Agency Information Collection Activities: Proposed Request and Comment Request, 24307-24310 [2015-10057]

Download as PDF Federal Register / Vol. 80, No. 83 / Thursday, April 30, 2015 / Notices Putnam Capital Appreciation Fund [File No. 811–7061] Summary: Applicant seeks an order declaring that it has ceased to be an investment company. Applicant transferred its assets to Putnam Investors Fund, and on December 29, 2008, made a distribution to its shareholders based on net asset value. Expenses of approximately $66,568 incurred in connection with the reorganization were paid by applicant. Filing Date: The application was filed on April 15, 2015. Applicant’s Address: One Post Office Sq., Boston, MA 02109. Putnam Classic Equity Fund [File No. 811–7223] Summary: Applicant seeks an order declaring that it has ceased to be an investment company. Applicant transferred its assets to The Putnam Fund for Growth and Income, and on December 29, 2008, made distributions to its shareholders based on net asset value. Expenses of approximately $66,568 incurred in connection with the reorganization were paid by applicant. Filing Date: The application was filed on April 15, 2015. Applicant’s Address: One Post Office Sq., Boston, MA 02109. mstockstill on DSK4VPTVN1PROD with NOTICES Putnam Discovery Growth Fund [File No. 811–6203] Summary: Applicant seeks an order declaring that it has ceased to be an investment company. Applicant transferred its assets to Putnam New Opportunities Fund (now known as Putnam Multi-Cap Growth Fund), and on December 29, 2008, made a distribution to its shareholders based on net asset value. Expenses of approximately $66,568 incurred in connection with the reorganization were paid by applicant. Filing Date: The application was filed on April 15, 2015. Applicant’s Address: One Post Office Sq., Boston, MA 02109. Putnam OTC & Emerging Growth Fund [File No. 811–3512] Summary: Applicant seeks an order declaring that it has ceased to be an investment company. Applicant transferred its assets to Putnam Vista Fund, and on December 29, 2008, made distributions to its shareholders based on net asset value. Expenses of approximately $66,568 incurred in connection with the reorganization were paid by applicant. Filing Date: The application was filed on April 15, 2015. Applicant’s Address: One Post Office Sq., Boston, MA 02109. VerDate Sep<11>2014 17:01 Apr 29, 2015 Jkt 235001 Putnam Tax-Free Health Care Fund [File No. 811–6659] Summary: Applicant, a closed-end investment company, seeks an order declaring that it has ceased to be an investment company. Applicant transferred its assets to Putnam Tax Exempt Income Fund, and on September 17, 2007, made a distribution to its shareholders based on net asset value. Expenses of approximately $335,299 incurred in connection with the reorganization were paid by applicant. Filing Date: The application was filed on April 13, 2015. Applicant’s Address: One Post Office Sq., Boston, MA 02109. Martin Currie Business Trust [File No. 811–8612] Summary: Applicant seeks an order declaring that it has ceased to be an investment company. On January 30, 2015, applicant made a liquidating distribution to its shareholders, based on net asset value. Expenses of $87,460 incurred in connection with the liquidation were paid by Martin Currie, Inc., applicant’s investment adviser. Filing Dates: The application was filed on March 24, 2015, and amended on April 23, 2015. Applicant’s Address: Saltire Court, 20 Castle Terrace, Edinburgh, Scotland EH1 2ES. Security Equity Fund [File No. 811– 22932] Summary: Applicant seeks an order declaring that i0t has ceased to be an investment company. Applicant transferred its assets to a corresponding shell series of Guggenheim Funds Trust, and on January 27, 2014 and September 23, 2014, made distributions to its shareholders based on net asset value. Expenses of $523,662 incurred in connection with the reorganization were paid by applicant and Security Investors, LLC, applicant’s investment adviser. Filing Dates: The application was filed on February 19, 2015, and amended on April 23, 2015. Applicant’s Address: 805 King Farm Blvd., Ste. 600, Rockville, MD 20850. For the Commission, by the Division of Investment Management, pursuant to delegated authority. Brent J. Fields, Secretary. [FR Doc. 2015–10094 Filed 4–29–15; 8:45 am] BILLING CODE 8011–01–P PO 00000 Frm 00078 Fmt 4703 Sfmt 4703 24307 SOCIAL SECURITY ADMINISTRATION [Docket No: SSA–2015–0027] 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 and an extension of OMB-approved information collections, and one new information collection. 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, Email address: OIRA_Submission@omb.eop.gov. (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: OR.Reports.Clearance@ssa.gov. Or you may submit your comments online through www.regulations.gov, referencing Docket ID Number [SSA– 2015–0015]. I. 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 June 29, 2015. Individuals can obtain copies of the collection instruments by writing to the above email address. 1. Application for a Social Security Number Card, the Social Security Number Application Process (SSNAP), and Internet SSN Replacement Card (iSSNRC) Application—20 CFR 422.103–422.110—0960–0066. SSA collects information on the SS–5 (used in the United States) and SS–5–FS (used outside the United States) to issue original or replacement Social Security cards. SSA also enters the application data into the Social Security Number Application Process (SSNAP) when E:\FR\FM\30APN1.SGM 30APN1 24308 Federal Register / Vol. 80, No. 83 / Thursday, April 30, 2015 / Notices applicants request a new or replacement card via telephone or in person. In addition, hospitals collect the same information on SSA’s behalf for newborn children through the Enumeration-at-Birth process. In this process, parents of newborns provide hospital birth registration clerks with information required to register these newborns. Hospitals send this information to State Bureaus of Vital Statistics (BVS), and they send the information to SSA’s National Computer Center. SSA then uploads the data to the to apply by completing an internet application and submitting the required evidence online rather than completing a paper Form SS–5, Application for a Social Security Card. The respondents for this collection are applicants for original and replacement Social Security cards, or individuals who wish to change information in their SSN records, who use any of the modalities described above. Type of Request: Revision of an OMBapproved information collection. SSA mainframe along with all other enumeration data, and we assign the newborn a Social Security number (SSN) and issue a Social Security card. Respondents can also use these modalities to request a change in their SSN records. Additionally, the iSSNRC application will collect information similar to the paper SS–5 for no-change replacement SSN cards for adult U.S. citizens. A new iSSNRC modality included in the current clearance will allow certain applicants for an SSN replacement card Number of respondents Application scenario Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) Respondents who do not have to provide parents’ SSNs .............................. * Adult U.S. Citizens requesting a replacement card with no changes through new iSSNRC modality .................................................................... Respondents whom we ask to provide parents’ SSNs (when applying for original SSN cards for children under age 18) ............................................ Applicants age 12 or older who need to answer additional questions so SSA can determine whether we previously assigned an SSN .................... Applicants asking for a replacement SSN card beyond the new allowable limits (i.e., who must provide additional documentation to accompany the application) ................................................................................................... Authorization to SSA to obtain personal information cover letter ................... Authorization to SSA to obtain personal information follow-up cover letter .... 10,500,000 1 8.5 1,487,500 1,500,000 1 5 125,000 400,000 1 9 60,000 1,500,000 1 9.5 237,500 900 500 500 1 1 1 60 15 15 900 125 125 Totals ........................................................................................................ 13,901,900 ........................ ........................ 1,911,150 * The total timeline for complete national coverage of the iSSNRC application is two years from the date of initial implementation and is dependent on the contractor enrolling each State into the network. By FY 2018, we would expect to issue about 1.5 million replacement cards annually via the iSSNRC application. However, the estimated volume could vary based on the date of implementation, when the contractor acquires States, and our marketing efforts to the public. Cost Burden: The state BVSs incur costs of approximately $11 million for transmitting data to SSA’s mainframe. However, SSA reimburses the states for these costs. 2. Third Party Liability Information Statement—42 CFR 433.136–433.139— 0960–0323. To reduce Medicaid costs, Medicaid state agencies must 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. Under these agreements, SSA obtains third party liability information using Form SSA– 8019, 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 OMBapproved information collection. Number of respondents Modality of completion Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) 200 51,381 1 1 5 5 17 4,282 Totals ........................................................................................................ mstockstill on DSK4VPTVN1PROD with NOTICES SSA–8012 Paper form ..................................................................................... Modernized SSI Claims System (MSSICS) ..................................................... 51,581 ........................ ........................ 4,299 3. Request for Deceased Individual’s Social Security Record—20 CFR 402.130—0960–0665. When a member of the public requests an individual’s Social Security record, SSA needs the name and address of the requestor as VerDate Sep<11>2014 17:01 Apr 29, 2015 Jkt 235001 well as a description of the requested record to process the request. SSA uses the information the respondent provides on Form SSA–711, or via an Internet request through SSA’s electronic Freedom of Information Act (eFOIA) PO 00000 Frm 00079 Fmt 4703 Sfmt 4703 Web site, 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. E:\FR\FM\30APN1.SGM 30APN1 24309 Federal Register / Vol. 80, No. 83 / Thursday, April 30, 2015 / Notices Type of Request: Revision of an OMBapproved information collection. Number of respondents Modality of completion Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) Internet Request through eFOIA ..................................................................... SSA–711 (paper) ............................................................................................. 49,800 200 1 1 7 7 5,810 23 Total .......................................................................................................... 50,000 ........................ ........................ 5,833 Cost Burden *: In addition, SSA charges fees to the respondent for this information. The following chart shows the fees per transaction based on the information the respondent provides on the SSA–711 (or in eFOIA): Cost per transaction Modality of completion Information provided (or not provided) SSA–711 (paper) ....................................................... SSA–711 (paper) ....................................................... eFOIA (Internet) ......................................................... SSN of decedent is not provided ................................................................ SSN of decedent is provided ...................................................................... SSN of decedent is not provided ................................................................ * As these costs are dependent on the respondent’s provided information, we charge them on an as needed basis, and cannot provide a total annual estimate of the cost burden. We do not know whether the respondent provided the decedent’s SSN until we manually review and process each SSA–711. 4. Function Report Adult—20 CFR 404.1512 & 416.912—0960–0681. Individuals receiving or applying for Social Security disability insurance (SSDI) or SSI must provide medical evidence and other proof SSA requires to prove their disability. SSA, and State disability determinations services on our behalf, collect the information using Form SSA–3373. We use the information to document how Number of respondents Modality of completion SSA–3373 ........................................................................................................ mstockstill on DSK4VPTVN1PROD with NOTICES II. SSA submitted the information collections below to OMB for clearance. Your comments regarding the 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 June 1, 2015. Individuals can obtain copies of the OMB clearance packages by writing to OR.Reports.Clearance@ssa.gov. 1. Data Exchange Request Form—20 CFR 401.100—0960–NEW. SSA maintains approximately 3,000 data exchange agreements and regularly receives new requests from Federal, Number of respondents Modality of completion SSA–157 .......................................................................................................... 2. Statement of Self-Employment Income—20 CFR 404.101, 404.110, VerDate Sep<11>2014 17:01 Apr 29, 2015 Jkt 235001 Frm 00080 Fmt 4703 Frequency of response Sfmt 4703 1 Average burden per response (minutes) 61 Estimated total annual burden (hours) 2,120,483 governments, or private organizations will use the form when voluntarily initiating a request for data exchange from SSA. Respondents are Federal, State, local, and foreign governments, as well as private organizations seeking to share data electronically with SSA. This is a correction notice: SSA published the incorrect burden information for this collection at 80 FR 9499, on February 23, 2015. We are correcting this error here. Type of Request: This is a new information collection request. Frequency of response 121 404.1096(a)–(d)—0960–0046. To qualify for insured status and thus collect PO 00000 claimants’ disabilities affect their ability to function, and to determine eligibility for SSI and SSDI claims. The respondents are Title II and Title XVI applicants (or current recipients undergoing redeterminations) for disability payments. Type of Request: Revision of an OMBapproved information collection. 2,085,721 State, local, and foreign governments, as well as private organizations, to share data electronically. SSA engages in various forms of data exchanges from Social Security number verifications to computer matches for benefit eligibility, depending on the requestor’s business needs. Section 1106 of the Social Security Act requires we consider the requestor’s legal authority to receive the data, our disclosure policies, systems’ feasibility, systems’ security, and costs before entering into a data exchange agreement. We will use Form SSA–157, Data Exchange Request Form, for this purpose. Requesting agencies, $29 $27 $18 1 Average burden per response (minutes) 30 Estimated total annual burden (hours) 61 Social Security benefits, self-employed individuals must demonstrate they have E:\FR\FM\30APN1.SGM 30APN1 24310 Federal Register / Vol. 80, No. 83 / Thursday, April 30, 2015 / Notices earned the minimum amount of selfemployment income (SEI) in a current year. SSA uses Form SSA–766, Statement of Self-Employment Income, to collect the information we need to determine if the individual will have 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 credit additional quarters of coverage to give the individual insured status thus expediting benefit payments. Number of respondents Modality of completion SSA–766 .......................................................................................................... 3. Request for Workers’ Compensation/Public Disability Benefit Information—20 CFR 404.408(e)—0960– 0098. Claimants for Social Security disability payments who are also receiving Worker’s Compensation/ Public Disability Benefits (WC/PDB) must notify SSA about their WC/PDB, so the agency can reduce claimants’ Social Security disability payments accordingly. If claimants provide necessary evidence, such as a copy of Number of respondents SSA–1709 ........................................................................................................ Dated: April 27, 2015. Faye I. Lipsky, Reports Clearance Officer, Social Security Administration. [FR Doc. 2015–10057 Filed 4–29–15; 8:45 am] BILLING CODE 4191–02–P DEPARTMENT OF STATE [Public Notice 9119] Culturally Significant Objects Imported for Exhibition Determinations: ‘‘American Encounters: The Simple Pleasures of Still Life’’ Notice is hereby given of the following determinations: Pursuant to the authority vested in me by the Act of October 19, 1965 (79 Stat. 985; 22 U.S.C. 2459), Executive Order 12047 of March 27, 1978, the Foreign Affairs Reform and Restructuring Act of 1998 (112 Stat. 2681, et seq.; 22 U.S.C. 6501 note, et seq.), Delegation of Authority No. 234 of October 1, 1999, and Delegation of Authority No. 236–3 of August 28, 2000 (and, as appropriate, Delegation of Authority No. 257 of April 15, 2003), I hereby determine that the objects to be included in the exhibition ‘‘American Encounters: The Simple Pleasures of mstockstill on DSK4VPTVN1PROD with NOTICES SUMMARY: VerDate Sep<11>2014 17:01 Apr 29, 2015 Jkt 235001 For further information, including a list of the imported objects, contact the Office of the Legal Adviser, U.S. Department of State, SA–5, L/PD, Fifth Floor (Suite 5H03), Washington, DC 20522–0505, telephone (202–632–6471), or email at section2459@state.gov. FOR FURTHER INFORMATION CONTACT: Frm 00081 Fmt 4703 Sfmt 4703 Average burden per response (minutes) 1 Estimated total annual burden (hours) 5 208 WC/PDB benefits to disability claimants. This is a correction notice. SSA published this information collection as a revision on February 23, 2015 at 80 FR 9500. Since we are not revising the Privacy Act Statement, this is now an extension of an OMB-approved information collection. Type of Request: Extension of an OMB-approved information collection. Frequency of response 120,000 Still Life,’’ imported from abroad for temporary exhibition within the United States, are of cultural significance. The objects are imported pursuant to loan agreements with the foreign owners or custodians. I also determine that the exhibition or display of the exhibit objects at the Crystal Bridges Museum of American Art, Bentonville, Arkansas, from on or about May 16, 2015, until on or about September 14, 2015, the High Museum of Art, Atlanta, Georgia, from on or about September 26, 2015, until on or about January 31, 2016, and at possible additional exhibitions or venues yet to be determined, is in the national interest. I have ordered that Public Notice of these Determinations be published in the Federal Register. PO 00000 Frequency of response 2,500 their award notice, benefit check, etc., that is sufficient verification. In cases where claimants cannot provide such evidence, SSA uses Form SSA–1709. The entity paying the WC/PDB benefits, its agent (such as an insurance carrier), or an administering public agency complete this form. The respondents are Federal, State, and local agencies, insurance carriers, and public or private self-insured companies administering Modality of completion Respondents are self-employed individuals who may be eligible for Social Security benefits. Type of Request: Revision of an OMBapproved information collection. Average burden per response (minutes) 1 15 Estimated total annual burden (hours) 30,000 Dated: April 20, 2015. Kelly Keiderling, Principal Deputy Assistant Secretary, Bureau of Educational and Cultural Affairs, Department of State. [FR Doc. 2015–10147 Filed 4–29–15; 8:45 am] BILLING CODE 4710–05–P DEPARTMENT OF STATE [Public Notice: 9116] Culturally Significant Objects Imported for Exhibition Determinations: ‘‘FRIDA KAHLO: Art, Garden, Life’’ Exhibition Notice is hereby given of the following Determinations: Pursuant to the authority vested in me by the Act of October 19, 1965 (79 Stat. 985; 22 U.S.C. 2459), Executive Order 12047 of March 27, 1978, the Foreign Affairs Reform and Restructuring Act of 1998 (112 Stat. 2681, et seq.; 22 U.S.C. 6501 note, et seq.), Delegation of Authority No. 234 of October 1, 1999, Delegation of Authority No. 236–3 of August 28, 2000 (and, as appropriate, Delegation of Authority No. 257 of April 15, 2003), I hereby determine that the objects to be included in the exhibition ‘‘FRIDA KAHLO: Art, Garden, Life,’’ imported from abroad for temporary exhibition SUMMARY: E:\FR\FM\30APN1.SGM 30APN1

Agencies

Social Security Administration

[Federal Register Volume 80, Number 83 (Thursday, April 30, 2015)]
[Notices]
[Pages 24307-24310]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-10057]

=======================================================================
-----------------------------------------------------------------------

SOCIAL SECURITY ADMINISTRATION

[Docket No: SSA-2015-0027]

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 and an extension of OMB-approved information
collections, and one new information collection.
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, Email address: OIRA_Submission@omb.eop.gov.
(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: OR.Reports.Clearance@ssa.gov.

Or you may submit your comments online through www.regulations.gov,
referencing Docket ID Number [SSA-2015-0015].
I. 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 June
29, 2015. Individuals can obtain copies of the collection instruments
by writing to the above email address.
1. Application for a Social Security Number Card, the Social
Security Number Application Process (SSNAP), and Internet SSN
Replacement Card (iSSNRC) Application--20 CFR 422.103-422.110--0960-
0066. SSA collects information on the SS-5 (used in the United States)
and SS-5-FS (used outside the United States) to issue original or
replacement Social Security cards. SSA also enters the application data
into the Social Security Number Application Process (SSNAP) when

[[Page 24308]]

applicants request a new or replacement card via telephone or in
person. In addition, hospitals collect the same information on SSA's
behalf for newborn children through the Enumeration-at-Birth process.
In this process, parents of newborns provide hospital birth
registration clerks with information required to register these
newborns. Hospitals send this information to State Bureaus of Vital
Statistics (BVS), and they send the information to SSA's National
Computer Center. SSA then uploads the data to the SSA mainframe along
with all other enumeration data, and we assign the newborn a Social
Security number (SSN) and issue a Social Security card. Respondents can
also use these modalities to request a change in their SSN records.
Additionally, the iSSNRC application will collect information similar
to the paper SS-5 for no-change replacement SSN cards for adult U.S.
citizens.
A new iSSNRC modality included in the current clearance will allow
certain applicants for an SSN replacement card to apply by completing
an internet application and submitting the required evidence online
rather than completing a paper Form SS-5, Application for a Social
Security Card.
The respondents for this collection are applicants for original and
replacement Social Security cards, or individuals who wish to change
information in their SSN records, who use any of the modalities
described above.
Type of Request: Revision of an OMB-approved information
collection.

----------------------------------------------------------------------------------------------------------------
Average
Number of Frequency of burden per Estimated
Application scenario respondents response response total annual
(minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
Respondents who do not have to provide parents' 10,500,000 1 8.5 1,487,500
SSNs...........................................
* Adult U.S. Citizens requesting a replacement 1,500,000 1 5 125,000
card with no changes through new iSSNRC
modality.......................................
Respondents whom we ask to provide parents' SSNs 400,000 1 9 60,000
(when applying for original SSN cards for
children under age 18).........................
Applicants age 12 or older who need to answer 1,500,000 1 9.5 237,500
additional questions so SSA can determine
whether we previously assigned an SSN..........
Applicants asking for a replacement SSN card 900 1 60 900
beyond the new allowable limits (i.e., who must
provide additional documentation to accompany
the application)...............................
Authorization to SSA to obtain personal 500 1 15 125
information cover letter.......................
Authorization to SSA to obtain personal 500 1 15 125
information follow-up cover letter.............
---------------------------------------------------------------
Totals...................................... 13,901,900 .............. .............. 1,911,150
----------------------------------------------------------------------------------------------------------------
* The total timeline for complete national coverage of the iSSNRC application is two years from the date of
initial implementation and is dependent on the contractor enrolling each State into the network. By FY 2018,
we would expect to issue about 1.5 million replacement cards annually via the iSSNRC application. However, the
estimated volume could vary based on the date of implementation, when the contractor acquires States, and our
marketing efforts to the public.

Cost Burden: The state BVSs incur costs of approximately $11
million for transmitting data to SSA's mainframe. However, SSA
reimburses the states for these costs.
2. Third Party Liability Information Statement--42 CFR 433.136-
433.139--0960-0323. To reduce Medicaid costs, Medicaid state agencies
must 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. Under these agreements, SSA
obtains third party liability information using Form SSA-8019, 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.

3. Request for Deceased Individual's Social Security Record--20 CFR
402.130--0960-0665. When a member of the public requests an
individual's Social Security record, 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, or via an Internet request through SSA's electronic
Freedom of Information Act (eFOIA) Web site, 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.

[[Page 24309]]

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

Cost Burden *: In addition, SSA charges fees to the respondent for
this information. The following chart shows the fees per transaction
based on the information the respondent provides on the SSA-711 (or in
eFOIA):

------------------------------------------------------------------------
Information provided Cost per
Modality of completion (or not provided) transaction
------------------------------------------------------------------------
SSA-711 (paper)................... SSN of decedent is $29
not provided.
SSA-711 (paper)................... SSN of decedent is $27
provided.
eFOIA (Internet).................. SSN of decedent is $18
not provided.
------------------------------------------------------------------------

* As these costs are dependent on the respondent's provided
information, we charge them on an as needed basis, and cannot provide a
total annual estimate of the cost burden. We do not know whether the
respondent provided the decedent's SSN until we manually review and
process each SSA-711.
4. Function Report Adult--20 CFR 404.1512 & 416.912--0960-0681.
Individuals receiving or applying for Social Security disability
insurance (SSDI) or SSI must provide medical evidence and other proof
SSA requires to prove their disability. SSA, and State disability
determinations services on our behalf, collect the information using
Form SSA-3373. We use the information to document how claimants'
disabilities affect their ability to function, and to determine
eligibility for SSI and SSDI claims. The respondents are Title II and
Title XVI applicants (or current recipients undergoing
redeterminations) for disability payments.
Type of Request: Revision of an OMB-approved information
collection.

II. SSA submitted the information collections below to OMB for
clearance. Your comments regarding the 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 June 1, 2015. Individuals can obtain copies of the OMB
clearance packages by writing to OR.Reports.Clearance@ssa.gov.
1. Data Exchange Request Form--20 CFR 401.100--0960-NEW. SSA
maintains approximately 3,000 data exchange agreements and regularly
receives new requests from Federal, State, local, and foreign
governments, as well as private organizations, to share data
electronically. SSA engages in various forms of data exchanges from
Social Security number verifications to computer matches for benefit
eligibility, depending on the requestor's business needs. Section 1106
of the Social Security Act requires we consider the requestor's legal
authority to receive the data, our disclosure policies, systems'
feasibility, systems' security, and costs before entering into a data
exchange agreement. We will use Form SSA-157, Data Exchange Request
Form, for this purpose. Requesting agencies, governments, or private
organizations will use the form when voluntarily initiating a request
for data exchange from SSA. Respondents are Federal, State, local, and
foreign governments, as well as private organizations seeking to share
data electronically with SSA.
This is a correction notice: SSA published the incorrect burden
information for this collection at 80 FR 9499, on February 23, 2015. We
are correcting this error here.
Type of Request: This is a new information collection request.

2. Statement of Self-Employment Income--20 CFR 404.101, 404.110,
404.1096(a)-(d)--0960-0046. To qualify for insured status and thus
collect Social Security benefits, self-employed individuals must
demonstrate they have

[[Page 24310]]

earned the minimum amount of self-employment income (SEI) in a current
year. SSA uses Form SSA-766, Statement of Self-Employment Income, to
collect the information we need to determine if the individual will
have 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 credit additional quarters of coverage to give the individual
insured status thus expediting benefit payments.
Respondents are self-employed individuals who may be eligible for
Social Security benefits.
Type of Request: Revision of an OMB-approved information
collection.

3. Request for Workers' Compensation/Public Disability Benefit
Information--20 CFR 404.408(e)--0960-0098. Claimants for Social
Security disability payments who are also receiving Worker's
Compensation/Public Disability Benefits (WC/PDB) must notify SSA about
their WC/PDB, so the agency can reduce claimants' Social Security
disability payments accordingly. If claimants provide necessary
evidence, such as a copy of their award notice, benefit check, etc.,
that is sufficient verification. In cases where claimants cannot
provide such evidence, SSA uses Form SSA-1709. The entity paying the
WC/PDB benefits, its agent (such as an insurance carrier), or an
administering public agency complete this form. The respondents are
Federal, State, and local agencies, insurance carriers, and public or
private self-insured companies administering WC/PDB benefits to
disability claimants.
This is a correction notice. SSA published this information
collection as a revision on February 23, 2015 at 80 FR 9500. Since we
are not revising the Privacy Act Statement, this is now an extension of
an OMB-approved information collection.
Type of Request: Extension of an OMB-approved information
collection.

Dated: April 27, 2015.
Faye I. Lipsky,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2015-10057 Filed 4-29-15; 8:45 am]
BILLING CODE 4191-02-P

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