Agency Information Collection Activities: Proposed Request, 73319-73320 [E5-7111]
Download as PDF
<![CDATA[
73319
Federal Register / Vol. 70, No. 236 / Friday, December 9, 2005 / Notices
Comments may be submitted by any of
the following methods:
Electronic Comments
• Use the Commission’s Internet
comment form (https://www.sec.gov/
rules/sro.shtml); or
• Send an e-mail to rulecomments@sec.gov. Please include File
No. SR–CBOE–2005–96 on the subject
line.
Paper Comments
• Send paper comments in triplicate
to Jonathan G. Katz, Secretary,
Securities and Exchange Commission,
Station Place, 100 F Street, NE.,
Washington, DC 20549–9303.
All submissions should refer to File
Number SR–CBOE–2005–96. This file
number should be included on the
subject line if e-mail is used. To help the
Commission process and review your
comments more efficiently, please use
only one method. The Commission will
post all comments on the Commission’s
Internet Web site (https://www.sec.gov/
rules/sro.shtml). Copies of the
submission, all subsequent
amendments, all written statements
with respect to the proposed rule
change that are filed with the
Commission, and all written
communications relating to the
proposed rule change between the
Commission and any person, other than
those that may be withheld from the
public in accordance with the
provisions of 5 U.S.C. 552, will be
available for inspection and copying in
the Commission’s Public Reference
Room. Copies of such filing also will be
available for inspection and copying at
the principal office of CBOE.
All comments received will be posted
without change; the Commission does
not edit personal identifying
information from submissions. You
should submit only information that
you wish to make available publicly. All
submissions should refer to File
Number SR–CBOE–2005–96 and should
be submitted on or before December 30,
2005.
For the Commission, by the Division of
Market Regulation, pursuant to delegated
authority.15
Jonathan G. Katz,
Secretary.
[FR Doc. E5–7103 Filed 12–8–05; 8:45 am]
BILLING CODE 8010–01–P
SOCIAL SECURITY ADMINISTRATION
Agency Information Collection
Activities: Proposed Request
The Social Security Administration
(SSA) publishes a list of information
collection packages that requires
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. 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 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.
(OMB), Office of Management and
Budget, Attn: Desk Officer for SSA. Fax:
202–395–6974.
(SSA), Social Security
Administration, DCFAM, Attn: Reports
Clearance Officer. Fax: 410–965–6400.
E-mail: OPLM.RCO@ssa.gov.
The information collection listed
below is pending at SSA and will be
submitted to OMB within 60 days from
the date of this notice. Therefore, your
Form number and name
Description
of form
SSA–9301 (Medicare Subsidy Quality Review Case Analysis Questionnaire).
Telephone questionnaire which will
be administered by SSA employees to applicants for Medicare
Part D Subsidy. Includes questions about family size, marriage,
income, assets, etc.
15 17
Number of
respondents
comments should be submitted to SSA
within 60 days from the date of this
publication. You can obtain a copy of
the collection instrument by calling the
SSA Reports Clearance Officer at 410–
965–0454 or by e-mailing or faxing your
request to the above e-mail address and
fax number.
Medicare Subsidy Quality Review Case
Analysis Forms—20 CFR 418(b)(5)—
0960–0707
Under the aegis of the Medicare
Modernization Act of 2003, SSA will
make Medicare Part D subsidy
determinations for the Medicare
Prescription Drug program for Medicare
beneficiaries with limited income and
resources. The subsidy determination is
based on applicants’ answers to
questions about household size, income,
and resources. This information is selfreported by applicants using form OMB
No. 0960–0696 (SSA–1020), and thus,
SSA needs a way to determine if this
form is being completed accurately and
completely and a way to validate its
determination decisions. To this end,
SSA will use the new Medicare Quality
Review system to check the accuracy of
the determination. In this system, SSA
will conduct phone interviews with
selected applicants and will confirm
information such as household size,
income, and resources. A questionnaire
and several other forms will be used as
part of the Medicare Quality Review
System. The collection instruments,
their descriptions, and burden
information are listed in the table
below.
Note: This Notice is for the permanent
approval of this collection, which was
cleared by OMB temporarily through
February 2006 as an emergency information
collection.
Type of Request: Extension of a
currently approved information
collection.
Frequency of
response
10,000
1
CFR 200.30–3(a)(12).
VerDate Aug<31>2005
14:22 Dec 08, 2005
Jkt 208001
PO 00000
Frm 00126
Fmt 4703
Sfmt 4703
E:\FR\FM\09DEN1.SGM
09DEN1
Average
burden
per response
(minutes)
35
Estimated
annual burden
(hours)
5,833
73320
Federal Register / Vol. 70, No. 236 / Friday, December 9, 2005 / Notices
Form number and name
Description
of form
SSA–9302 (Notice of Quality Review
Acknowledgement Form for those
with Phones).
SSA–8510 (Authorization to the Social Security Administration to Obtain Personal Information).
After receiving notice of the scheduled date/time of the telephone
questionnaire, Part D applicants
will return this form confirming
their availability for the interview
and making note of any special
needs for the call.
Same as for SSA–9302, except
used by participants without
phones or whose phone numbers
are not known by SSA. On form
SSA–9303, however, participants
confirm receipt of the letter and
are asked to call SSA on a specified date.
This checklist, which accompanies
forms SSA–9302 and SSA–9303,
is a list of the documentation respondents are supposed to have
prepared when SSA calls them to
conduct the Quality Review phone
interview. Their burden is accounted for in the burdens for
forms SSA–9302 and SSA–9303.
Form which SSA will send to various third parties to obtain/confirm
information reported by beneficiaries.
Following the phone interview, SSA
sends this notice to the participants advising them of the documents they must return to SSA.
Form completed by insurance companies confirming type, face
value, cash surrender value and
dividends for insurance policies of
applicants for Medicare Part D
subsidy.
Beneficiaries give their permission
for SSA to contact third parties to
obtain/confirm information.
Total ...........................................
...........................................................
SSA–9303 (Notice of Quality Review
Acknowledgement Form for those
without Phones).
SSA–9304 (Checklist of Required Information).
SSA–9308 (Request for Information)
SSA–9310 (Request for Documents)
SSA–9309
(Life
Verification Form).
Insurance
Total Estimated Annual Burden:
17,249 hours.
Dated: December 2, 2005.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security
Administration.
[FR Doc. E5–7111 Filed 12–8–05; 8:45 am]
BILLING CODE 4191–02–P
SOCIAL SECURITY ADMINISTRATION
Notice Announcing Addresses for
Service of Process
AGENCY:
Social Security Administration
(SSA).
ACTION:
Notice.
As set forth in a Federal
Register rule in the Rules and
Regulations section, we have amended
our rules regarding service of legal
SUMMARY:
VerDate Aug<31>2005
14:22 Dec 08, 2005
Jkt 208001
Number of
respondents
Frequency of
response
1
15
2,500
1,000
1
15
250
........................
........................
........................
........................
20,000
1
15
5,000
10,000
1
5
833
8,000
1
15
2,000
10,000
1
5
833
69,000
........................
........................
17,249
FOR FURTHER INFORMATION CONTACT:
Lawrence A. Levey, Office of the
General Counsel, Office of Program Law,
Social Security Administration, 6401
Frm 00127
Fmt 4703
Estimated
annual burden
(hours)
10,000
process in lawsuits involving judicial
review of Agency final decisions on
individual claims for benefits under
titles II, VIII, and/or XVI of the Social
Security Act. Under the new rules,
summonses and complaints in these
types of cases should be mailed directly
to the office in SSA’s Office of the
General Counsel (OGC) that is
responsible for the processing and
handling of litigation in the particular
jurisdiction in which the complaint has
been filed. The names and current
addresses of those offices, and the
jurisdictions for which they are
currently responsible, are detailed in
this Notice.
PO 00000
Average
burden
per response
(minutes)
Sfmt 4703
Security Boulevard, Baltimore, MD
21235–6401, (410) 965–3460.
In
accordance with our revised procedures,
as codified at 20 CFR 423.1 and
published in the Rules and Regulations
section, summonses and complaints in
cases involving judicial review of
Agency final decisions on individual
claims for benefits under titles II, VIII,
and/or XVI of the Social Security Act
should be mailed directly to the office
in SSA’s Office of the General Counsel
that is responsible for the processing
and handling of litigation in the
particular jurisdiction in which the
complaint has been filed. The
jurisdictional responsibilities and the
names and addresses of these offices are
as follows:
SUPPLEMENTARY INFORMATION:
E:\FR\FM\09DEN1.SGM
09DEN1
]]>Agencies
[Federal Register Volume 70, Number 236 (Friday, December 9, 2005)]
[Notices]
[Pages 73319-73320]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E5-7111]
=======================================================================
-----------------------------------------------------------------------
SOCIAL SECURITY ADMINISTRATION
Agency Information Collection Activities: Proposed Request
The Social Security Administration (SSA) publishes a list of
information collection packages that requires 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. 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 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.
(OMB), Office of Management and Budget, Attn: Desk Officer for SSA.
Fax: 202-395-6974.
(SSA), Social Security Administration, DCFAM, Attn: Reports
Clearance Officer. Fax: 410-965-6400. E-mail: OPLM.RCO@ssa.gov.
The information collection listed below is 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 a copy of the collection
instrument by calling the SSA Reports Clearance Officer at 410-965-0454
or by e-mailing or faxing your request to the above e-mail address and
fax number.
Medicare Subsidy Quality Review Case Analysis Forms--20 CFR 418(b)(5)--
0960-0707
Under the aegis of the Medicare Modernization Act of 2003, SSA will
make Medicare Part D subsidy determinations for the Medicare
Prescription Drug program for Medicare beneficiaries with limited
income and resources. The subsidy determination is based on applicants'
answers to questions about household size, income, and resources. This
information is self-reported by applicants using form OMB No. 0960-0696
(SSA-1020), and thus, SSA needs a way to determine if this form is
being completed accurately and completely and a way to validate its
determination decisions. To this end, SSA will use the new Medicare
Quality Review system to check the accuracy of the determination. In
this system, SSA will conduct phone interviews with selected applicants
and will confirm information such as household size, income, and
resources. A questionnaire and several other forms will be used as part
of the Medicare Quality Review System. The collection instruments,
their descriptions, and burden information are listed in the table
below.
Note: This Notice is for the permanent approval of this
collection, which was cleared by OMB temporarily through February
2006 as an emergency information collection.
Type of Request: Extension of a currently approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average
Description of Number of Frequency of burden per Estimated
Form number and name form respondents response response annual burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-9301 (Medicare Subsidy Telephone 10,000 1 35 5,833
Quality Review Case Analysis questionnaire
Questionnaire). which will be
administered by
SSA employees
to applicants
for Medicare
Part D Subsidy.
Includes
questions about
family size,
marriage,
income, assets,
etc.
[[Page 73320]]
SSA-9302 (Notice of Quality After receiving 10,000 1 15 2,500
Review Acknowledgement Form notice of the
for those with Phones). scheduled date/
time of the
telephone
questionnaire,
Part D
applicants will
return this
form confirming
their
availability
for the
interview and
making note of
any special
needs for the
call.
SSA-9303 (Notice of Quality Same as for SSA- 1,000 1 15 250
Review Acknowledgement Form 9302, except
for those without Phones). used by
participants
without phones
or whose phone
numbers are not
known by SSA.
On form SSA-
9303, however,
participants
confirm receipt
of the letter
and are asked
to call SSA on
a specified
date.
SSA-9304 (Checklist of This checklist, .............. .............. .............. ..............
Required Information). which
accompanies
forms SSA-9302
and SSA-9303,
is a list of
the
documentation
respondents are
supposed to
have prepared
when SSA calls
them to conduct
the Quality
Review phone
interview.
Their burden is
accounted for
in the burdens
for forms SSA-
9302 and SSA-
9303.
SSA-9308 (Request for Form which SSA 20,000 1 15 5,000
Information). will send to
various third
parties to
obtain/confirm
information
reported by
beneficiaries.
SSA-9310 (Request for Following the 10,000 1 5 833
Documents). phone
interview, SSA
sends this
notice to the
participants
advising them
of the
documents they
must return to
SSA.
SSA-9309 (Life Insurance Form completed 8,000 1 15 2,000
Verification Form). by insurance
companies
confirming
type, face
value, cash
surrender value
and dividends
for insurance
policies of
applicants for
Medicare Part D
subsidy.
SSA-8510 (Authorization to the Beneficiaries 10,000 1 5 833
Social Security give their
Administration to Obtain permission for
Personal Information). SSA to contact
third parties
to obtain/
confirm
information.
-----------------
Total..................... ................ 69,000 .............. .............. 17,249
----------------------------------------------------------------------------------------------------------------
Total Estimated Annual Burden: 17,249 hours.
Dated: December 2, 2005.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. E5-7111 Filed 12-8-05; 8:45 am]
BILLING CODE 4191-02-P
