Agency Information Collection Activities: Proposed Request, Comment Request and Correction Request, 70650-70652 [05-22983]
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70650
Federal Register / Vol. 70, No. 224 / Tuesday, November 22, 2005 / Notices
For the Commission, by the Division of
Market Regulation, pursuant to delegated
authority.23
Jonathan G. Katz,
Secretary.
[FR Doc. E5–6409 Filed 11–21–05; 8:45 am]
BILLING CODE 8010–01–P
SMALL BUSINESS ADMINISTRATION
Data Collection Available for Public
Comments and Recommendations
Notice and request for
comments.
ACTION:
SUMMARY: In accordance with the
Paperwork Reduction Act of 1995, this
notice announces the Small Business
Administration’s intentions to request
approval on a new and/or currently
approved information collection.
DATES: Submit comments on or before
January 23, 2006.
ADDRESSES: Send all comments
regarding whether this information
collection is necessary for the proper
performance of the function of the
agency, whether the burden estimates
are accurate, and if there are ways to
minimize the estimated burden and
enhance the quality of the collection, to
Gail Hepler, Chief 504 Program Branch,
Office of Financial Assistance, Small
Business Administration, 409 3rd Street,
SW., Suite 8300, Washington, DC 20416.
FOR FURTHER INFORMATION CONTACT: Gail
Hepler, Chief, 504 Program Branch,
202–205–7530, gail.hepler@sba.gov.
Curtis B. Rich, Management Analyst,
202–205–7030, curtis.rich@sba.gov.
SUPPLEMENTARY INFORMATION:
Title: ‘‘Gulf Coast Relief Financing
Pilot Information Collection.’’
Description of Respondents: Small
Businesses devastated by Hurricanes
Katrina and Rita.
Form No.’s: 2276–Parts ABC, 2279,
2280, 2281 and 2282.
Annual Responses: 8,000.
Annual Burden: 8,000.
Jacqueline White,
Chief, Administrative Information Branch.
[FR Doc. 05–23044 Filed 11–21–05; 8:45 am]
BILLING CODE 8025–01–P
SOCIAL SECURITY ADMINISTRATION
Agency Information Collection
Activities: Proposed Request,
Comment Request and Correction
Request
The Social Security Administration
(SSA) publishes a list of information
23 17
CFR 200.30–3(a)(12).
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17:22 Nov 21, 2005
Jkt 208001
collection packages that will require
clearance by the Office of Management
and Budget (OMB) in compliance with
Pub. L. 104–13, the Paperwork
Reduction Act of 1995, effective October
1, 1995. The information collection
packages that may be included in this
notice are for new information
collections, approval of existing
information collections, revisions to
OMB-approved information collections,
and extensions (no change) of OMBapproved 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 on ways
to minimize burden on respondents,
including the use of automated
collection techniques or other forms of
information technology. Written
comments and recommendations
regarding the information collection(s)
should be submitted to the OMB Desk
Officer and the SSA Reports Clearance
Officer. The information can be mailed
and/or faxed to the individuals at the
addresses and fax numbers listed below:
(OMB), Office of Management and
Budget, Attn: Desk Officer for SSA,
Fax: 202–395–6974.
(SSA), Social Security Administration,
DCFAM, Attn: Reports Clearance
Officer, 1333 Annex Building, 6401
Security Blvd., Baltimore, MD 21235,
Fax: 410–965–6400.
I. The information collections listed
below are pending at SSA and will be
submitted to OMB within 60 days from
the date of this notice. Therefore, your
comments should be submitted to SSA
within 60 days from the date of this
publication. You can obtain copies of
the collection instruments by calling the
SSA Reports Clearance Officer at 410–
965–0454 or by writing to the address
listed above.
1. Application for Widow’s or
Widower’s Insurance Benefits—20 CFR
404.335–.338—0960–0004. SSA uses the
information collected on the Form SSA–
10–BK to determine if the applicant
meets the statutory and regulatory
conditions for entitlement to
widow(er)’s benefits. The respondents
are applicants for Widow(er)’s benefits.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 288,580.
Frequency of Response: 1.
Average Burden per Response: 15
minutes.
Estimated Annual Burden: 72,145
hours.
2. Application for Parent’s Insurance
Benefits—20 CFR 404.370–404.374, 20
CFR 404.601–404.603—0960–0012.
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Form SSA–7–F6 collects information to
entitle an individual to his parent’s
insurance benefits. The respondents are
individuals who wish to apply to
receive their parent’s insurance benefits.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 1,400.
Frequency of Response: 1.
Average Burden per Response: 15
minutes.
Estimated Annual Burden: 350 hours.
3. Statement of Marital Relationship
(by One of the Parties)—20 CFR
404.726—0960–0038. SSA uses the
information collected on Form SSA–
754–F4 to determine whether the
conditions for establishing a commonlaw marriage under State law are met.
The respondents are applicants for
spouse’s benefits.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 30,000.
Frequency of Response: 1.
Average Burden per Response: 30
minutes.
Estimated Annual Burden: 15,000
hours.
4. Medical Source Statement of
Ability To Do Work Related Activities
(Physical and Mental)—20 CFR
404.1512–404.1514, 404.912–404.914,
404.1517, 416.917, 404.1519–404.1520,
416.919–416.920, 404.946, 416.946—
0960–0662. The HA–1151 and HA–1152
are used to collect data that is required
to determine the residual functional
capacity (RFC) of individuals who are
appealing denied claims for benefits
based on disability. RFC must be
determined to decide cases that cannot
be decided based on current work
activity or on medical facts alone. The
respondents are medical sources who
are paid by SSA to provide reports
based either on existing medical
evidence or on consultative
examinations conducted for the
purposes of the report.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 10,000.
Frequency of Response: 20.
Average Burden per Response: 15
minutes.
Estimated Annual Burden: 50,000
hours.
5. SSI-Quality Review Case analysis—
0960–0133. The form SSA–8508 is used
in a personal interview with a sample of
Supplemental Security Income (SSI)
recipients and covers all elements of SSI
eligibility. The information is used to
assess the effectiveness of SSI policies
and procedures and to determine
payment accuracy rates. The
respondents are SSI recipients.
Type of Request: Extension of an
OMB-approved information collection.
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Federal Register / Vol. 70, No. 224 / Tuesday, November 22, 2005 / Notices
Number of Respondents: 3,900.
Frequency of Response: 1.
Average Burden per Response: 60
minutes.
Estimated Annual Burden: 3,900
hours.
6. Report of New Information in
Disability Cases—20 CFR 404.460,
404.468, 404.408, 404.1588—0960–
0071. The information collected on
Form SSA–612 is used to update the
disability records of respondents, based
on changes reported. The form is used
to gather information on a number of
topics that can affect the beneficiary’s or
the applicant’s entitlement to disability
benefits. This includes, but is not
limited to, information about a return to
work, improvement in the medical
condition, Workers’ Compensation
settlements or representative payee
issues. The respondents are applicants
for and recipients of Title II disability
benefits.
Number of Respondents: 27,000.
Frequency of Response: 1.
Average Burden per Response: 5
minutes.
Estimated Annual Burden: 2,250
hours.
7. Statement of Living Arrangements,
In-Kind Support and Maintenance—20
CFR, 416.1130–.1148—0960–0174.
Form SSA–8006 provides a national
uniform vehicle for collecting
information from SSI applicants and
recipients about whether they receive
income from in-kind support and
maintenance. Responses are used to
determine eligibility for SSI benefits.
The respondents are individuals
applying for SSI or whose eligibility is
being reevaluated.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 173,380.
Frequency of Response: 1.
Average Burden per Response: 7
minutes.
Estimated Annual Burden: 20,228
hours.
Type of Request: Extension of an
OMB-approved information collection.
II. The information collections listed
below have been submitted to OMB for
clearance. Your comments on the
information collections would be most
useful if received by OMB and SSA
within 30 days from the date of this
publication. You can obtain a copy of
the OMB clearance packages by calling
the SSA Reports Clearance Officer at
410–965–0454, or by writing to the
address listed above.
1. Supplement to Claim of Person
Outside the United States—20 CFR
404.460, 404.463, 422.505(b), 42 CFR
407.27(c)—0960–0051. The information
collected on Form SSA–21 is used to
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17:22 Nov 21, 2005
Jkt 208001
determine the continuing entitlement to
Social Security benefits and the proper
benefit amounts for alien beneficiaries
living outside the United States. It is
also used to determine whether benefits
are subject to withholding tax. The
respondents are individuals entitled to
Social Security benefits who are, will
be, or have been residing outside the
United States.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 35,000.
Frequency of Response: 1.
Average Burden per Response: 10
minutes.
Estimated Annual Burden: 5,833
hours.
2. Report on Individual with Mental
Impairment—20 CFR 404.1513,
416.913—0960–0058. Form SSA–824 is
used by SSA to determine the claimant’s
medical status prior to making a
disability determination. The
respondents are physicians, medical
directors, medical record librarians and
other health professionals.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden per Response: 36
minutes.
Estimated Annual Burden: 30,000
hours.
3. Claimant’s Work Background—20
CFR 404.1565(b), 416.965(b)—0960–
0300. The information collected on
Form HA–4633 is needed and used to
afford claimants their statutory right to
a hearing and decision under the Social
Security Act. The information is used by
SSA in cases in which claimants for
disability benefits have requested a
hearing on the determination regarding
their claim. A completed form provides
an updated summary of a claimant’s
past relevant work and helps the
administrative law judge to better
decide whether or not the claimant is
disabled. The respondents are claimants
requesting hearings for benefits based
on disability under Titles II and/or XVI
of the Act.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 120,000.
Frequency of Response: 1.
Average Burden per Response: 15
minutes.
Estimated Annual Burden: 30,000
hours.
4. Coverage of Employees of State and
Local Governments—20 CFR 404,
Subpart M—0960–0425. States (and
Interstate Instrumentalities) are required
to provide wage information and
deposit related contributions for pre1987 periods to SSA. The regulations at
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70651
20 CFR 404, Subpart M set forth the
rules for States submitting reports of
deposits and related recordkeeping. The
respondents are State and local
governments or Interstate
Instrumentalities.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 52.
Frequency of Response: 1.
Average Burden per Response: 1 hour.
Estimated Annual Burden: 52 hours.
5. Medical Report on Adult with
Allegation of Human Immunodeficiency
Virus (HIV) Infection; Medical Report
on Child with Allegation of Human
Immunodeficiency Virus (HIV)
Infection—20 CFR 416.993–416.994—
0960–0500. Collection of the
information on Forms SSA–4814–F5
and SSA–4815–F6 is necessary for SSA
to determine if an individual with HIV
infection meets the requirements for
presumptive disability (PD) payments.
The SSA Field Office (FO) will mail the
appropriate form to the claimant’s
medical source for completion and
return to the FO. The FO staff will use
the information on the form to
determine if a PD is warranted. The
respondents are the medical sources of
applicants for SSI disability payments.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 59,100.
Frequency of Response: 1.
Average Burden per Response: 10
minutes.
Estimated Annual Burden: 9,850
hours.
6. SSI Notice of Interim Assistance
Reimbursement (IAR)—0960–0546.
Forms SSA–8125 and SSA–L8125–F6
are used by SSA to obtain the amount
of Interim Assistance Reimbursement
(IAR) a State is due before it can pay
IAR to the State in various situations.
When SSA releases the first retroactive
SSI payment the SSA–8125 is filled out
by the State for accounting and auditing
purposes. The SSA–L8125–F6 is only
used in cases when SSA must ensure
that an IAR State does not send a
residual IAR payment to a recipient who
may be affected by the dedicated
account and installment provision as set
forth in Pub. Law 100–203. Respondents
are State IAR officers.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden per Response: 10
minutes.
Estimated Annual Burden: 8,333
hours.
III. The information collections listed
below have been submitted to OMB for
clearance. These notices have been
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70652
Federal Register / Vol. 70, No. 224 / Tuesday, November 22, 2005 / Notices
previously published, and are being
republished because changes have been
made to the collections’ burden
estimates. Your comments on the
information collections would be most
useful if received by OMB and SSA
within 30 days from the date of this
publication. You can obtain a copy of
the OMB clearance packages by calling
the SSA Reports Clearance Officer at
410–965–0454, or by writing to the
address listed above.
1. General Request for Social Security
Records, eFOIA—20 CFR 402.130—
0960–NEW. The eFOIA is a new
electronic form that the public can use
to request public information from the
Agency. SSA uses the information
collected on this electronic request for
Social Security records to respond to the
public’s request for information under
the rights provided by the Freedom of
Information Act (FOIA), and to track
those requests by amount received, type
of request, fees charged and responses
sent within the required 20 days.
Respondents are individuals or agencies
requesting documents under FOIA.
Type of Request: New information
collection.
Number of Respondents: 5,000.
Frequency of Response: 1.
Average Burden per Response: 3
minutes.
Estimated Annual Burden: 250 hours.
2. Application to Collect a Fee for
Payee Services—0960–NEW.
Information requested on form SSA–445
will be used to determine whether the
applicant meets the requirements to
become a fee for service organizational
payee, and if the applicant has provided
all the information and documentation
required. Based on the information
provided on form SSA–445, SSA will
issue a determination authorizing or
denying permission to collect fees for
payee services. The respondents are fee
for payee service applicants.
Type of Request: New information
collection.
Number of Respondents: 100.
Frequency of Response: 1.
Average Burden per Response: 10
minutes.
Estimated Annual Burden: 17 hours.
DEPARTMENT OF STATE
OFFICE OF THE UNITED STATES
TRADE REPRESENTATIVE
[Public Notice 5234]
Culturally Significant Objects Imported
for Exhibition Determinations:
‘‘Masterpieces From an English
Country House: The Fitzwilliam
Collection’’
AGENCY:
ACTION:
Notice.
SUMMARY: 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 [64 FR 56014],
Delegation of Authority No. 236 of
October 19, 1999 [64 FR 57920], as
amended, and Delegation of Authority
No. 257 of April 15, 2003 [68 FR 19875],
I hereby determine that the objects to be
included in the exhibition,
‘‘Masterpieces from an English Country
House: The Fitzwilliam Collection,’’
imported from abroad for temporary
exhibition within the United States, are
of cultural significance. The objects are
imported pursuant to a loan agreement
with the foreign lender. I also determine
that the exhibition or display of the
exhibit objects at the Chrysler Museum
of Art, Norfolk, Virginia, from on or
about April 28, 2006, to on or about
August 13, 2006, the Memphis Brooks
Museum of Art, Memphis, Tennessee,
from on or about September 15, 2006, to
on or about December 3, 2006, and at
possible additional venues yet to be
determined, is in the national interest.
Public Notice of these determinations is
ordered to be published in the Federal
Register.
For
further information, such as a list of
exhibit objects, contact Paul W.
Manning, Attorney-Adviser, Office of
the Legal Adviser, 202/453–8052, and
the address is United States Department
of State, SA–44, Room 700, 301 4th
Street, SW., Washington, DC 20547–
0001.
FOR FURTHER INFORMATION CONTACT:
Dated: November 15, 2005.
C. Miller Crouch,
Principal Deputy Assistant Secretary for
Educational and Cultural Affairs, Department
of State.
[FR Doc. 05–23110 Filed 11–21–05; 8:45 am]
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Office of the United States
Trade Representative.
AGENCY:
ACTION:
Department of State.
Dated: November 15, 2005.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security
Administration.
[FR Doc. 05–22983 Filed 11–21–05; 8:45 am]
VerDate Aug<31>2005
Andean Trade Preference Act (ATPA),
as Amended: Notice Regarding the
2005 Annual Review
Notice.
SUMMARY: The Office of the United
States Trade Representative (USTR)
received petitions in September 2005 to
review certain practices in certain
beneficiary developing countries to
determine whether such countries are in
compliance with the ATPA eligibility
criteria. This notice publishes a list of
the September 2005 petitions that were
filed in response to the announcement
of the annual review.
FOR FURTHER INFORMATION CONTACT:
Bennett M. Harman, Deputy Assistant
U.S. Trade Representative for Latin
America, at (202) 395–9446.
The ATPA
(19 U.S.C. 3201 et seq.), as renewed and
amended by the Andean Trade
Promotion and Drug Eradication Act of
2002 (ATPDEA) in the Trade Act of
2002 (Pub. L. 107–210), provides trade
benefits for eligible Andean countries.
Pursuant to section 3103(d) of the
ATPDEA, USTR promulgated
regulations (15 CFR part 2016) (68 FR
43922) regarding the review of
eligibility of countries for the benefits of
the ATPA, as amended. The 2005
Annual ATPA Review is the third such
review to be conducted pursuant to the
ATPA regulations.
In a Federal Register notice dated
August 18, 2005, USTR initiated the
2005 ATPA Annual Review and
announced a deadline of September 19,
2005 for the filing of petitions (70 FR
48622). Following is the list of
responsive petitions that were filed for
the 2005 review:
SUPPLEMENTARY INFORMATION:
Peru
ExxonMobil
USTR also received updated
information regarding certain matters
under consideration from the 2003 and
2004 ATPA reviews:
Ecuador Human Rights Watch
Ecuador U.S./Labor Education in the
Americas Project
Ecuador AFL/CIO
Peru Parsons Corporation
USTR will announce the results of the
preliminary review of the 2005 petitions
as well as the results of the review of the
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]]>Agencies
[Federal Register Volume 70, Number 224 (Tuesday, November 22, 2005)]
[Notices]
[Pages 70650-70652]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-22983]
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SOCIAL SECURITY ADMINISTRATION
Agency Information Collection Activities: Proposed Request,
Comment Request and Correction Request
The Social Security Administration (SSA) publishes a list of
information collection packages that will require clearance by the
Office of Management and Budget (OMB) in compliance with Pub. L. 104-
13, the Paperwork Reduction Act of 1995, effective October 1, 1995. The
information collection packages that may be included in this notice are
for new information collections, approval of existing information
collections, revisions to OMB-approved information collections, and
extensions (no change) 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 on ways to minimize
burden on respondents, including the use of automated collection
techniques or other forms of information technology. Written comments
and recommendations regarding the information collection(s) should be
submitted to the OMB Desk Officer and the SSA Reports Clearance
Officer. The information can be mailed and/or faxed to the individuals
at the addresses and fax numbers listed below:
(OMB), Office of Management and Budget, Attn: Desk Officer for SSA,
Fax: 202-395-6974.
(SSA), Social Security Administration, DCFAM, Attn: Reports Clearance
Officer, 1333 Annex Building, 6401 Security Blvd., Baltimore, MD 21235,
Fax: 410-965-6400.
I. The information collections listed below are pending at SSA and
will be submitted to OMB within 60 days from the date of this notice.
Therefore, your comments should be submitted to SSA within 60 days from
the date of this publication. You can obtain copies of the collection
instruments by calling the SSA Reports Clearance Officer at 410-965-
0454 or by writing to the address listed above.
1. Application for Widow's or Widower's Insurance Benefits--20 CFR
404.335-.338--0960-0004. SSA uses the information collected on the Form
SSA-10-BK to determine if the applicant meets the statutory and
regulatory conditions for entitlement to widow(er)'s benefits. The
respondents are applicants for Widow(er)'s benefits.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 288,580.
Frequency of Response: 1.
Average Burden per Response: 15 minutes.
Estimated Annual Burden: 72,145 hours.
2. Application for Parent's Insurance Benefits--20 CFR 404.370-
404.374, 20 CFR 404.601-404.603--0960-0012. Form SSA-7-F6 collects
information to entitle an individual to his parent's insurance
benefits. The respondents are individuals who wish to apply to receive
their parent's insurance benefits.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 1,400.
Frequency of Response: 1.
Average Burden per Response: 15 minutes.
Estimated Annual Burden: 350 hours.
3. Statement of Marital Relationship (by One of the Parties)--20
CFR 404.726--0960-0038. SSA uses the information collected on Form SSA-
754-F4 to determine whether the conditions for establishing a common-
law marriage under State law are met. The respondents are applicants
for spouse's benefits.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 30,000.
Frequency of Response: 1.
Average Burden per Response: 30 minutes.
Estimated Annual Burden: 15,000 hours.
4. Medical Source Statement of Ability To Do Work Related
Activities (Physical and Mental)--20 CFR 404.1512-404.1514, 404.912-
404.914, 404.1517, 416.917, 404.1519-404.1520, 416.919-416.920,
404.946, 416.946--0960-0662. The HA-1151 and HA-1152 are used to
collect data that is required to determine the residual functional
capacity (RFC) of individuals who are appealing denied claims for
benefits based on disability. RFC must be determined to decide cases
that cannot be decided based on current work activity or on medical
facts alone. The respondents are medical sources who are paid by SSA to
provide reports based either on existing medical evidence or on
consultative examinations conducted for the purposes of the report.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 10,000.
Frequency of Response: 20.
Average Burden per Response: 15 minutes.
Estimated Annual Burden: 50,000 hours.
5. SSI-Quality Review Case analysis--0960-0133. The form SSA-8508
is used in a personal interview with a sample of Supplemental Security
Income (SSI) recipients and covers all elements of SSI eligibility. The
information is used to assess the effectiveness of SSI policies and
procedures and to determine payment accuracy rates. The respondents are
SSI recipients.
Type of Request: Extension of an OMB-approved information
collection.
[[Page 70651]]
Number of Respondents: 3,900.
Frequency of Response: 1.
Average Burden per Response: 60 minutes.
Estimated Annual Burden: 3,900 hours.
6. Report of New Information in Disability Cases--20 CFR 404.460,
404.468, 404.408, 404.1588--0960-0071. The information collected on
Form SSA-612 is used to update the disability records of respondents,
based on changes reported. The form is used to gather information on a
number of topics that can affect the beneficiary's or the applicant's
entitlement to disability benefits. This includes, but is not limited
to, information about a return to work, improvement in the medical
condition, Workers' Compensation settlements or representative payee
issues. The respondents are applicants for and recipients of Title II
disability benefits.
Number of Respondents: 27,000.
Frequency of Response: 1.
Average Burden per Response: 5 minutes.
Estimated Annual Burden: 2,250 hours.
7. Statement of Living Arrangements, In-Kind Support and
Maintenance--20 CFR, 416.1130-.1148--0960-0174. Form SSA-8006 provides
a national uniform vehicle for collecting information from SSI
applicants and recipients about whether they receive income from in-
kind support and maintenance. Responses are used to determine
eligibility for SSI benefits. The respondents are individuals applying
for SSI or whose eligibility is being reevaluated.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 173,380.
Frequency of Response: 1.
Average Burden per Response: 7 minutes.
Estimated Annual Burden: 20,228 hours.
Type of Request: Extension of an OMB-approved information
collection.
II. The information collections listed below have been submitted to
OMB for clearance. Your comments on the information collections would
be most useful if received by OMB and SSA within 30 days from the date
of this publication. You can obtain a copy of the OMB clearance
packages by calling the SSA Reports Clearance Officer at 410-965-0454,
or by writing to the address listed above.
1. Supplement to Claim of Person Outside the United States--20 CFR
404.460, 404.463, 422.505(b), 42 CFR 407.27(c)--0960-0051. The
information collected on Form SSA-21 is used to determine the
continuing entitlement to Social Security benefits and the proper
benefit amounts for alien beneficiaries living outside the United
States. It is also used to determine whether benefits are subject to
withholding tax. The respondents are individuals entitled to Social
Security benefits who are, will be, or have been residing outside the
United States.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 35,000.
Frequency of Response: 1.
Average Burden per Response: 10 minutes.
Estimated Annual Burden: 5,833 hours.
2. Report on Individual with Mental Impairment--20 CFR 404.1513,
416.913--0960-0058. Form SSA-824 is used by SSA to determine the
claimant's medical status prior to making a disability determination.
The respondents are physicians, medical directors, medical record
librarians and other health professionals.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden per Response: 36 minutes.
Estimated Annual Burden: 30,000 hours.
3. Claimant's Work Background--20 CFR 404.1565(b), 416.965(b)--
0960-0300. The information collected on Form HA-4633 is needed and used
to afford claimants their statutory right to a hearing and decision
under the Social Security Act. The information is used by SSA in cases
in which claimants for disability benefits have requested a hearing on
the determination regarding their claim. A completed form provides an
updated summary of a claimant's past relevant work and helps the
administrative law judge to better decide whether or not the claimant
is disabled. The respondents are claimants requesting hearings for
benefits based on disability under Titles II and/or XVI of the Act.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 120,000.
Frequency of Response: 1.
Average Burden per Response: 15 minutes.
Estimated Annual Burden: 30,000 hours.
4. Coverage of Employees of State and Local Governments--20 CFR
404, Subpart M--0960-0425. States (and Interstate Instrumentalities)
are required to provide wage information and deposit related
contributions for pre-1987 periods to SSA. The regulations at 20 CFR
404, Subpart M set forth the rules for States submitting reports of
deposits and related recordkeeping. The respondents are State and local
governments or Interstate Instrumentalities.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 52.
Frequency of Response: 1.
Average Burden per Response: 1 hour.
Estimated Annual Burden: 52 hours.
5. Medical Report on Adult with Allegation of Human
Immunodeficiency Virus (HIV) Infection; Medical Report on Child with
Allegation of Human Immunodeficiency Virus (HIV) Infection--20 CFR
416.993-416.994--0960-0500. Collection of the information on Forms SSA-
4814-F5 and SSA-4815-F6 is necessary for SSA to determine if an
individual with HIV infection meets the requirements for presumptive
disability (PD) payments. The SSA Field Office (FO) will mail the
appropriate form to the claimant's medical source for completion and
return to the FO. The FO staff will use the information on the form to
determine if a PD is warranted. The respondents are the medical sources
of applicants for SSI disability payments.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 59,100.
Frequency of Response: 1.
Average Burden per Response: 10 minutes.
Estimated Annual Burden: 9,850 hours.
6. SSI Notice of Interim Assistance Reimbursement (IAR)--0960-0546.
Forms SSA-8125 and SSA-L8125-F6 are used by SSA to obtain the amount of
Interim Assistance Reimbursement (IAR) a State is due before it can pay
IAR to the State in various situations. When SSA releases the first
retroactive SSI payment the SSA-8125 is filled out by the State for
accounting and auditing purposes. The SSA-L8125-F6 is only used in
cases when SSA must ensure that an IAR State does not send a residual
IAR payment to a recipient who may be affected by the dedicated account
and installment provision as set forth in Pub. Law 100-203. Respondents
are State IAR officers.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden per Response: 10 minutes.
Estimated Annual Burden: 8,333 hours.
III. The information collections listed below have been submitted
to OMB for clearance. These notices have been
[[Page 70652]]
previously published, and are being republished because changes have
been made to the collections' burden estimates. Your comments on the
information collections would be most useful if received by OMB and SSA
within 30 days from the date of this publication. You can obtain a copy
of the OMB clearance packages by calling the SSA Reports Clearance
Officer at 410-965-0454, or by writing to the address listed above.
1. General Request for Social Security Records, eFOIA--20 CFR
402.130--0960-NEW. The eFOIA is a new electronic form that the public
can use to request public information from the Agency. SSA uses the
information collected on this electronic request for Social Security
records to respond to the public's request for information under the
rights provided by the Freedom of Information Act (FOIA), and to track
those requests by amount received, type of request, fees charged and
responses sent within the required 20 days. Respondents are individuals
or agencies requesting documents under FOIA.
Type of Request: New information collection.
Number of Respondents: 5,000.
Frequency of Response: 1.
Average Burden per Response: 3 minutes.
Estimated Annual Burden: 250 hours.
2. Application to Collect a Fee for Payee Services--0960-NEW.
Information requested on form SSA-445 will be used to determine whether
the applicant meets the requirements to become a fee for service
organizational payee, and if the applicant has provided all the
information and documentation required. Based on the information
provided on form SSA-445, SSA will issue a determination authorizing or
denying permission to collect fees for payee services. The respondents
are fee for payee service applicants.
Type of Request: New information collection.
Number of Respondents: 100.
Frequency of Response: 1.
Average Burden per Response: 10 minutes.
Estimated Annual Burden: 17 hours.
Dated: November 15, 2005.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 05-22983 Filed 11-21-05; 8:45 am]
BILLING CODE 4191-02-P
