Agency Information Collection Activities: Proposed Request and Comment Request, 26443-26446 [E7-8804]
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Federal Register / Vol. 72, No. 89 / Wednesday, May 9, 2007 / Notices
(Catalog of Federal Domestic Assistance
Numbers 59002 and 59008)
Percent
Herbert L. Mitchell,
Associate Administrator for Disaster
Assistance.
[FR Doc. E7–8831 Filed 5–8–07; 8:45 am]
BILLING CODE 8025–01–P
SMALL BUSINESS ADMINISTRATION
[Disaster Declaration # 10862 and # 10863]
Texas Disaster # TX–00251
U.S. Small Business
Administration.
ACTION: Notice.
sroberts on PROD1PC70 with NOTICES
AGENCY:
Percent
For Physical Damage:
Homeowners With Credit
Available Elsewhere ..........
18:12 May 08, 2007
2.875
8.000
5.750
Jkt 211001
Primary Counties:
Rutland.
Contiguous Counties:
Vermont, Addison, Bennington,
Windsor. New York, Washington.
The Interest Rates are:
Percent
5.250
4.000
4.000
The number assigned to this disaster for
physical damage is 10862C and for economic
injury is 108630.
SUMMARY: This is a Notice of the
Presidential declaration of a major
disaster for the State of Texas (FEMA–
1697–DR), dated 05/01/2007.
Incident: Severe Storms and
Tornadoes.
Incident Period: 04/21/2007 through
04/24/2007.
Effective Date: 05/01/2007.
Physical Loan Application Deadline
Date: 07/02/2007.
Economic Injury (EIDL) Loan
Application Deadline Date: 02/01/2008.
ADDRESSES: Submit completed loan
applications to: U.S. Small Business
Administration Processing and
Disbursement Center, 14925 Kingsport
Road, Fort Worth, TX 76155.
FOR FURTHER INFORMATION CONTACT: A.
Escobar, Office of Disaster Assistance,
U.S. Small Business Administration,
409 3rd Street, SW., Suite 6050,
Washington, DC 20416.
SUPPLEMENTARY INFORMATION: Notice is
hereby given that as a result of the
President’s major disaster declaration on
05/01/2007, applications for disaster
loans may be filed at the address listed
above or other locally announced
locations.
The following areas have been
determined to be adversely affected by
the disaster:
Primary Counties (Physical Damage and
Economic Injury Loans):
Maverick, Moore, Swisher.
Contiguous Counties (Economic Injury
Loans Only):
Texas, Armstrong, Briscoe, Carson,
Castro, Dallam, Dimmit, Floyd,
Hale, Hansford, Hartley,
Hutchinson, Kinney, Oldham,
Potter, Randal, Sherman, Uvalde,
Webb, Zavala.
The Interest Rates are:
VerDate Aug<31>2005
Homeowners Without Credit
Available Elsewhere ..........
Businesses With Credit Available Elsewhere ..................
Other (Including Non-Profit
Organizations) With Credit
Available Elsewhere ..........
Businesses And Non-Profit
Organizations
Without
Credit Available Elsewhere
For Economic Injury:
Businesses & Small Agricultural Cooperatives Without
Credit Available Elsewhere
(Catalog of Federal Domestic Assistance
Numbers 59002 and 59008)
Herbert L. Mitchell,
Associate Administrator for Disaster
Assistance.
[FR Doc. E7–8829 Filed 5–8–07; 8:45 am]
26443
Homeowners With Credit Available Elsewhere .....................
Homeowners Without Credit
Available Elsewhere ..............
Businesses With Credit Available Elsewhere .....................
Businesses & Small Agricultural
Cooperatives Without Credit
Available Elsewhere ..............
Other (Including Non-Profit Organizations) With Credit
Available Elsewhere ..............
Businesses And Non-Profit Organizations Without Credit
Available Elsewhere ..............
5.750
2.875
8.000
4.000
5.250
4.000
SMALL BUSINESS ADMINISTRATION
The number assigned to this disaster
for physical damage is 10860 B and for
economic injury is 10861 0. The States
which received an EIDL Declaration #
are Vermont and New York.
[Disaster Declaration # 10860 and # 10861]
(Catalog of Federal Domestic Assistance
Numbers 59002 and 59008)
BILLING CODE 8025–01–P
Dated: May 1, 2007.
Steven C. Preston,
Administrator.
[FR Doc. E7–8830 Filed 5–8–07; 8:45 am]
Vermont Disaster # VT–00002
U.S. Small Business
Administration.
ACTION: Notice.
AGENCY:
BILLING CODE 8025–01–P
This is a notice of an
Administrative declaration of a disaster
for the State of Vermont dated 05/01/
2007.
Incident: Severe Storms and Flooding.
Incident Period: 04/15/2007 through
04/16/2007.
Effective Date: 05/01/2007.
Physical Loan Application Deadline
Date: 07/02/2007.
Economic Injury (EIDL) Loan
Application Deadline Date: 02/01/2008
ADDRESSES: Submit completed loan
applications to:
U.S. Small Business Administration,
Processing And Disbursement Center,
14925 Kingsport Road, Fort Worth, TX
76155.
FOR FURTHER INFORMATION CONTACT: A.
Escobar, Office of Disaster Assistance,
U.S. Small Business Administration,
409 3rd Street SW., Suite 6050,
Washington, DC 20416.
SUPPLEMENTARY INFORMATION: Notice is
hereby given that as a result of the
Administrator’s disaster declaration,
applications for disaster loans may be
filed at the address listed above or other
locally announced locations.
The following areas have been
determined to be adversely affected by
the disaster:
SUMMARY:
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Sfmt 4703
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 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
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Federal Register / Vol. 72, No. 89 / Wednesday, May 9, 2007 / Notices
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.
(SSA), Social Security
Administration, DCBFM, 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. Representative Payee Evaluation
Report—20 CFR 404.2065 & 416.665—
0960–0069. Sections 205(j) and
1631(a)(2) of the Social Security Act
provide that a representative payee may
be appointed to receive benefits on
behalf of an individual entitled to Title
II and/or Title XVI benefits when that
individual is unable to manage or direct
the management of those funds by
themselves. The representative payee is
required to report to SSA at least once
per year on how those funds received
have been used or conserved. When a
representative payee fails to adequately
report to SSA as required, SSA will
conduct a face-to-face interview with
the payee to complete an SSA–624,
Representative Payee Evaluation Report,
in order to determine the continued
suitability of the representative payee to
serve as a payee. The respondents are
individuals and organizations who act
as representative payees for Title II and
Title XVI benefits who fail to comply
with SSA’s statutory annual reporting
requirement.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 252,000.
Frequency of Response: 1.
Average Burden per Response: 30
minutes.
Estimated Annual Burden: 126,000
hours.
2. Request for Change in Time/Place
of Disability Hearing—20 CFR
404.914(c)(2) and 416.1414(c)(2)—0960–
0348. The information on Form SSA–
769 is used by SSA and the State
Disability Determination Services (DDS)
to provide claimants with a structured
format to exercise their right to request
a change in time or place of a scheduled
disability hearing. The information will
be used as a basis for granting or
denying requests for changes and for
rescheduling disability hearings.
Respondents are claimants who wish to
request a change in the time and/or
place of their hearing.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 7,483.
Frequency of Response: 1.
Average Burden Per Response: 8
minutes.
Estimated Annual Burden: 998 hours.
3. Agency/Employer Government
Pension Offset Questionnaire—20 CFR
404.408(a)—0960–0470. The
information collected by form SSA–
4163 will provide SSA with accurate
information from the agency paying the
pension, for purposes of applying the
pension-offset provision. The form will
be used only when (1) the claimant does
not have the information and (2) the
pension-paying agency has not
cooperated with the claimant.
Respondents are Federal and State
Collection instrument
Respondents
sroberts on PROD1PC70 with NOTICES
SSA–3988 ........................................................................................................
SSA–3989 ........................................................................................................
Totals ........................................................................................................
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
VerDate Aug<31>2005
18:12 May 08, 2007
Jkt 211001
30,000
30,000
60,000
the SSA Reports Clearance Officer at
410–965–0454, or by writing to the
address listed above.
1. 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
PO 00000
Frm 00112
Fmt 4703
Sfmt 4703
Government agencies which have
information needed by SSA to
determine if the GPO applies and the
amount of offset.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 1000.
Frequency of Response: 1.
Average Burden Per Response: 3
minutes.
Estimated Annual Burden: 50 hours.
4. Child Care Dropout
Questionnaire—20 CFR 404.211(e)(4)—
0960–0474. Information collected on
this form is ed by SSA to determine if
an individual qualifies for a child care
exclusion in computing the individual’s
disability benefit amount. Respondents
are applicants for disability benefits.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 2000.
Frequency of Response: 1.
Average Burden Per Response: 5
minutes.
Estimated Annual Burden: 167 hours.
5. Statement for Determining
Continuing Eligibility for Supplemental
Security Income Payments—Adult,
Form SSA–3988; Statement for
Determining Continuing Eligibility for
Supplemental Security Income
Payments—Child, Form SSA–3989—20
CFR Subpart B—416.204—0960–0643.
Forms SSA–3988 and SSA–3989 will
be used to determine whether SSI
recipients have met and continue to
meet all statutory and regulatory nonmedical requirements for Supplemental
Security Income eligibility, and whether
they have been and are still receiving
the correct payment amount. The SSA–
3988 and SSA–3989 are designed as
self-help forms that will be mailed to
recipients or to their representative
payees for completion and return to
SSA. The respondents are recipients of
SSI payments or their representatives.
Type of Request: Revisions to an
existing OMB information collection.
Frequency of
response
Average burden per response
1
1
........................
26 min.
26 min.
........................
Estimated annual burden
(hours)
13,000
13,000
26,000
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
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Federal Register / Vol. 72, No. 89 / Wednesday, May 9, 2007 / Notices
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.
2. Application for Child’s Insurance
Benefits—20 CFR 404.350–404.368,
404.603, & 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
Number of
respondents
Type of request
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.
Average
burden per
response
(minutes)
Frequency per
response
Estimated
annual burden
Life Claims .......................................................................................................
Life Claims—MCS ...........................................................................................
Life Claims—Signature Proxy ..........................................................................
Death Claims ...................................................................................................
Death Claims—MCS ........................................................................................
Death Claims—Signature Proxy ......................................................................
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 .................................................................................................
1,740,000
........................
........................
344,141
3. Work History Report—20 CFR
404.1512 and 416.912— 0960–0578. The
information collected by form SSA–
3369 is needed to determine disability
by the State DDS. The information will
be used to document an individual’s
past work history. The respondents are
applicants for SSI disability payments
and Social Security disability benefits.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 1,000,000.
Frequency of Response: 1.
Average Burden Per Response: 30
minutes.
Estimated Annual Burden: 500,000
hours.
4. Beneficiary Interview and Auditor’s
Observations Form—0960–0630. The
information collected through the
Beneficiary Interview and Auditor’s
Observation Form, SSA–322, will be
used by SSA’s Office of the Inspector
General to interview beneficiaries and/
or their payees to determine whether
representative payees are complying
with their duties and responsibilities
under SSA’s regulations at 20 CFR
404.2035 and 416.635. Respondents to
this collection will be randomly
selected SSI recipients and Social
Security beneficiaries who have
representative payees.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 2,550.
Frequency of Response: 1.
Average Burden Per Response: 15
minutes.
Estimated Annual Burden: 638 hours.
Number of
respondents
Form No.
5. Report to U.S. SSA by Person
Receiving Benefits for a Child or Adult
Unable to Handle Funds; Report to U.S.
SSA—0960–0049. SSA needs the
information on Form SSA–7161–OCR–
SM to monitor the performance of
representative payees outside the U.S
and the information on Form SSA–
7162–OCR–SM to determine continuing
entitlement to Social Security benefits
and correct benefit amounts for
beneficiaries outside the U.S. The
respondents are individuals outside the
U.S. who are receiving benefits either
for someone else, or on their own
behalf, under title II of the Social
Security Act.
Type of Request: Revision of an OMBapproved information collection.
Average
burden per
response
(minutes)
Frequency of
response
Estimated
annual burden
(hours)
30,000
236,500
1
1
15
5
7,500
19,708
Totals ........................................................................................................
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SSA–7161–OCR–SM ......................................................................................
SSA–7162–OCR–SM ......................................................................................
257,000
........................
........................
27,208
6. Real Property Current Market Value
Estimate—0960–0471. The SSA–L2794
is used to obtain current market value
estimates of real property owned by
applicants for, or recipients of, SSI
payments (or a person whose resources
are deemed to such an individual). The
value of an individual’s resources,
including non-home real property is one
of the eligibility requirements for SSI
payments. The respondents are
individuals with knowledge of local real
property values.
VerDate Aug<31>2005
18:12 May 08, 2007
Jkt 211001
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 5,438.
Frequency of Response: 1.
Average Burden Per Response: 20
minutes.
Estimated Annual Burden: 1,813
hours.
7. Requests for Self-Employment
Information, Employee Information,
Employer Information—20 CFR
422.120—0960–0508. SSA uses forms
SSA–L2765, SSA–L3365 and SSA–
PO 00000
Frm 00113
Fmt 4703
Sfmt 4703
L4002 to request correct information
when an employer, employee or selfemployed person reports an individual’s
earnings without a Social Security
Number (SSN) or with an incorrect
name or SSN. The respondents are
employers, employees or self-employed
individuals who are requested to
furnish additional identifying
information.
Type of Request: Revision of an OMBapproved information collection.
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Federal Register / Vol. 72, No. 89 / Wednesday, May 9, 2007 / Notices
Number of
respondents
Form No.
SSA–L2765 ......................................................................................................
SSA–L3365 ......................................................................................................
SSA–L4002 ......................................................................................................
Total ...................................................................................................
8. Questionnaire for Children
Claiming SSI Benefits—0960–0499. The
information collected on form SSA–
3881–BK is used by SSA to evaluate
disability in children who are appealing
an unfavorable disability decision or
whose continuing disability is being
reviewed. The form requests the names
and addresses of non-medical sources
such as schools, counselors, agencies,
organizations or therapists who would
have information about a child’s
functioning. The respondents are
children or their representatives who
are appealing an unfavorable decision
on their claim or whose continuing
disability is being reviewed.
Type of Request: Extension of OMBapproved collection.
Number of Respondents: 253,000.
Frequency of Response: 1.
Average Burden Per Response: 30
minutes.
Estimated Annual Burden: 126,500
hours.
Dated: May 2, 2007.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security
Administration.
[FR Doc. E7–8804 Filed 5–8–07; 8:45 am]
BILLING CODE 4191–02–P
DEPARTMENT OF TRANSPORTATION
Federal Aviation Administration
Notice of Intent To Rule on Request To
Release Airport Property at the
Rockwood Municipal Airport,
Rockwood, TN
Federal Aviation
Administration (FAA), DOT.
ACTION: Request for public comment.
sroberts on PROD1PC70 with NOTICES
AGENCY:
SUMMARY: The Federal Aviation
Administration is requesting public
comment on the release of land at the
Rockwood Municipal Airport in the City
of Rockwood, Tennessee. This property,
approximately 25 acres, will change to
a non-aeronautical use. This action is
taken under the provisions of Section
125 of the Wendell H. Ford Aviation
Investment Reform Act for the 21st
Century (AIR 21).
DATES: Comments must be received on
or before June 8, 2007.
VerDate Aug<31>2005
18:12 May 08, 2007
Jkt 211001
15,400
173,100
656,000
844,500
Documents are available for
review at the Tennessee Department of
Transportation, Division of Aeronautics,
424 Knapp Blvd, Bldg 4219, Nashville,
TN 37217 and the FAA Airports District
Office, 2862 Business Park Drive,
Building G, Memphis, TN 38118.
Written comments on the Sponsor’s
request must be delivered or mailed to:
Mr. Phillip J. Braden, Manager,
Memphis Airports District Office, 2862
Business Park Drive, Building G,
Memphis, TN 38118.
In addition, a copy of any comments
submitted to the FAA must be mailed or
delivered to Mr. Bob Woods, Director,
TDOT, Division of Aeronautics, P.O.
Box 17326, Nashville, TN 37217.
FOR FURTHER INFORMATION CONTACT: Mr.
Michael Thompson, Program Manager,
Federal Aviation Administration,
Memphis Airports District Office, 2862
Business Park Drive, Building G,
Memphis, TN 38118. The application
may be reviewed in person at this same
location, by appointment.
SUPPLEMENTARY INFORMATION: The FAA
proposes to rule and invites public
comment on the request to release
property at the Rockwood Municipal
Airport, Rockwood, TN. Under the
provisions of AIR 21 (49 U.S.C.
47107(h)(2)).
On April 27, 2007, the FAA
determined that the request to release
property at the Rockwood Municipal
Airport submitted by the airport owner
meets the procedural requirements of
the Federal Aviation Administration.
The FAA may approve the request, in
whole or in part, no later than June 8,
2007.
The following is a brief overview of
the request:
ADDRESSES:
The City of Rockwood, Tennessee, owner
of the Rockwood Municipal Airport, is
proposing the release of approximately 25
acres of airport property so the property can
be converted to use for industrial
development.
Any person may inspect, by
appointment, the request in person at
the FAA office listed above under FOR
FURTHER INFORMATION CONTACT.
In addition, any person may, upon
appointment and request, inspect the
request, notice and other documents
germane to the request in person at the
PO 00000
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Fmt 4703
Sfmt 4703
Frequency of
response
Average
burden per
response
(minutes)
1
1
1
........................
10
10
10
........................
Estimated
annual burden
(hours)
2,567
28,850
109,333
140,750
Tennessee Department of
Transportation, Division of Aeronautics.
Issued in Memphis, TN on April 27, 2007.
Phillip J. Braden,
Manager, Memphis Airports District Office,
Southern Region.
[FR Doc. 07–2272 Filed 5–8–07; 8:45 am]
BILLING CODE 4910–13–M
DEPARTMENT OF TRANSPORTATION
Federal Aviation Administration
Notice of Meetings of the National
Parks Overflights Advisory Group
Aviation Rulemaking Committee and
the Grand Canyon Working Group
ACTION:
Notice of meetings.
SUMMARY: The Federal Aviation
Administration (FAA) and the National
Park Service (NPS), in accordance with
the National Parks Air Tour
Management Act of 2000, announce the
next meeting of the National Parks
Overflights Advisory Group (NPOAG)
Aviation Rulemaking Committee (ARC).
In addition, the FAA and NPS are
announcing the next meeting of the
Grand Canyon Working Group (GCWG).
The GCWG is a self-contained group
within the NPOAG. This notification
provides the dates, location, and
agendas for the meetings.
DATES AND LOCATION: The GCWG
meetings will take place on June 12 and
June 13, 2007. The NPOAG ARC will
meet on June 14 and 15, 2007. The
meetings will take place in the Arizona/
Barcelona Rooms at the Chaparral Suites
Resort, 5001 N. Scottsdale Road,
Scottsdale, Arizona 85250, phone
number (480) 949–1414. The meetings
will begin at 8:30 a.m. each day.
Members of either group (NPOAG/
GCWG) as well as the public can attend
both meetings.
FOR FURTHER INFORMATION CONTACT: For
the NPOAG meeting contact Barry
Brayer, AWP–1SP, Special Programs,
Federal Aviation Administration,
Western-Pacific Region Headquarters,
P.O. Box 92007, Los Angeles, CA
90009–2007, telephone: (310) 725–3800,
e-mail: Barry.Brayer@faa.gov, or Karen
Trevino, National Park Service, Natural
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]]>Agencies
[Federal Register Volume 72, Number 89 (Wednesday, May 9, 2007)]
[Notices]
[Pages 26443-26446]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E7-8804]
=======================================================================
-----------------------------------------------------------------------
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
[[Page 26444]]
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.
(SSA), Social Security Administration, DCBFM, 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. Representative Payee Evaluation Report--20 CFR 404.2065 &
416.665--0960-0069. Sections 205(j) and 1631(a)(2) of the Social
Security Act provide that a representative payee may be appointed to
receive benefits on behalf of an individual entitled to Title II and/or
Title XVI benefits when that individual is unable to manage or direct
the management of those funds by themselves. The representative payee
is required to report to SSA at least once per year on how those funds
received have been used or conserved. When a representative payee fails
to adequately report to SSA as required, SSA will conduct a face-to-
face interview with the payee to complete an SSA-624, Representative
Payee Evaluation Report, in order to determine the continued
suitability of the representative payee to serve as a payee. The
respondents are individuals and organizations who act as representative
payees for Title II and Title XVI benefits who fail to comply with
SSA's statutory annual reporting requirement.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 252,000.
Frequency of Response: 1.
Average Burden per Response: 30 minutes.
Estimated Annual Burden: 126,000 hours.
2. Request for Change in Time/Place of Disability Hearing--20 CFR
404.914(c)(2) and 416.1414(c)(2)--0960-0348. The information on Form
SSA-769 is used by SSA and the State Disability Determination Services
(DDS) to provide claimants with a structured format to exercise their
right to request a change in time or place of a scheduled disability
hearing. The information will be used as a basis for granting or
denying requests for changes and for rescheduling disability hearings.
Respondents are claimants who wish to request a change in the time and/
or place of their hearing.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 7,483.
Frequency of Response: 1.
Average Burden Per Response: 8 minutes.
Estimated Annual Burden: 998 hours.
3. Agency/Employer Government Pension Offset Questionnaire--20 CFR
404.408(a)--0960-0470. The information collected by form SSA-4163 will
provide SSA with accurate information from the agency paying the
pension, for purposes of applying the pension-offset provision. The
form will be used only when (1) the claimant does not have the
information and (2) the pension-paying agency has not cooperated with
the claimant. Respondents are Federal and State Government agencies
which have information needed by SSA to determine if the GPO applies
and the amount of offset.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 1000.
Frequency of Response: 1.
Average Burden Per Response: 3 minutes.
Estimated Annual Burden: 50 hours.
4. Child Care Dropout Questionnaire--20 CFR 404.211(e)(4)--0960-
0474. Information collected on this form is ed by SSA to determine if
an individual qualifies for a child care exclusion in computing the
individual's disability benefit amount. Respondents are applicants for
disability benefits.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 2000.
Frequency of Response: 1.
Average Burden Per Response: 5 minutes.
Estimated Annual Burden: 167 hours.
5. Statement for Determining Continuing Eligibility for
Supplemental Security Income Payments--Adult, Form SSA-3988; Statement
for Determining Continuing Eligibility for Supplemental Security Income
Payments--Child, Form SSA-3989--20 CFR Subpart B--416.204--0960-0643.
Forms SSA-3988 and SSA-3989 will be used to determine whether SSI
recipients have met and continue to meet all statutory and regulatory
non-medical requirements for Supplemental Security Income eligibility,
and whether they have been and are still receiving the correct payment
amount. The SSA-3988 and SSA-3989 are designed as self-help forms that
will be mailed to recipients or to their representative payees for
completion and return to SSA. The respondents are recipients of SSI
payments or their representatives.
Type of Request: Revisions to an existing OMB information
collection.
----------------------------------------------------------------------------------------------------------------
Estimated
Collection instrument Respondents Frequency of Average burden annual burden
response per response (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3988........................................ 30,000 1 26 min. 13,000
SSA-3989........................................ 30,000 1 26 min. 13,000
Totals...................................... 60,000 .............. .............. 26,000
----------------------------------------------------------------------------------------------------------------
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. 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
[[Page 26445]]
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.
2. Application for Child's Insurance Benefits--20 CFR 404.350-
404.368, 404.603, & 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
---------------------------------------------------------------
Totals...................................... 1,740,000 .............. .............. 344,141
----------------------------------------------------------------------------------------------------------------
3. Work History Report--20 CFR 404.1512 and 416.912-- 0960-0578.
The information collected by form SSA-3369 is needed to determine
disability by the State DDS. The information will be used to document
an individual's past work history. The respondents are applicants for
SSI disability payments and Social Security disability benefits.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 1,000,000.
Frequency of Response: 1.
Average Burden Per Response: 30 minutes.
Estimated Annual Burden: 500,000 hours.
4. Beneficiary Interview and Auditor's Observations Form--0960-
0630. The information collected through the Beneficiary Interview and
Auditor's Observation Form, SSA-322, will be used by SSA's Office of
the Inspector General to interview beneficiaries and/or their payees to
determine whether representative payees are complying with their duties
and responsibilities under SSA's regulations at 20 CFR 404.2035 and
416.635. Respondents to this collection will be randomly selected SSI
recipients and Social Security beneficiaries who have representative
payees.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 2,550.
Frequency of Response: 1.
Average Burden Per Response: 15 minutes.
Estimated Annual Burden: 638 hours.
5. Report to U.S. SSA by Person Receiving Benefits for a Child or
Adult Unable to Handle Funds; Report to U.S. SSA--0960-0049. SSA needs
the information on Form SSA-7161-OCR-SM to monitor the performance of
representative payees outside the U.S and the information on Form SSA-
7162-OCR-SM to determine continuing entitlement to Social Security
benefits and correct benefit amounts for beneficiaries outside the U.S.
The respondents are individuals outside the U.S. who are receiving
benefits either for someone else, or on their own behalf, under title
II of the Social Security Act.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average
Number of Frequency of burden per Estimated
Form No. respondents response response annual burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-7161-OCR-SM................................. 30,000 1 15 7,500
SSA-7162-OCR-SM................................. 236,500 1 5 19,708
---------------------------------------------------------------
Totals...................................... 257,000 .............. .............. 27,208
----------------------------------------------------------------------------------------------------------------
6. Real Property Current Market Value Estimate--0960-0471. The SSA-
L2794 is used to obtain current market value estimates of real property
owned by applicants for, or recipients of, SSI payments (or a person
whose resources are deemed to such an individual). The value of an
individual's resources, including non-home real property is one of the
eligibility requirements for SSI payments. The respondents are
individuals with knowledge of local real property values.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 5,438.
Frequency of Response: 1.
Average Burden Per Response: 20 minutes.
Estimated Annual Burden: 1,813 hours.
7. Requests for Self-Employment Information, Employee Information,
Employer Information--20 CFR 422.120--0960-0508. SSA uses forms SSA-
L2765, SSA-L3365 and SSA-L4002 to request correct information when an
employer, employee or self-employed person reports an individual's
earnings without a Social Security Number (SSN) or with an incorrect
name or SSN. The respondents are employers, employees or self-employed
individuals who are requested to furnish additional identifying
information.
Type of Request: Revision of an OMB-approved information
collection.
[[Page 26446]]
----------------------------------------------------------------------------------------------------------------
Average
Number of Frequency of burden per Estimated
Form No. respondents response response annual burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L2765....................................... 15,400 1 10 2,567
SSA-L3365....................................... 173,100 1 10 28,850
SSA-L4002....................................... 656,000 1 10 109,333
Total....................................... 844,500 .............. .............. 140,750
----------------------------------------------------------------------------------------------------------------
8. Questionnaire for Children Claiming SSI Benefits--0960-0499. The
information collected on form SSA-3881-BK is used by SSA to evaluate
disability in children who are appealing an unfavorable disability
decision or whose continuing disability is being reviewed. The form
requests the names and addresses of non-medical sources such as
schools, counselors, agencies, organizations or therapists who would
have information about a child's functioning. The respondents are
children or their representatives who are appealing an unfavorable
decision on their claim or whose continuing disability is being
reviewed.
Type of Request: Extension of OMB-approved collection.
Number of Respondents: 253,000.
Frequency of Response: 1.
Average Burden Per Response: 30 minutes.
Estimated Annual Burden: 126,500 hours.
Dated: May 2, 2007.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security Administration.
[FR Doc. E7-8804 Filed 5-8-07; 8:45 am]
BILLING CODE 4191-02-P
