
Systemic Alien Verification for Entitlements (SAVE) program. SSA
determines if the individual qualifies for PRUCOL status based on the
SAVE program 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.
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Average
Average burden Estimated total theoretical Total annual
Modality of completion Number of Frequency of per response annual burden hourly cost opportunity
responses response (minutes) (hours) amount cost (dollars)
(dollars) * **
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Personal Interview................................ 1,049 1 5 87 * $27.07 ** $2,355
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* We based this figure on average U.S. worker's hourly wages, as reported by Bureau of Labor Statistics data (<a href="https://www.bls.gov/oes/current/oes_nat.htm#00-0000">https://www.bls.gov/oes/current/oes_nat.htm#00-0000</a>).
[[Page 35374]]
** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; rather,
these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual charge to
respondents to complete the application.
7. Request for Deceased Individual's Social Security Record--20 CFR
402.130--0960-0665. The Freedom of Information Act (FOIA), at 5 U.S.C.
552(a)(3) of the U.S. Code, provides instructions for members of the
public to request records from Federal agencies. When a member of the
public requests an individual's Social Security record under FOIA, SSA
needs the name and address of the requestor as well as a description of
the requested record to process the request. SSA uses the information
the respondent provides on Form SSA-711, Request for Deceased
Individual's Social Security Record, or via an internet request through
SSA's electronic Freedom of Information Act (eFOIA) website, to:
(1) Verify the wage earner is deceased; and (2) access the correct
Social Security record. Respondents are members of the public
requesting deceased individuals' Social Security records.
Type of Request: Revision of an OMB-approved information
collection.
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Average
Average burden Estimated theoretical Average wait Total annual
Modality of completion Number of Frequency of per response total annual hourly cost time in field opportunity
respondents response (minutes) burden (hours) amount office cost (dollars)
(dollars) * (minutes) ** ***
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Internet Request through eFOIA.......... 49,800 1 7 5,810 * $27.07 .............. *** $157,277
SSA-711 (paper)......................... 200 1 7 23 * 27.07 ** 24 *** 2,788
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Total............................... 50,000 .............. .............. 5,833 .............. .............. *** 160,065
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* We based this figure on average U.S. worker's hourly wages, as reported by Bureau of Labor Statistics data (<a href="https://www.bls.gov/oes/current/oes_nat.htm#00-0000">https://www.bls.gov/oes/current/oes_nat.htm#00-0000</a>).
** We based this figure on the average FY 2021 wait times for field offices, based on SSA's current management information data.
*** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; rather,
these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual charge to
respondents to complete the application.
8. Request for Business Entity Taxpayer Information--0960-0731. SSA
requires law firms or other business entities to complete Form SSA-
1694, Request for Business Entity Taxpayer Information, if they wish to
serve as appointed representatives and receive direct payment of fees
from SSA. SSA uses the information to issue a Form 1099-MISC. SSA also
uses the information to allow business entities to designate
individuals to serve as entity administrators authorized to perform
certain administrative duties on their behalf, such as providing bank
account information, maintaining entity information, and updating
individual affiliations. Respondents are law firms or other business
entities with attorneys or other qualified individuals as partners or
employees who represent claimants before SSA.
Type of Request: Revision of an OMB-approved information
collection.
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Average
Average burden Estimated theoretical Total annual
Modality of completion Number of Frequency of per response total annual hourly cost opportunity
respondents response (minutes) burden (hours) amount cost (dollars)
(dollars) * **
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SSA-1694 (Paper)........................................ 366 1 20 122 * $61.03 ** $7,446
BSO online submission................................... 103 1 20 34 * 61.03 ** 2,075
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Totals.............................................. 469 .............. .............. 156 .............. ** 9,521
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* We based this figure on the average legal occupation's hourly salary, as reported by Bureau of Labor Statistics data (<a href="https://www.bls.gov/oes/current/oes_nat.htm#00-00000">https://www.bls.gov/oes/current/oes_nat.htm#00-00000</a>).
** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; rather,
these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual charge to
respondents to complete the application.
Dated: June 29, 2021.
Eric Lowman,
Acting Reports Clearance Officer, Office of Legislative Development and
Operations, Social Security Administration.
[FR Doc. 2021-14167 Filed 7-1-21; 8:45 am]
BILLING CODE 4191-02-P
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This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.