s4191-02-U
SOCIAL SECURITY ADMINISTRATION
[Docket No: SSA-2024-0025]
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 of OMB-approved information collections, and one new collection for
OMB-approval.
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
(SSA)
Social Security Administration, OLCA
Attn: Reports Clearance Director
Mail Stop 3253 Altmeyer
6401 Security Blvd.
Baltimore, MD 21235
Fax: 833-410-1631

Email address: OR.Reports.Clearance@ssa.gov
Or you may submit your comments online through
https://www.reginfo.gov/public/do/PRAmain by clicking on Currently under Review Open for Public Comments and choosing to click on one of SSA’s published items. Pleas
reference Docket ID Number [SSA-2024-0025] in your submitted response.
I.

The information collection below is pending at SSA. SSA will submit it 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 [INSERT DATE 60 DAYS AFTER DATE OF
PUBLICATION IN THE FEDERAL REGISTER]. Individuals can obtain copies
of the collection instruments by writing to the above email address.
1. Social Security Number Verification Services -- 20 CFR 401.45 -0960-0660. Internal Revenue Service regulations require employers to provide
wage and tax data to SSA using Form W-2, or its electronic equivalent. As
part of this process, the employer must furnish the employee’s name and Social
Security number (SSN). In addition, the employee’s name and SSN must
match SSA’s records for SSA to post earnings to the employee’s earnings
record, which SSA maintains. SSA offers the Social Security Number
Verification Service (SSNVS), which allows employers to verify the reported
names and SSNs of their employees match those in SSA’s records. SSNVS is
a cost-free, voluntary method for employers to verify employee information via
the Internet. SSA annotates data an employer supplies to SSA for verification
that does not match SSA’s records with a no match indicator and returns it to
the employer. The respondents are employers who need to verify SSN data
using SSA’s records.
Type of Request: Revision of an OMB-approved information collection.

Modality of
Completion

SSNVS

Number of
Frequency Number
Average
Respondents of
of
Burden
Response Responses per
Response
(minutes)

Estimated
Total
Annual
Burden
(hours)

Average
Theoretical
Hourly
Cost
Amount
(dollars)*
44,891
60 2,663,460
5
221,955
$43.65*
* We based this figure on the average hourly wage for Accountants and

Total
Annual
Opportunity
Cost
(dollars)**
$9,688,336**

Auditors, as reported by the U.S. Bureau of Labor Statistics data
(https://www.bls.gov/oes/current/oes132011.htm).
** 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. 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. While SSA respondents may submit these
requests in writing, SSA also allows for the use of Form SSA-711, Deceased
Individual’s Social Security Records, for FOIA requests for a deceased
individual’s records for genealogical research, family estate matters, and other
reasons. SSA then uses the information the respondent provides on Form
SSA-711, or via an Internet request through SSA’s electronic Freedom of
Information Act Xpress (FOIAXpress) 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.
Modality of
Completion

Number of
Frequency Average
Respondents of
Burden
Response
Per
Response
(minutes)

Internet
Request
through
FOIAXpress
SSA-711
(paper)
Total

Estimated
Total
Annual
Burden
(hours)

Average
Theoretical
Hourly Cost
Amount
(dollars)*

49,800

7

5,810

$31.48*

1

23

$31.48*

Average
Wait Time
in Field
Office or
for
Teleservice
Centers
(minutes)
**

Total Annual
Opportunity
Cost
(dollars)***

$182,899***

21**

$2,928***

50,000
5,833
$185,827***
* We based this figure on average U.S. worker’s hourly wages, as reported by
Bureau of Labor Statistics data (https://www.bls.gov/oes/current/oes_nat.htm).
** We based this figure on averaging both the average FY 2024 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.
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 [INSERT DATE 30 DAYS
AFTER DATE OF PUBLICATION IN THE FEDERAL REGISTER].

Individuals can obtain copies of these OMB clearance packages by writing to the
OR.Reports.Clearance@ssa.gov.
1. Supportive Housing & Individual Placement and Support (SHIPS) Study - 0960-NEW
Background:
Homelessness and unemployment are linked issues, with rising housing costs
often leaving people unable to afford homes when combined with
unemployment. The instability of housing makes finding employment even
more challenging, creating a difficult cycle to break. While studies have
shown that supportive housing programs improve housing stability, there is no
significant evidence that such programs reliably increase employment among
residents. (For the purposes of this study, we define supportive housing as
housing services coupled with additional services that include case
management support. These include place-based permanent supportive
housing, scattered site permanent supportive housing, and rapid rehousing.)
Conversely, Individual Placement and Support (IPS), a proven method for
supporting employment, has not demonstrated effectiveness in stabilizing
housing. SSA is requesting clearance to collect data for the Supportive
Housing and Individual Placement and Support (SHIPS) study, under the
Interventional Cooperative Agreement Program (ICAP), to determine whether
participation in Individual Placement and Support (IPS) improves the
employment, income, health, and self-sufficiency of people who are recently
homeless and living in supportive housing. ICAP allows SSA to partner with
various non-federal groups and organizations to advance interventional
research connected to the Supplemental Security Income (SSI) and Social
Security Disability Insurance (SSDI) programs. SSA awarded Westat a

cooperative agreement to conduct SHIPS. In addition to SSA, Westat is
partnering with three subrecipients for this project: (1) People Assisting the
Homeless (PATH), (2) the University of Southern California (USC), and
(3) the Research Foundation for Mental Hygiene (RFMH) to implement the
SHIPS study.
ICAP SHIPS Study Project Description
The SHIPS study is a randomized controlled trial (RCT) designed to determine
whether participation in Individual Placement and Support (IPS) improves the
employment, income, health, and self-sufficiency of people who are recently
homeless and living in supportive housing. The SHIPS study will mark the
first study testing the effectiveness of implementing IPS in a supportive
housing program. SSA hypothesizes that combining the two most successful
evidence-based practices that separately address homelessness and supported
employment will yield a single intervention that effectively addresses both.
The intent of the SHIPS study is to measure the effectiveness of
evidence-based IPS compared to the services provided by local WorkSource
Centers broadly available to jobseekers in the Los Angeles area, The housing
case managers will refer PATH clients interested in finding employment and
will randomly assign participants to one of two groups:
a. IPS: The Individual Placement and Support (IPS) service team will offer a
range of structured services customized to participants’ personal needs,
preferences, and challenges related to disabilities and/or mental health
conditions. IPS was specifically designed as a supported employment
model for individuals with serious mental illness and includes standardized
training and fidelity requirements. Components of IPS that differ from
those offered by WorkSource Services include integrated treatment that

incorporates vocational and mental health services; benefits planning; and
focus on rapid job search without extensive training.
b. WorkSource Centers: Under PATH’s current housing model, housing
case managers refer PATH clients who express interest in finding
employment to local American Job Centers, known as WorkSource Centers
in Los Angeles. The City of Los Angeles Economic and Workforce
Development Department operates the WorkSource Centers, and follow an
employment services model that varies by WorkSource Center; is not
evidence-based or subject to fidelity monitoring, and is not necessarily
responsive to the individual needs of jobseekers with disabilities.
The primary goals of the SHIPS study are:
•

To measure the effects of IPS participation on employment, income,
health, and long-term self-sufficiency measured as a combination of
housing stability, income, and receipt of DI and SSI benefits.

•

To describe the study population in order to understand both the
generalizability of the study’s findings and the potential reasons for the
observed effects.

•

To explore the IPS implementation process to understand barriers and
facilitators to high-fidelity IPS implementation in the supportive housing
context.

Grantee researchers and SSA will use the information collected during this
study to 1) assess the short-term and long-term effectiveness of the proposed
intervention to improve employment, income, and self-sufficiency;
2) understand the implementation process; 3) provide detailed subgroupspecific data related to the effect of IPS.

The respondents are residents in supportive housing units operated by PATH
who are unemployed and looking for employment.
Modality of
Completion

Number of
Respondents

Frequency Number of Average
of
Responses Burden
Response
per
Response
(minutes)

Estimated
Total
Annual
Burden
(hours)

Average
Theoretical
Hourly Cost
Amount
(dollars)*

Average
Wait Time in
Office or for
Teleservice
Centers
(minutes) **

Total Annual
Opportunity
Cost
(dollars)***

Study
enrollees:
baseline
interview

1

60

$13.30*

24**

$3,724***

Study
enrollees:
quarterly
interviews
Study
enrollees:
final
interview
PATH
Interviews:
Staff
SHIPS
Interviews:
enrollees
Totals

7

1,400

233

$13.30*

21**

$4,030***

1

60

$13.30*

21**

$3,591***

1

60

$31.94*

24**

$224***

1

60

$13.30*

24**

$93***

250
643
$11,662***
* We based this figure on the average DI payments based on SSA's current FY
2024 data (https://mwww.ba.ssa.gov/legislation/2024FactSheet.pdf), and
survey researchers (https://www.bls.gov/oes/current/oes193022.htm)
** We based this figure on averaging both the average FY 2024 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.

2. Partnership Questionnaire -- 20 CFR 404.1080-404.1082 -- 0960-0025.
SSA considers partnership income in determining entitlement to Social
Security benefits. SSA uses information from Form SSA-7104 to determine
several aspects of eligibility for benefits, including the accuracy of reported
partnership earnings; the veracity of a retirement; and lag earnings where SSA
needs this information to determine the status of the insured. The respondents
are applicants for, and recipients of, Title II Social Security benefits who are
reporting partnership earnings.
Type of Request: Revision of an OMB-approved information collection.
Modality of Number of
Frequency Average
Completion Respondents of
Burden
Response Per
Response
(minutes)
SSA-7104
(mailed)
SSA-7104
(completed
in or
brought to a
field office)
Totals

Estimated
Total
Annual
Burden
(hours)

2,154

30

Average
Theoretical
Hourly
Cost
Amount
(dollars)*
1.077
$31.48*

2,154

30

1,077

$31.48*

Average
Wait Time
in Field
Office
(minutes)**

Total
Annual
Opportunity
Cost
(dollars)***
$33,904***

24**

$61,040***

4308
2154
$94,944***
* We based this figure on average the U.S. citizen’s hourly salary, as reported
by Bureau of Labor Statistics data
(https://www.bls.gov/oes/current/oes_nat.htm).
** We based this figure on the average FY 2024 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.

3. Certification by Religious Group -- 20 CFR 404.1075 -- 0960-0093. SSA is
responsible for determining whether religious groups meet the qualifications
exempting certain members and sects from payment of Self-Employment
Contribution Act taxes under the Internal Revenue Code, Section 1402(g).
SSA sends Form SSA-1458, Certification by Religious Group, to a group’s
authorized spokesperson to complete and verify organizational members meet
or continue to meet the criteria for exemption. The respondents are
spokespersons for religious groups or sects.
Type of Request: Revision of an OMB-approved information collection.
Modality of Number of
Frequency Average
Completion Respondents of
Burden
Response per
Response
(minutes)
SSA-1458

Estimated
Total
Annual
Burden
(hours)

Average
Total
Theoretical Annual
Hourly
Opportunity
Cost
Cost
Amount
(dollars)**
(dollars)*
142
1
15
35
$31.48*
$1,102**
* We based this figure on average U.S. worker’s hourly wages, as reported by
Bureau of Labor Statistics data
(https://www.bls.gov/oes/current/oes_nat.htm).
** 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. Medical Source Statement of Ability To Do Work Related Activities
(Physical and Mental) -- 20 CFR 404.1512-404.1513, 416.912-416.913,
404.1517, and 416.917 -- 0960-0662. When a claimant appeals a denied
disability claim, SSA may ask the claimant to have a consultative examination
at the agency’s expense, if the claimant’s medical sources cannot, or will not,
give the agency sufficient evidence to determine whether the claimant is

disabled. The medical providers who perform these consultative examinations
provide a statement about the claimant’s state of disability. Specifically, these
medical source statements determine the work-related capabilities of these
claimants. SSA collects the medical data on the HA-1151 and HA-1152 to
assess the work-related physical and mental capabilities of claimants who
appeal SSA’s previous determination on their issue of disability. The
respondents are medical sources who provide reports based either on existing
medical evidence or on consultative examinations.
Type of Request: Revision of an OMB-approved information collection.
Modality of Number of
Frequency Average
Completion Respondents of
Burden
Response Per
Response
(minutes)

Estimated
Total
Annual
Burden
(hours)

Average
Total Annual
Theoretical Opportunity
Hourly
Cost
Cost
(dollars)**
Amount
(dollars)*
HA-1151
5,000
30
15
37,500
$49.07*
$1,840,125**
HA-1152
5,000
30
15
37,500
$49.07*
$1,840,125**
Totals
10,000
75,000
$3,680,250**
* We based this figure on average medical professionals’ salaries, as reported
by the U.S. Bureau of Labor Statistics
(https://www.bls.gov/oes/current/oes290000.htm).
** 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. Filing Claims Under the Federal Tort Claims Act -- 20 CFR 429.101429.110 -- 0960-0667. The Federal Tort Claims Act (FTCA) is the mechanism
for compensating people who Federal employees injured through negligent or
wrongful acts that occurred during the performance of those employees’

official duties. SSA accepts claims filed under the FTCA for damages against
the United States; loss of property; personal injury; or death resulting from an
SSA employee’s wrongful act or omission. The various types of claims
included under this information collection request require claimants to provide
information SSA can use to determine whether to make an award, compromise,
or settlement under the FTCA. The respondents are individuals or entities
making a claim under the FTCA.
Type of Request: Revision of an OMB-approved information collection.
Regulation
Citations

429.102;
429.103*
429.104(a)
429.104(b)
429.104(c)
429.106(b)
Totals

Number of
Frequency Average
Respondents of
Burden
Response Per
Response
(minutes)
1

Estimated
Total
Annual
Burden
(hours)
Average
Theoretical
Hourly
Cost
Amount
(dollars)**
$31.48**

Total
Annual
Opportunity
Cost
(dollars)***
$0***

8
1
60
8
$31.48**
$252***
30
1
60
30
$31.48**
$944***
1
1
60
1
$31.48**
$32***
1
1
60
1
$31.48**
$32***
41
40
$1,260***
* We are including a one-hour placeholder burden for 20 CFR 429.102 and
429.103, as respondents complete OMB-approved Form SF-95,
OMB No. 1105-0008. Since the burden for these citations is covered under a
separate OMB number, we are not double-counting the burden here.
** We based this figure on the average U.S. citizen’s hourly salary, as reported
by the U.S. Bureau of Labor Statistics
(https://www.bls.gov/oes/current/oes_nat.htm#00-0000).
*** 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. Internet and Telephone Appointment Applications -- 20 CFR
404.620-404.630, 416.330-416.340 -- 0960-0822. SSA offers both Internet
and Telephone appointment options for applicants or recipients who wish to
request an appointment when they are unable to complete one of SSA’s online
or automated telephone applications because they failed the initial verification
checks, or when they state their reading language preference is other than
English.
SSA offers two modalities for scheduling appointments: (1) an Internet-based
option (iAppointment), and (2) the Enhanced Leads and Appointment System
(eLAS):
iAppointment: iAppointment is an online process that allows members of the
public an easy-to-use method to schedule an appointment with the servicing
office of their choice. Since the application date can affect when a claimant’s
benefit begins, iAppointment establishes a protective filing date and provides
respondents information related to the date by which they must file their actual
application. The iAppointment application propagates information the
applicant already entered onto any of SSA’s Internet applications for SSN,
name, date of birth, and gender. However, applicants must provide minimal
additional information: mailing address; telephone number; language
preference; type of appointment (Disability, Retirement, Medicare); and
whether they prefer a telephone interview or in-office appointment.
iAppointment is a customer-centric application. If the available appointment
times do not meet the customer’s needs, iAppointment allows them to enter a
different zip code to identify another field office, which may offer different

appointment times. At this time, SSA only allows domestic first party
applicants to use iAppointment. If users indicate they are filing as third parties,
iAppointment provides a message directing them to call the National 800
Number for assistance. If a foreign first party user is unable to complete
iClaim, iAppointment directs them to contact a Social Security representative,
and provides a link to SSA’s Service Around the World website.
Enhanced Leads and Appointment System (eLAS) – eLAS is an Intranetbased version of the iAppointment screens for use by SSA technicians both in
the field offices and call centers. eLAS interacts with iAppointment directly to
ensure we always record the same information whether an individual requests
an appointment through our Internet screens, or via telephone. eLAS is a
non-public facing system that allows SSA employees in the field offices,
workload support units, and teleservice centers to use an telephone interview
process to schedule appointments and document an individual’s intent to file
using a specific script and asking the same questions to each individual. We
use eLAS with individuals who use our automated telephone system, or who
prefer not to use iAppointment to set up their appointment.
The respondents are individuals who are unable to use our Internet or
automated telephone systems because they failed the initial verification checks,
or because they state their reading language preference is other than English

Modality
of
Completion

iAppointment

Number of
Frequency Average
Respondents of
Burden
Response Per
Response
(minutes)

20,965

10

Estimated
Annual
Burden
(hours)

Average
Theoretical
Cost
Amount
(dollars)*

3,494

$31.48*

Average
Combined
Wait Time
in Field
Office or
for
Teleservice
Center
(minutes)**

Total Annual
Opportunity
Cost (dollars)
***

$103,981***

eLAS
Totals

7,270,161
1
10 1,211,694
$31.48*
7,291,126
1,215,188
Type of Request: Request for a new information collection.

21**

$111,786***
$215,767***

* We based these figures on average U.S. worker’s hourly wages (based on BLS.gov
data, (https://www.bls.gov/oes/current/oes_nat.htm#00-0000).
** We based this figure on the combined average FY 2024 wait times for field offices
(approximately 24 minutes per respondent) and teleservice centers (approximately 17
minutes per respondent), 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.
Dated: June 28, 2024.
Tasha Harley,
Acting Reports Clearance Officer,
Social Security Administration.
[FR Doc. 2024-14685 Filed: 7/3/2024 8:45 am; Publication Date: 7/5/2024]