Agency Information Collection Activities: Proposed Request and Comment Request, 7107-7110 [E7-2418]
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Federal Register / Vol. 72, No. 30 / Wednesday, February 14, 2007 / Notices
requires any Series A–1 Permit Holder
to maintain a primary affiliation with an
eligible member organization at all
times that such holder holds a permit.
Member organizations, which do not
include individuals but which are
defined as ‘‘a corporation, partnership
(general or limited), limited liability
partnership, limited liability company,
business trust or similar organization’’
which meet certain criteria, are not
covered by the Rule 702 prohibition.
The Exchange is proposing the
deletion of Rule 702 not only because it
is confusing, but also because a
member’s ability to carry customer
accounts is in many ways dictated by
the member’s ability to comply with
relevant securities laws and regulations
including, but not limited to, Exchange
Act Rules 15c3–1 and 15c3–3,7 and
related rules, which do not make
distinctions on the basis of a member’s
organizational and corporate structure.8
The Exchange believes that Rule 702 is
therefore superfluous.
2. Statutory Basis
The Exchange believes that its
proposal is consistent with Section 6(b)
of the Act in general, and furthers the
objectives of Section 6(b)(5) of the Act
in particular, in that it is designed to
promote just and equitable principles of
trade, to remove impediments to and
perfect the mechanism of a free and
open market and a national market
system, and, in general to protect
investors and the public interest, by
eliminating a confusing and
unnecessary Exchange rule.
B. Self-Regulatory Organization’s
Statement on Burden on Competition
The Exchange does not believe that
the proposed rule change will impose
any burden on competition that is not
necessary or appropriate in furtherance
of the purposes of the Act.
7 17
CFR 240.15c3–1 and 240.15c3–3.
example, the customer protection provisions
of Rule 15c3–3 under the Act requires brokerdealers to maintain physical possession or control
of customer fully-paid and excess margin securities.
Further, Phlx member firms for which the Exchange
is the DEA generally do not carry public customer
accounts. If a Phlx member firm carries customer
accounts it is required to become a member of a
national securities association (e.g., the National
Association of Securities Dealers (‘‘NASD’’)). Under
agreements that the Phlx has entered into with
other self-regulatory organizations (‘‘SROs’’) in
accordance with Rule 17d–2 under the Act, any
Phlx member that is also a member of another SRO
(including the NASD) would be assigned to another
DEA.
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8 For
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C. Self-Regulatory Organization’s
Statement on Comments on the
Proposed Rule Change Received From
Members, Participants, or Others
No written comments were either
solicited or received.
III. Date of Effectiveness of the
Proposed Rule Change and Timing for
Commission Action
Within 35 days of the date of
publication of this notice in the Federal
Register or within such longer period (i)
as the Commission may designate up to
90 days of such date if it finds such
longer period to be appropriate and
publishes its reasons for so finding or
(ii) as to which Phlx consents, the
Commission shall: (a) By order approve
such proposed rule change, or (b)
institute proceedings to determine
whether the proposed rule change
should be disapproved.
7107
provisions of 5 U.S.C. 552, will be
available for inspection and copying in
the Commission’s Public Reference
Room. Copies of the filing also will be
available for inspection and copying at
the principal office of the Phlx. 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–Phlx–2005–68 and should
be submitted on or before March 7,
2007.
For the Commission, by the Division of
Market Regulation, pursuant to delegated
authority.9
Nancy M. Morris,
Secretary.
[FR Doc. E7–2550 Filed 2–13–07; 8:45 am]
BILLING CODE 8010–01–P
IV. Solicitation of Comments
Interested persons are invited to
submit written data, views, and
arguments concerning the foregoing,
including whether the proposed rule
change is consistent with the Act.
Comments may be submitted by any of
the following methods:
SOCIAL SECURITY ADMINISTRATION
Agency Information Collection
Activities: Proposed Request and
Comment Request
The Social Security Administration
(SSA) publishes a list of information
collection packages that will require
Electronic Comments
clearance by the Office of Management
• Use the Commission’s Internet
and Budget (OMB) in compliance with
comment form (https://www.sec.gov/
Pub.L. 104–13, the Paperwork
rules/sro.shtml); or
Reduction Act of 1995, effective October
• Send an e-mail to rule1, 1995. The information collection
comments@sec.gov. Please include File
packages that may be included in this
Number SR–Phlx–2005–68 on the
notice are for new information
subject line.
collections, approval of existing
information collections, revisions to
Paper Comments
OMB-approved information collections,
• Send paper comments in triplicate
and extensions (no change) of OMBto Nancy M. Morris, Secretary,
approved information collections.
Securities and Exchange Commission,
SSA is soliciting comments on the
100 F Street, NE., Washington, DC
accuracy of the agency’s burden
20549–1090.
estimate; the need for the information;
All submissions should refer to File
its practical utility; ways to enhance its
Number SR–Phlx–2005–68. This file
quality, utility, and clarity; and on ways
number should be included on the
to minimize burden on respondents,
subject line if e-mail is used. To help the including the use of automated
Commission process and review your
collection techniques or other forms of
comments more efficiently, please use
information technology. Written
only one method. The Commission will comments and recommendations
post all comments on the Commission’s regarding the information collection(s)
Internet Web site (https://www.sec.gov/
should be submitted to the OMB Desk
rules/sro.shtml). Copies of the
Officer and the SSA Reports Clearance
submission, all subsequent
Officer. The information can be mailed,
amendments, all written statements
faxed or e-mailed to the individuals at
with respect to the proposed rule
the addresses and fax numbers listed
below:
change that are filed with the
Commission, and all written
(OMB), Office of Management and
communications relating to the
Budget, Attn: Desk Officer for SSA,
proposed rule change between the
Fax: 202–395–6974, E-mail address:
Commission and any person, other than
OIRA_Submission@omb.eop.gov.
those that may be withheld from the
9 17 CFR 200.30–3(a)(12).
public in accordance with the
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Federal Register / Vol. 72, No. 30 / Wednesday, February 14, 2007 / Notices
(SSA), Social Security Administration,
DCFAM, Attn: Reports Clearance
Officer, 1333 Annex Building, 6401
Security Blvd., Baltimore, MD 21235,
Fax: 410–965–6400, E-mail address:
OPLM.RCO@ssa.gov.
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 Child’s Insurance
Benefits—20 CFR 404.350–404.368,
404.603, and 416.350—0960–0010. SSA
uses the information collected by the
SSA–4–BK to entitle children of living
Type of
request
Number of
respondents
and deceased workers to monthly Social
Security payments. Respondents are
guardians completing the form on behalf
of the children of living or deceased
workers, or the children of living or
deceased workers.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 1,740,000.
Estimated Annual Burden: 344,141
hours.
Frequency per
response
Average
burden per
response
(minutes)
Estimated annual burden
46,250
439,375
439,375
40,750
387,125
387,125
1
1
1
1
1
1
10
10
9
15
15
14
7,708
73,229
65,906
10,188
96,781
90,329
Totals ........................................................................................................
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Life Claims .......................................................................................................
Life Claims—MCS ...........................................................................................
Life Claims—Signature Proxy ..........................................................................
Death Claims ...................................................................................................
Death Claims—MCS ........................................................................................
Death Claims—Signature Proxy ......................................................................
1,740,000
........................
........................
344,141
2. Physician’s/Medical Officer’s
Statement of Patient’s Capability to
Manage Benefits—20 CFR 404.2015 and
416.615—0960–0024. The information
collected on the SSA–787 is used to
determine whether an individual is
capable of handling his or her own
benefits. This information is also used
for leads in selecting a representative
payee, if needed. The respondents are
physicians of the beneficiaries or
medical officers of the institution in
which the beneficiaries reside.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 120,000.
Frequency of Response: 1.
Average Burden Per Response: 10
minutes.
Estimated Annual Burden: 20,000
hours.
3. Modified Benefit Formula
Questionnaire—Foreign Pension—
0960–0561. The information collected
on the SSA–308 is used to determine
exactly how much (if any) of a foreign
pension may be used to reduce the
amount of Social Security retirement or
disability benefits under the modified
benefit formula. The respondents are
applicants for Social Security retirement
or disability benefits.
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.
4. Authorization to Release Medical
Report to Physician—20 CFR 401.55 &
401.100—0960–NEW. If the claimant,
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his or her court appointed
representative, or a parent of a minor
child wants the consultative
examination (CE) report sent to the
claimant’s treating physician, he or she
will complete the information requested
on Form SSA–91 and send it to SSA for
processing. SSA will use the
information collected to send the CE
report to the authorized physician.
Respondents are applicants for
disability claims.
Type of Request: Collection in use
without an OMB number.
Number of Respondents: 7,922.
Frequency of Response: 1.
Average Burden Per Response: 5
minutes.
Estimated Annual Burden: 660 hours.
5. Claimant Travel Reimbursement
Request—20 CFR 404.999a–d—0960–
NEW. The claimants have the right to be
reimbursed for their travel expenses to
and from a consultative examination
(CE). In order to be reimbursed, the
claimants must submit an itemized list
of what they spent to travel round trip
to the CE. The SSA–104 is sent to the
claimants with the CE appointment
notice. If the claimants want to be
reimbursed for their travel expenses,
they must complete, sign and return the
SSA–104 to SSA. SSA uses the
information collected on this form to
determine the amount of
reimbursement. Respondents are
applicants for disability claims.
Type of Request: Collection in use
without an OMB number.
Number of Respondents: 11,092.
Frequency of Response: 1.
Average Burden Per Response: 10
minutes.
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Estimated Annual Burden: 1,849
hours.
6. Treating Physician Consultative
Examination Interest Form—20 CFR
404.1519g–i—0960–NEW. The
individual’s treating physician (TP) is
the preferred source to perform a
consultative examination (CE). SSA uses
the SSA–84 to ascertain whether the TP
is interested in performing the CE. This
form is sent to the claimant’s treating
physician along with the medical
evidence of record request letter. If the
treating physician is interested in
performing the CE, he or she indicates
interest by completing the SSA–84 and
returning it to SSA. If the form is not
returned, SSA assumes that the TP is
not interested in performing the CE.
Respondents are the claimants’ treating
physicians.
Type of Request: Collection in use
without an OMB number.
Number of Respondents: 168.
Frequency of Response: 1.
Average Burden Per Response: 5
minutes.
Estimated Annual Burden: 14 hours.
7. Electronic Records Express—0960–
NEW. Electronic Records Express (ERE)
is a new Internet-based platform which
facilitates the electronic submission of
medical and school records needed for
the disability process. These records are
currently mailed as hard paper copies to
SSA and state Disability Determination
Services (DDSs) under the aegis of OMB
No. 0960–0555, the Clearance of
Information Collections Conducted by
State Disability Determination Services
on Behalf of SSA. While SSA and the
DDSs will continue to accept paper
copies, ERE offers respondents the
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opportunity to submit these records
electronically. The revised burden for
the actual document submission will
continue to be covered under 0960–
0555; this new collection covers the ERE
registration and user training process.
The respondents are medical providers
and school professionals who submit
information to SSA on behalf of
disability applicants or beneficiaries.
Type of Request: New information
collection.
Number of Respondents: 20,000.
Frequency of Response: 1.
Average Burden Per Response: 5
minutes.
Estimated Annual Burden: 1,667
hours.
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. Application of Circuit Court Law—
20 CFR 404.985 & 416.1458—0960–
0581. Under SSA regulations, persons
may request re-adjudication on the basis
that the application of an acquiescence
ruling (AR) would change a prior
determination or decision. We will use
the information provided to determine
whether they are entitled to readjudication of their claims in
accordance with these regulations. We
will review the available information in
the requests to determine whether the
issue(s) stated in the AR pertains to the
claimant’s case. If re-adjudication is
appropriate, we will consider only those
issue(s) covered by the AR. Any new
determination or decision will be
subject to administrative or judicial
review in accordance with our
regulations. Individuals who request
readjudication are claimants for Social
Security benefits and Supplemental
Security Income payments.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 10,000.
Frequency of Response: 1.
Average Burden Per Response: 17
minutes.
Estimated Annual Burden: 2,833
hours.
2. Physical Residual Functional
Capacity Assessment and Mental
Residual Functional Capacity
Assessment—20 CFR 404.1545–
404.1546 & 416.945–416.946—0960–
0431. The information collected on
forms SSA–4734–BK and SSA–4734–
F4–SUP is needed by SSA to assist in
the adjudication of disability claims
involving physical and/or mental
impairments. The forms assist the State
DDS offices to evaluate the severity of
impairments by providing standardized
data collection forms. The use of these
forms by the DDSs ensures nationally
consistent evaluations presented in a
concise, clear and readily
understandable manner. The
respondents are primarily doctors in
DDSs funded and administered by SSA.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 2,397,646.
Frequency of Response: 1.
Average Burden Per Response: 20
minutes.
Estimated Annual Burden: 799,215
hours.
3. Substitution of Party Upon Death of
Claimant—20 CFR 404.957(c)(4) &
416.1457(c)(4)—0960–0288. The HA–
539 is used to collect information from
any individual who asks to be made a
substitute party for a claimant for either
Social Security benefits or
Supplemental Security Income
payments who dies while his or her
request for a hearing is pending. This
information is needed and used by SSA
to afford these individuals their
Collection
method
statutory right to a hearing and decision
under the Social Security Act.
Respondents are individuals
requesting to proceed with hearings as
substitute parties for deceased claimants
for Social Security benefits or
Supplemental Security Income
payments.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 4,320.
Frequency of Response: 1.
Average Burden Per Response: 5
minutes.
Estimated Annual Burden: 360 hours.
4. Child Relationship Statement—20
CFR 404.355 & 404.731—0960–0116.
The information collected on the SSA–
2519 is used to help determine the
entitlement of children to Social
Security benefits under section
216(h)(3) of the Social Security Act
(deemed child provision). Respondents
are persons with knowledge of the
relationship between the number holder
and his/her alleged biological child who
is filing for benefits.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden Per Response: 15
minutes.
Estimated Annual Burden: 12,500
hours.
5. Application for Lump Sum Death
Payment—20 CFR 404.390–404.392—
0960–0013. The Social Security
Administration (SSA) needs the
information collected on Form SSA–8–
F4 to authorize payment of the lump
sum death payment (LSDP) to a widow,
widower, or children as defined in
Section 202(i) of the Act. Respondents
are applicants for LSDP.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 587,000.
Estimated Annual Burden: 93,187.
Number of
respondents
Estimated
completion
time
(minutes)
Burden
hours
278,825
278,825
29,350
10
9
10
46,471
41,824
4,892
Totals ....................................................................................................................................
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MCS .............................................................................................................................................
MCS/Signature Proxy ..................................................................................................................
Paper ...........................................................................................................................................
587,000
........................
93,187
6. Certificate of Support—20 CFR
404.370, 404.750, 404.408a—0960–
0001. The information collected on the
SSA–760–F4 is used to determine
whether the parent of a deceased worker
or the spouse meets the one-half support
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requirement specified in SSA
regulations. Respondents are parents of
deceased workers, or spouses who may
qualify for an exception to Government
Pension Offset.
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Type of Request: Revision of an OMB
approved information collection.
Number of Respondents: 18,000.
Frequency of Response: 1.
Average Burden Per Response: 15
minutes.
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Estimated Annual Burden: 4,500
hours.
7. Request for Reinstatement (Title
II)—20 CFR 404.1592b–404.1592f—
0960–NEW. Form SSA–371 is used by
former beneficiaries for Title II benefits
who wish to request Expedited
Reinstatement (EXR) of their Title II
disability benefits. SSA uses the SSA–
371 to obtain a signed statement from
the individual requesting EXR, and to
verify that the applicant meets the EXR
requirements. The form will be
maintained in the disability folder of the
applicant to demonstrate that the
individual was aware of the EXR
requirements and chose to request EXR.
Respondents are applicants for EXR of
Title II disability benefits.
Type of Request: Collection in use
without an OMB number.
Number of Respondents: 10,000.
Frequency of Response: 1.
Average Burden per Response: 2
minutes.
Estimated Annual Burden: 333 hours.
8. Request for Reinstatement (Title
XVI)—20 CFR 416.999–416.999d—
0960–NEW. Form SSA–372 is used by
former SSI claimants who wish to
request Expedited Reinstatement (EXR)
of their Title XVI disability payments.
SSA uses the SSA–372 to obtain a
signed statement from the individual
requesting EXR and to verify that the
requestor meets the EXR requirements.
The form will be maintained in the
disability folder of the applicant to
demonstrate that the individual was
aware of the EXR requirements and
chose to request EXR. Respondents are
applicants for EXR of Title XVI
disability payments.
Type of Request: Collection in use
without an OMB number.
Number of Respondents: 2,000.
Frequency of Response: 1.
Average Burden per Response: 2
minutes.
Estimated Annual Burden: 67 hours.
9. Vendor List Registration Form—
0960–NEW. SSA maintains an Employer
Wage Reporting and Instructions
Vendor Web site. On this site, relevant
vendors are allowed to list their
products and services free of charge.
Vendors wishing to list their
information on the site can submit these
requests via a written registration form
or through the Web site itself. The
respondents are vendors who offer
employer wage reporting services and
who want SSA to list their information
on the relevant Web site.
Type of Request: New information
collection.
Number of Respondents: 500.
Frequency of Response: 1.
Average Burden Per Response: 8
minutes.
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Estimated Annual Burden: 67 hours.
Dated: February 7, 2007.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security
Administration.
[FR Doc. E7–2418 Filed 2–13–07; 8:45 am]
BILLING CODE 4191–02–P
DEPARTMENT OF TRANSPORTATION
Office of the Secretary
[Docket No. OST–2003–15660]
Notice of Request for Renewal of a
Currently Approved Information
Collection
Office of the Secretary, DOT.
Notice.
AGENCY:
ACTION:
DEPARTMENT OF STATE
[Public Notice 5696]
Culturally Significant Object Imported
for Exhibition Determinations: ‘‘Italian
Women Artists From Renaissance to
Baroque’’
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, Delegation of Authority
No. 236 of October 19, 1999, as
amended, and Delegation of Authority
No. 257 of April 15, 2003 [68 FR 19875],
I hereby determine that the object to be
included in the exhibition ‘‘Italian
Women Artists from Renaissance to
Baroque’’, imported from abroad for
temporary exhibition within the United
States, is of cultural significance. The
object is imported pursuant to a loan
agreement with the foreign owner or
custodian. I also determine that the
exhibition or display of the exhibit
object at the National Museum of
Women in the Arts, Washington, DC,
from on or about March 16, 2007, until
on or about July 15, 2007, 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, including a list of
the exhibit object, contact Wolodymyr
Sulzynsky, Attorney-Adviser, Office of
the Legal Adviser, U.S. Department of
State (telephone: (202) 453–8050). The
address is U.S. Department of State, SA–
44, 301 4th Street, SW., Room 700,
Washington, DC 20547–0001.
FOR FURTHER INFORMATION CONTACT:
Dated: February 6, 2007.
C. Miller Crouch,
Principal Deputy Assistant Secretary for
Educational and Cultural Affairs, Department
of State.
[FR Doc. E7–2559 Filed 2–13–07; 8:45 am]
BILLING CODE 4710–05–P
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SUMMARY: In accordance with the
Paperwork Reduction Act of 1995 this
notice announces the Department of
Transportation’s (DOT’s) intention to
request an extension for a currently
approved information collection.
DATES: Comments on this notice must be
received by April 16, 2007.
ADDRESSES: You may submit comments
[identified by DOT DMS Docket Number
OST–2003–15660] by any of the
following methods:
• Web Site: https://dms.dot.gov.
Follow the instructions for submitting
comments on the DOT electronic docket
site.
• Fax: 1–202–493–2251.
• Mail: Docket Management Facility;
U.S. Department of Transportation, 400
Seventh Street, SW., Nassif Building,
Room PL–401, Washington, DC 20590–
001.
• Hand Delivery: Room PL–401 on
the plaza level of the Nassif Building,
400 Seventh Street, SW., Washington,
DC, between 9 a.m. and 5 p.m., Monday
through Friday, except on Federal
holidays.
• Federal eRulemaking Portal: Go to
https://www.regulations.gov. Follow the
online instructions for submitting
comments.
Instructions: All submissions must
include the agency name and docket
number or Regulatory Identification
Number (RIN) for this rulemaking. For
detailed instructions on submitting
comments and additional information
on the rulemaking process, see the
Public Participation heading of the
SUPPLEMENTARY INFORMATION section of
this document. Note that all comments
received will be posted without change
to https://dms.dot.gov including any
personal information provided. Please
see the Privacy Act heading under
Regulatory Notes.
Docket: For access to the docket to
read background documents or
comments received, go to https://
dms.dot.gov at any time or to Room PL–
401 on the plaza level of the Nassif
Building, 400 Seventh Street, SW.,
Washington, DC, between 9 a.m. and 5
p.m., Monday through Friday, except
Federal holidays.
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]]>Agencies
[Federal Register Volume 72, Number 30 (Wednesday, February 14, 2007)]
[Notices]
[Pages 7107-7110]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E7-2418]
=======================================================================
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SOCIAL SECURITY ADMINISTRATION
Agency Information Collection Activities: Proposed Request and
Comment 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, faxed or e-mailed 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, E-mail address: OIRA--Submission@omb.eop.gov.
[[Page 7108]]
(SSA), Social Security Administration, DCFAM, Attn: Reports Clearance
Officer, 1333 Annex Building, 6401 Security Blvd., Baltimore, MD 21235,
Fax: 410-965-6400, E-mail address: OPLM.RCO@ssa.gov.
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 Child's Insurance Benefits--20 CFR 404.350-
404.368, 404.603, and 416.350--0960-0010. SSA uses the information
collected by the SSA-4-BK to entitle children of living and deceased
workers to monthly Social Security payments. Respondents are guardians
completing the form on behalf of the children of living or deceased
workers, or the children of living or deceased workers.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 1,740,000.
Estimated Annual Burden: 344,141 hours.
----------------------------------------------------------------------------------------------------------------
Average
Number of Frequency per burden per Estimated
Type of request respondents response response annual burden
(minutes)
----------------------------------------------------------------------------------------------------------------
Life Claims..................................... 46,250 1 10 7,708
Life Claims--MCS................................ 439,375 1 10 73,229
Life Claims--Signature Proxy.................... 439,375 1 9 65,906
Death Claims.................................... 40,750 1 15 10,188
Death Claims--MCS............................... 387,125 1 15 96,781
Death Claims--Signature Proxy................... 387,125 1 14 90,329
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Totals...................................... 1,740,000 .............. .............. 344,141
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2. Physician's/Medical Officer's Statement of Patient's Capability
to Manage Benefits--20 CFR 404.2015 and 416.615--0960-0024. The
information collected on the SSA-787 is used to determine whether an
individual is capable of handling his or her own benefits. This
information is also used for leads in selecting a representative payee,
if needed. The respondents are physicians of the beneficiaries or
medical officers of the institution in which the beneficiaries reside.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 120,000.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 20,000 hours.
3. Modified Benefit Formula Questionnaire--Foreign Pension--0960-
0561. The information collected on the SSA-308 is used to determine
exactly how much (if any) of a foreign pension may be used to reduce
the amount of Social Security retirement or disability benefits under
the modified benefit formula. The respondents are applicants for Social
Security retirement or disability benefits.
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.
4. Authorization to Release Medical Report to Physician--20 CFR
401.55 & 401.100--0960-NEW. If the claimant, his or her court appointed
representative, or a parent of a minor child wants the consultative
examination (CE) report sent to the claimant's treating physician, he
or she will complete the information requested on Form SSA-91 and send
it to SSA for processing. SSA will use the information collected to
send the CE report to the authorized physician. Respondents are
applicants for disability claims.
Type of Request: Collection in use without an OMB number.
Number of Respondents: 7,922.
Frequency of Response: 1.
Average Burden Per Response: 5 minutes.
Estimated Annual Burden: 660 hours.
5. Claimant Travel Reimbursement Request--20 CFR 404.999a-d--0960-
NEW. The claimants have the right to be reimbursed for their travel
expenses to and from a consultative examination (CE). In order to be
reimbursed, the claimants must submit an itemized list of what they
spent to travel round trip to the CE. The SSA-104 is sent to the
claimants with the CE appointment notice. If the claimants want to be
reimbursed for their travel expenses, they must complete, sign and
return the SSA-104 to SSA. SSA uses the information collected on this
form to determine the amount of reimbursement. Respondents are
applicants for disability claims.
Type of Request: Collection in use without an OMB number.
Number of Respondents: 11,092.
Frequency of Response: 1.
Average Burden Per Response: 10 minutes.
Estimated Annual Burden: 1,849 hours.
6. Treating Physician Consultative Examination Interest Form--20
CFR 404.1519g-i--0960-NEW. The individual's treating physician (TP) is
the preferred source to perform a consultative examination (CE). SSA
uses the SSA-84 to ascertain whether the TP is interested in performing
the CE. This form is sent to the claimant's treating physician along
with the medical evidence of record request letter. If the treating
physician is interested in performing the CE, he or she indicates
interest by completing the SSA-84 and returning it to SSA. If the form
is not returned, SSA assumes that the TP is not interested in
performing the CE. Respondents are the claimants' treating physicians.
Type of Request: Collection in use without an OMB number.
Number of Respondents: 168.
Frequency of Response: 1.
Average Burden Per Response: 5 minutes.
Estimated Annual Burden: 14 hours.
7. Electronic Records Express--0960-NEW. Electronic Records Express
(ERE) is a new Internet-based platform which facilitates the electronic
submission of medical and school records needed for the disability
process. These records are currently mailed as hard paper copies to SSA
and state Disability Determination Services (DDSs) under the aegis of
OMB No. 0960-0555, the Clearance of Information Collections Conducted
by State Disability Determination Services on Behalf of SSA. While SSA
and the DDSs will continue to accept paper copies, ERE offers
respondents the
[[Page 7109]]
opportunity to submit these records electronically. The revised burden
for the actual document submission will continue to be covered under
0960-0555; this new collection covers the ERE registration and user
training process. The respondents are medical providers and school
professionals who submit information to SSA on behalf of disability
applicants or beneficiaries.
Type of Request: New information collection.
Number of Respondents: 20,000.
Frequency of Response: 1.
Average Burden Per Response: 5 minutes.
Estimated Annual Burden: 1,667 hours.
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. Application of Circuit Court Law--20 CFR 404.985 & 416.1458--
0960-0581. Under SSA regulations, persons may request re-adjudication
on the basis that the application of an acquiescence ruling (AR) would
change a prior determination or decision. We will use the information
provided to determine whether they are entitled to re-adjudication of
their claims in accordance with these regulations. We will review the
available information in the requests to determine whether the issue(s)
stated in the AR pertains to the claimant's case. If re-adjudication is
appropriate, we will consider only those issue(s) covered by the AR.
Any new determination or decision will be subject to administrative or
judicial review in accordance with our regulations. Individuals who
request readjudication are claimants for Social Security benefits and
Supplemental Security Income payments.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 10,000.
Frequency of Response: 1.
Average Burden Per Response: 17 minutes.
Estimated Annual Burden: 2,833 hours.
2. Physical Residual Functional Capacity Assessment and Mental
Residual Functional Capacity Assessment--20 CFR 404.1545-404.1546 &
416.945-416.946--0960-0431. The information collected on forms SSA-
4734-BK and SSA-4734-F4-SUP is needed by SSA to assist in the
adjudication of disability claims involving physical and/or mental
impairments. The forms assist the State DDS offices to evaluate the
severity of impairments by providing standardized data collection
forms. The use of these forms by the DDSs ensures nationally consistent
evaluations presented in a concise, clear and readily understandable
manner. The respondents are primarily doctors in DDSs funded and
administered by SSA.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 2,397,646.
Frequency of Response: 1.
Average Burden Per Response: 20 minutes.
Estimated Annual Burden: 799,215 hours.
3. Substitution of Party Upon Death of Claimant--20 CFR
404.957(c)(4) & 416.1457(c)(4)--0960-0288. The HA-539 is used to
collect information from any individual who asks to be made a
substitute party for a claimant for either Social Security benefits or
Supplemental Security Income payments who dies while his or her request
for a hearing is pending. This information is needed and used by SSA to
afford these individuals their statutory right to a hearing and
decision under the Social Security Act.
Respondents are individuals requesting to proceed with hearings as
substitute parties for deceased claimants for Social Security benefits
or Supplemental Security Income payments.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 4,320.
Frequency of Response: 1.
Average Burden Per Response: 5 minutes.
Estimated Annual Burden: 360 hours.
4. Child Relationship Statement--20 CFR 404.355 & 404.731--0960-
0116. The information collected on the SSA-2519 is used to help
determine the entitlement of children to Social Security benefits under
section 216(h)(3) of the Social Security Act (deemed child provision).
Respondents are persons with knowledge of the relationship between the
number holder and his/her alleged biological child who is filing for
benefits.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 12,500 hours.
5. Application for Lump Sum Death Payment--20 CFR 404.390-404.392--
0960-0013. The Social Security Administration (SSA) needs the
information collected on Form SSA-8-F4 to authorize payment of the lump
sum death payment (LSDP) to a widow, widower, or children as defined in
Section 202(i) of the Act. Respondents are applicants for LSDP.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 587,000.
Estimated Annual Burden: 93,187.
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Estimated
Number of completion
Collection method respondents time Burden hours
(minutes)
----------------------------------------------------------------------------------------------------------------
MCS............................................................. 278,825 10 46,471
MCS/Signature Proxy............................................. 278,825 9 41,824
Paper........................................................... 29,350 10 4,892
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Totals...................................................... 587,000 .............. 93,187
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6. Certificate of Support--20 CFR 404.370, 404.750, 404.408a--0960-
0001. The information collected on the SSA-760-F4 is used to determine
whether the parent of a deceased worker or the spouse meets the one-
half support requirement specified in SSA regulations. Respondents are
parents of deceased workers, or spouses who may qualify for an
exception to Government Pension Offset.
Type of Request: Revision of an OMB approved information
collection.
Number of Respondents: 18,000.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
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Estimated Annual Burden: 4,500 hours.
7. Request for Reinstatement (Title II)--20 CFR 404.1592b-
404.1592f--0960-NEW. Form SSA-371 is used by former beneficiaries for
Title II benefits who wish to request Expedited Reinstatement (EXR) of
their Title II disability benefits. SSA uses the SSA-371 to obtain a
signed statement from the individual requesting EXR, and to verify that
the applicant meets the EXR requirements. The form will be maintained
in the disability folder of the applicant to demonstrate that the
individual was aware of the EXR requirements and chose to request EXR.
Respondents are applicants for EXR of Title II disability benefits.
Type of Request: Collection in use without an OMB number.
Number of Respondents: 10,000.
Frequency of Response: 1.
Average Burden per Response: 2 minutes.
Estimated Annual Burden: 333 hours.
8. Request for Reinstatement (Title XVI)--20 CFR 416.999-416.999d--
0960-NEW. Form SSA-372 is used by former SSI claimants who wish to
request Expedited Reinstatement (EXR) of their Title XVI disability
payments. SSA uses the SSA-372 to obtain a signed statement from the
individual requesting EXR and to verify that the requestor meets the
EXR requirements. The form will be maintained in the disability folder
of the applicant to demonstrate that the individual was aware of the
EXR requirements and chose to request EXR. Respondents are applicants
for EXR of Title XVI disability payments.
Type of Request: Collection in use without an OMB number.
Number of Respondents: 2,000.
Frequency of Response: 1.
Average Burden per Response: 2 minutes.
Estimated Annual Burden: 67 hours.
9. Vendor List Registration Form--0960-NEW. SSA maintains an
Employer Wage Reporting and Instructions Vendor Web site. On this site,
relevant vendors are allowed to list their products and services free
of charge. Vendors wishing to list their information on the site can
submit these requests via a written registration form or through the
Web site itself. The respondents are vendors who offer employer wage
reporting services and who want SSA to list their information on the
relevant Web site.
Type of Request: New information collection.
Number of Respondents: 500.
Frequency of Response: 1.
Average Burden Per Response: 8 minutes.
Estimated Annual Burden: 67 hours.
Dated: February 7, 2007.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. E7-2418 Filed 2-13-07; 8:45 am]
BILLING CODE 4191-02-P
