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Federal Register / Vol. 86, No. 186 / Wednesday, September 29, 2021 / Notices
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.

Number of respondents
Modality of completion
credit additional quarters of coverage to give the individual insured status and expedite benefit payments. Respondents are self-employed individuals potentially eligible for Social Security benefits.
Type of Request: Revision of an OMBapproved information collection.

year. SSA uses Form SSA766, 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
3. Statement of Self-Employment Income20 CFR 404.101, 404.110, &
404.109609600046. To qualify for insured status, and collect Social Security benefits, self-employed individuals must demonstrate they earned the minimum amount of selfemployment income SEI in a current
SSA766

Frequency of response
910

Average burden per response minutes
1

Estimated total annual burden hours 5

76

Average theoretical hourly cost amount dollars
$27.07

Total annual opportunity cost dollars
$2,057

We based this figure on the average U.S. workers hourly wages, as reported by Bureau of Labor Statistics data https www.bls.gov/oes/current/oes_nat.htm00-0000.
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.

4. Substitution of Party Upon Death of Claimant20 CFR 404.957c4 &
416.1457c409600288. A judge may dismiss a request for a hearing on a pending claim of a deceased individual for Social Security benefits or Supplemental Security Income SSI
payments. Individuals who believe the dismissal may adversely affect them may complete Form HA539, Notice
Regarding Substitution of Party Upon Death of Claimant, which allows them to request to become a substitute party for the deceased claimant. The judge and the hearing office support staff use the information from the HA539 to: 1
Maintain a written record of request; 2
establish the relationship of the requester to the deceased claimant; 3
determine the substituted individuals
Number of respondents
Modality of completion
HA539

Frequency of response
4,000

Average burden per response minutes
1

wishes regarding an oral hearing or decision on the record; and 4 admit the data into the claimants official record as an exhibit. The respondents are individuals requesting to be substitute parties for a deceased claimant.
Type of Request: Revision of an OMBapproved information collection.
Estimated total annual burden hours
5

333

Average theoretical hourly cost amount dollars
$10.95

Total annual opportunity cost dollars
$3,646

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We based this figure on the average DI payments based on SSAs current FY 2021 data https www.ssa.gov/legislation/2021FactSheet.pdf.
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. Continuation of Supplemental Security Income Payments for the Temporarily Institutionalized Certification of Period and Need to Maintain Home20 CFR
416.212b109600516. When SSI
recipients: 1 Enter a public institution;
or 2 enter a private medical treatment facility with Medicaid paying more than 50 percent of expenses, SSA reduces recipients SSI payments to a nominal sum. However, if this institutionalization is temporary defined as a maximum of three months, SSA may waive the reduction.
Before SSA can waive the SSI payment reduction, the agency must receive the
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following documentation: 1 A
physicians certification stating the SSI
recipient will only be institutionalized for a maximum of three months; and 2
certification from the recipient, the recipients family, or friends, confirming the recipient needs SSI payments to maintain the living arrangements to which the individual will return postinstitutionalization. To obtain this information, SSA employees contact the recipient or a knowledgeable source to collect the required physicians certification and the statement of need.
SSA does not require any specific format for these items, so long as we obtain the necessary attestations. The
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respondents are SSI recipients, their family or friends, as well as physicians or hospital staff members who treat the SSI recipient.
Type of Request: Revision of an OMBapproved information collection.
NOTE: We created a fillable PDF form to collect the same information as collected through the SSI Claims System screens. The new form, SSA186, Temporary Institutionalization Statement to Maintain Household and Physician Certification, will make it easier for the recipients, representative payees, and institutions to obtain the statement of need and the physicians certification all on one standardized document.

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