Daily Rules, Proposed Rules, and Notices of the Federal Government


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 to 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.


Office of Management and Budget, Attn: Desk Officer for SSA, Fax: 202-395-6974, Email


Social Security Administration, DCRDP, Attn: Reports Clearance Director, 107 Altmeyer Building, 6401 Security Blvd., Baltimore, MD 21235, Fax: 410-966-2830, Email

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 December 14, 2012. Individuals can obtain copies of the collection instruments by writing to the above email address.

1.Certificate of Support--20 CFR 404.370, 404.750, 404.408a--0960-0001.A parent of a deceased, fully insured worker may be entitled to Social Security Old-Age, Survivors, and Disability Insurance (OASDI) benefitsbased on the earnings record of the deceased worker under certain conditions. One of the conditions is the parent must have received at least one-half support from the deceased worker. The one-half support requirement also applies to a spousal applicant in determining whether OASDI benefits are subject to Government Pension Offset (GPO). SSA uses the information from Form SSA-760-F4 to determine if the parent of a deceased worker or a spouse applicant meets the one-half support requirement. Respondents are (1) parents of deceased workers and (2) spouses who may meet the GPO exception.

Type of Request:Revision of an OMB-approved information collection.

2.Pre-1957 Military Service Federal Benefit Questionnaire--20 CFR 404.1301-404.1371--0960-0120.SSA may grant gratuitous military wage credits for active military or naval service (under certain conditions) during the period September 16, 1940 through December 31, 1956, if no other Federal agency (other than the Veterans Administration) credited the service for benefit eligibility or computation purposes. We use Form SSA-2512 to collect specific information about other Federal, military, or civilian benefits the wage earner may receive when the applicant indicates both pre-1957 military service and the receipt of a Federal benefit. SSA uses the data in the claims adjudication process to grant gratuitous military wage credits when applicable, and to solicit sufficient information to determine eligibility. Respondents are applicants for Social Security benefits on a record where the wage earner claims pre-1957 military service.

Type of Request:Revision of an OMB-approved information collection.

3.Authorization for the Social Security Administration to Obtain Account Records from a Financial Institution and Request for Records--20 CFR 416.200, 416.203--0960-0293.SSA collects and verifies financial information from individuals applying for Supplemental Security Income (SSI) to determine if the applicant meets the SSI resource eligibility requirements. If the SSI claimants provide records that are incomplete, unavailable, or seemingly altered, SSA contacts their financial institution to verify the existence, ownership, and value of accounts owned. Financial institutions require individuals to sign Form SSA-4641-U2 to authorize them to disclose records to SSA. The respondents are financial institutions of SSI applicants, recipients, and their deemors.

Type of Request:Revision of an OMB-approved information collection.

4.Response to Notice of Revised Determination--20 CFR 404.913-404.914, 404.992(b), 416.1413-416.1414 and 416.1492(d)--0960-0347.When SSA determines that (1) claimants for initial disability benefits do not actually have a disability or (2) current disability recipients' records show their disability ceased, SSA notifies the disability claimants or recipients of this decision. In response to this notice, the affected claimants and disability recipients have the following recourse: (1) They may request a disability hearing to contest SSA's decision and (2) they may submit additional information or evidence for SSA to consider. Disability claimants, recipients, and their representatives use Form SSA-765 to accomplish these two actions. The respondents are disability claimants, current disability recipients, or their representatives.

Type of Request:Revision of an OMB-approved information collection.

5.Notification of a Social Security Number (SSN) To An Employer for Wage Reporting--20 CFR 422.103(a)--0960-0778.Individuals applying for employment must provide an SSN or indicate they have applied for one. However, when an individual applies for an initial SSN, there is a delay between the assignment of the number and the delivery of the SSN card. At an individual's request, SSA uses Form SSA-132 to send the individual's SSN to an employer. Mailing this information to the employer (1) ensures the employer has the correct SSN for the individual; (2) allows SSA to receive correct earnings information for wage reporting purposes; and (3) reduces the delay in the initial SSN assignment and delivery of the SSN information directly to the employer. It also enables SSA to verify the employer as a safeguard for the applicant's personally identifiable information. The majority of individuals who take advantage of this option are in the United States with exchange visitor and student visas; however, we allow any applicant for an SSN to use the SSA-132. The respondents are individuals applying for an initial SSN who ask SSA to mail confirmation of their application or the SSN to their employers.

Type of Request:Revision of an OMB-approved information collection.

Dated: October 10, 2012. Faye Lipsky, Reports Clearance Director, Social Security Administration.