Agency Information Collection Activities: Proposed Request and Comment Request, 18782-18786 [E9-9318]
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18782
Federal Register / Vol. 74, No. 78 / Friday, April 24, 2009 / Notices
(7) the rules of some arbitration forums
may impose time limits for bringing a
claim in arbitration; in some cases, a
claim that is ineligible for arbitration
may be brought in court.
The proposed rule change transfers
NASD Rule 3080 into the Consolidated
FINRA Rulebook as FINRA Rule 2263
with several minor changes. First, the
proposed rule change amends the
current title ‘‘Disclosure to Associated
Person When Signing Form U–4’’ to
clarify that the rule relates to arbitration
disclosures. Accordingly, the new
proposed title is ‘‘Arbitration Disclosure
to Associated Persons Signing or
Acknowledging Form U4.’’
Second, proposed FINRA Rule 2263
clarifies that a member must provide the
required arbitration disclosures
whenever a member asks an associated
person, pursuant to proposed FINRA
Rule 1010 (as described above), to
manually sign an initial or amended
Form U4, or to otherwise provide
written (which may be electronic)
acknowledgement of an amendment to
the Form.
Lastly, the proposed rule change
updates the rule language to reflect
recent amendments to FINRA’s Code of
Arbitration Procedure requiring
arbitrators to provide an explained
decision to the parties in eligible cases
if there is a joint request by all parties
at least 20 days before the first
scheduled hearing date.18
FINRA will announce the
implementation date of the proposed
rule change in a Regulatory Notice to be
published no later than 90 days
following Commission approval.
mstockstill on PROD1PC66 with NOTICES
2. Statutory Basis
FINRA believes that the proposed rule
change is consistent with the provisions
of Section 15A(b)(6) of the Act,19 which
requires, among other things, that
FINRA rules must be designed to
prevent fraudulent and manipulative
acts and practices, to promote just and
equitable principles of trade, and, in
general, to protect investors and the
public interest. FINRA believes that the
proposed changes to NASD Rule 1140
will clarify and streamline the Form U4
electronic filing and amendment
requirements for both members and
members’ associated persons, consistent
with the goals of investor protection.
FINRA also believes that the proposed
changes to NASD Rule 3080 will clarify
the required arbitration disclosures and
18 See Securities Exchange Act Release No. 59358
(Feb. 4, 2009), 74 FR 6928 (Feb. 11, 2009) (Order
Approving File No. SR–FINRA–2008–051).
19 15 U.S.C. 78o–3(b)(6).
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16:20 Apr 23, 2009
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when members must provide those
disclosures to their associated persons.
B. Self-Regulatory Organization’s
Statement on Burden on Competition
FINRA does not believe that the
proposed rule change will result in any
burden on competition that is not
necessary or appropriate in furtherance
of the purposes of the Act.
C. Self-Regulatory Organization’s
Statement on Comments on the
Proposed Rule Change Received From
Members, Participants, or Others
Written comments were neither
solicited nor 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 the self-regulatory
organization consents, the Commission
will:
(A) By order approve such proposed
rule change, or
(B) Institute proceedings to determine
whether the proposed rule change
should be disapproved.
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:
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, 100 F Street, NE., Washington,
DC 20549, on official business days
between the hours of 10 a.m. and 3 p.m.
Copies of such filing also will be
available for inspection and copying at
the principal office of FINRA. 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–FINRA–2009–019 and
should be submitted on or before May
15, 2009
For the Commission, by the Division of
Trading and Markets, pursuant to delegated
authority.20
Florence E. Harmon,
Deputy Secretary.
[FR Doc. E9–9372 Filed 4–23–09; 8:45 am]
BILLING CODE 8010–01–P
SOCIAL SECURITY ADMINISTRATION
Agency Information Collection
Activities: Proposed Request and
Comment Request
Electronic Comments
The Social Security Administration
(SSA) publishes a list of information
collection packages requiring clearance
by the Office of Management and
Budget (OMB) in compliance with
Public Law (Pub. L.) 104–13, the
Paperwork Reduction Act of 1995,
effective October 1, 1995. This notice
includes revisions and extensions of
Paper Comments
OMB-approved Information Collections
• Send paper comments in triplicate
and a new collection.
to Elizabeth M. Murphy, Secretary,
SSA is soliciting comments on the
Securities and Exchange Commission,
accuracy of the agency’s burden
100 F Street, NE., Washington, DC
estimate; the need for the information;
20549–1090.
its practical utility; ways to enhance its
All submissions should refer to File
quality, utility, and clarity; and ways to
Number SR–FINRA–2009–019. This file minimize the burden on respondents,
number should be included on the
including the use of automated
subject line if e-mail is used. To help the collection techniques or other forms of
Commission process and review your
information technology. Mail, e-mail, or
comments more efficiently, please use
fax your comments and
only one method. The Commission will
20 17 CFR 200.30–3(a)(12).
post all comments on the Commission’s
• 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
Number SR–FINRA–2009–019 on the
subject line.
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Federal Register / Vol. 74, No. 78 / Friday, April 24, 2009 / Notices
recommendations on the information
collection(s) to the OMB Desk Officer
and the SSA Reports Clearance Officer
to the addresses or 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, 1332 Annex Building, 6401
Security Blvd., Baltimore, MD 21235.
Fax: 410–965–6400. E-mail address:
OPLM.RCO@ssa.gov.
I. The information collection below is
pending at SSA. SSA will submit it to
OMB within 60 days from the date of
this notice. To be sure we consider your
comments, we must receive them no
later than June 23, 2009. Individuals can
obtain copies of the collection
instrument by calling the SSA Reports
Clearance Officer at 410–965–3758 or by
writing to the e-mail address listed
above.
1. Social Security Benefits
Application—20 CFR 404.310–.311,
.315–.322, .330–.333, .601–.603, and
.1501–.1512—0960–0618. This
collection comprises the various
application modalities for retirement,
survivors, and disability benefits. These
modalities include paper forms (SSA
Forms SSA–1, SSA–2, and SSA–16),
Modernized Claims System (MCS)
screens for in-person field office
interview applications, and the Internetbased iClaim application. This
information collection request (ICR) will
expand the potential user base for the
iClaim.
Type of Collection: Revision to an
existing OMB-approved information
collection.
Paper Forms/Accompanying MCS
Screens Burden Information:
FORM SSA–1
Number of
respondents
Collection method
Frequency of
response
Average
burden
per response
(min)
Estimated
annual burden
(hours)
MCS .................................................................................................................
MCS/Signature Proxy ......................................................................................
Paper ...............................................................................................................
Medicare-only MCS .........................................................................................
Medicare-only Paper ........................................................................................
172,200
1,549,800
21,000
299,000
1,000
1
1
1
1
1
11
10
11
7
7
31,570
258,300
3,850
34,883
117
Totals ........................................................................................................
2,043,000
........................
........................
328,720
Frequency
of response
Average
burden
per response
(min)
FORM SSA–2
Number of
respondents
Collection method
Estimated
annual burden
(hours)
MCS .................................................................................................................
MCS/Signature Proxy ......................................................................................
Paper ...............................................................................................................
36,860
331,740
3,800
1
1
1
15
14
15
9,215
77,406
950
Totals ........................................................................................................
372,400
........................
........................
87,571
Frequency
of response
Average
burden
per response
(min)
FORM SSA–16
Number of
respondents
Collection method
Estimated
annual burden
(hours)
MCS .................................................................................................................
MCS/Signature Proxy ......................................................................................
Paper ...............................................................................................................
218,657
1,967,913
24,161
1
1
1
20
19
20
72,886
623,172
8,054
Totals ........................................................................................................
2,210,731
........................
........................
704,112
Frequency of
response
Average
burden
per response
(min)
ICLAIM
BURDEN INFORMATION
Number of
respondents
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Form type
Estimated
annual burden
(hours)
iClaim 3rd Party ...............................................................................................
iClaim Applicant after 3rd Party Completion ...................................................
First Party iClaim .............................................................................................
Medicare-only iClaim .......................................................................................
28,118
28,118
541,851
200,000
1
1
1
1
15
5
15
10
7,030
2,343
135,463
33,333
Totals ........................................................................................................
798,087
........................
........................
178,169
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Federal Register / Vol. 74, No. 78 / Friday, April 24, 2009 / Notices
Aggregate Public Reporting Burden:
1,298,572 hours.
2. Electronic Records Express (Third
Parties)—20 CFR 404.1700–404.1715—
0960–0767. Electronic Records Express
is an online system that enables medical
providers and various third party
representatives to submit disability
claimant information electronically to
SSA as part of the disability application
process. We are revising this OMB
number to add new functionality for
third parties who use this system.
Type of Request: Revision of an
existing OMB-approved information
collection.
Number of Respondents: 66,000.
Frequency of Response: 40.
By registering these individuals, SSA:
(1) Authenticates and authorizes them
to do business with us; (2) allows them
access to our records for the claimants
they represent; (3) facilitates direct
payment of authorized fees to appointed
representatives; and (4) collects
information needed to meet Internal
Revenue Service (IRS) requirements to
issue specific IRS forms, if we pay these
representatives in excess of a specific
amount ($600).
This ICR is for changes we will
implement later in the year. The
respondents are appointed claimant
representatives.
Type of Request: Revision to an OMBapproved information collection.
Average Burden per Response: 1
minute.
Estimated Annual Burden: 44,000
hours.
3. Registration of Individual for
Appointed Representative Services—
0960–0732. SSA uses Form SSA–1699
to register the following people:
• Individuals appointed as
representatives;
• Individuals who will perform
advocacy services on behalf of an
appointed representative;
• Individuals who will act on behalf
of an appointed representative and want
access to our electronic services;
• Individuals who will serve as
administrators for an entity appointed
as a representative.
Collection
method
Number of
respondents
Frequency of
response
Average
burden
per response
(min)
Estimated
annual burden
(hours)
SSA–1699 (paper form) ...................................................................................
Internet-based SSA–1699 ...............................................................................
52,800
13,200
1
1
30
22
26,400
4,840
Totals ........................................................................................................
66,000
........................
........................
31,240
4. State Agency Report of Obligations
for SSA Disability Programs (SSA–
4513); Time Report of Personnel
Services for Disability Determination
Services (SSA–4514); State Agency
Schedule of Equipment Purchased for
SSA Disability Programs (SSA–871)—20
CFR 404.1626—0960–0421. SSA uses
Forms SSA–4513, SSA–4514, and SSA–
871 to collect data necessary for detailed
analysis and evaluation of costs State
Disability Determination Services (DDS)
incur in making disability
determinations for SSA. SSA also
Frequency of
response
Respondents
utilizes the data to determine funding
levels for each DDS. Respondents are
State DDSs.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 54.
Estimated Annual Burden: 756 hours.
Average burden
per response
(min)
Total annual
responses
Estimated
annual burden
(hours)
SSA–4513 & Addendum ..................................
SSA–4514 ........................................................
SSA–871 ..........................................................
54
54
54
4
4
4
216
216
216
90
90
30
324
324
108
Total ..........................................................
162
............................
............................
............................
756
5. Application for Special Benefits for
World War II Veterans—20 CFR 408,
Subparts B, C and D—0960–0615. Title
VIII of the Social Security Act (Special
Benefits for Certain World War II
Veterans) allows a qualified World War
II veteran who resides outside the
United States to receive monthly
payments. The regulations set out the
requirements an individual needs to
meet to qualify for and become entitled
to Special Veterans Benefits (SVB). SSA
uses Form SSA–2000–F6 to elicit the
information necessary to determine
Number of
respondents
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Section No.
§ 408.202(d); § 408.210; § 408.230(a); § 408.305; §§ 408.310-.315
§ 408.232(a) .....................................................................................
§ 408.320 .........................................................................................
§ 408.340 .........................................................................................
§ 408.345 .........................................................................................
§ 408.351(d) & (f) .............................................................................
§ 408.355(a) .....................................................................................
§ 408.360(a) .....................................................................................
§ 408.404(c) .....................................................................................
§§ 408.410–.412 ..............................................................................
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entitlement to SVB. The respondents are
individuals who are applying for SVB
under Title VIII of the Social Security
Act.
Type of Request: Revision of an OMBapproved information collection.
100
1
1
1
1
1
1
1
6
6
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Average burden
per response
(min)
Frequency of
response
E:\FR\FM\24APN1.SGM
1
1
1
1
1
1
1
1
1
1
24APN1
20
15
15
15
15
30
15
15
15
15
Estimated
annual burden
(hours)
33
0
0
0
0
1
0
0
2
2
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Federal Register / Vol. 74, No. 78 / Friday, April 24, 2009 / Notices
Number of
respondents
Section No.
Average burden
per response
(min)
Frequency of
response
Estimated
annual burden
(hours)
71
66
71
6
1
1
1
1
15
30
15
30
18
33
18
3
Totals ........................................................................................
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§ 408.420(a), (b) ..............................................................................
§§ 408.430 & .432 ............................................................................
§ 408.435(a), (b), (c) ........................................................................
§ 408.437(b), (c), (d) ........................................................................
333
............................
............................
110
II. SSA has submitted the information
collections listed below to OMB for
clearance. Your comments on the
information collections would be most
useful if OMB and SSA receive them
within 30 days from the date of this
publication. To be sure we consider
your comments, we must receive them
no later than May 26, 2009. You can
obtain a copy of the OMB clearance
packages by calling the SSA Reports
Clearance Officer at 410–965–3758 or by
writing to the above e-mail address.
1. Request for Withdrawal of
Application—20 CFR 404.640—0960–
0015. Individuals complete Form SSA–
521 to request withdrawal of an
application for benefits. SSA uses the
information from Form SSA–521 to
process the request for withdrawal. The
respondents are applicants for Old Age,
Survivors, and Disability Insurance
(OASDI) benefits.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 100,000.
Frequency of Response: 1.
Average Burden per Response: 5
minutes.
Estimated Annual Burden: 8,333
hours.
2. Application for Search of Census
Records for Proof of Age—20 CFR
404.716—0960–0097. SSA uses the
information from Form SSA–1535–U3
to provide the Census Bureau with
identification information sufficient to
allow an accurate search of census
records to establish proof of age for an
individual applying for Social Security
benefits. When preferred evidence of
age is not available and the available
evidence is not convincing, SSA may
request the U.S. Department of
Commerce, Bureau of the Census, to
search its records to establish a
claimant’s date of birth. The Census
Bureau uses the information from a
completed, signed SSA–1535–U3 to bill
SSA for the search. The respondents are
applicants for Social Security benefits
who need to establish their date of birth
as a factor of entitlement.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 18,030.
Frequency of Response: 1.
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Average Burden per Response: 12
minutes.
Estimated Annual Burden: 3,606
hours.
3. Workers’ Compensation/Public
Disability Questionnaire—20 CFR
404.408—0960–0247. Section 224 of the
Social Security Act provides for the
reduction of disability insurance
benefits (DIB) when the combination of
DIB and any workers’ compensation
(WC) and/or certain Federal, State, or
local public disability benefits (PDB)
exceeds 80 percent of the worker’s
average current earnings. SSA uses
Form SSA–546 to collect the data
necessary to determine if the worker’s
receipt of WC/PDB payments will cause
a reduction of DIB. The respondents are
applicants for Title II DIB.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 100,000.
Frequency of Response: 1.
Average Burden per Response: 15
minutes.
Estimated Annual Burden: 25,000
hours.
4. Claimant’s Medication—20 CFR
404.1512, 416.912—0960–0289. In cases
where a claimant is requesting a hearing
after denial of his or her claim for Social
Security benefits, SSA uses Form HA–
4632 to request information from the
claimant regarding the medications he
or she is using. This information helps
the Administrative Law Judge hearing
the case to inquire fully into the medical
treatment the claimant is receiving and
the effect of medications on the
claimant’s medical impairments and
functional capacity. Respondents are
applicants for OASDI benefits and/or
Supplemental Security Income (SSI)
payments.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 200,000.
Frequency of Response: 1.
Average Burden per Response: 15
minutes.
Estimated Annual Burden: 50,000
hours.
5. Statement of Funds You Provided
to Another and Statement of Funds You
Received—20 CFR 416.1103(f)—0960–
0481. Forms SSA–2854 and SSA–2855
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collect information on an SSI
beneficiary’s allegations that he or she
borrowed funds informally from a noncommercial lender; e.g., a relative or
friend. The borrower/beneficiary and
the lender of the funds complete these
statements. SSA requires information
from Forms SSA–2854 and SSA–2855 to
determine whether the proceeds from
the transaction are income to the
borrower. If the transaction constitutes a
bona fide loan, the proceeds are not
income to the borrower. Form SSA–
2855 (Statement of Funds You
Received) requests information from the
SSI applicant/recipient by personal
interview. Form SSA–2854 (Statement
of Funds You Provided to Another)
requests information by mail from the
other party to the transaction. The
respondents are SSI recipients who
informally borrow money and those
persons who lend the funds.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 40,000.
Frequency of Response: 1.
Average Burden per Response: 10
minutes.
Estimated Annual Burden: 6,667
hours.
6. Self-Employment/Corporate Officer
Questionnaire—20 CFR 404.435(e),
404.446—0960–0487. SSA uses Form
SSA–4184 to develop earnings and
corroborate the claimant’s allegations of
retirement when the claimant is selfemployed or a corporate officer. SSA
uses the information to determine an
individual’s OASDI benefit amount. The
respondents are self-employed
individuals or corporate officers who
apply for OASDI benefits.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden per Response: 20
minutes.
Estimated Annual Burden: 16,667
hours.
Note: This is a correction notice. SSA
published this information collection as an
extension on February 17, 2009 at 74 FR
7506. Since we are revising the Privacy Act
Statement, this is now a revision.
7. Application for SSA Employee
Testimony—20 CFR 403.100–155—
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Federal Register / Vol. 74, No. 78 / Friday, April 24, 2009 / Notices
0960–0619. SSA regulations at 20 CFR
403.100–155 establish policies and
procedures for an individual,
organization, or governmental entity to
request official agency information,
records, or testimony of an agency
employee in a legal proceeding when
the agency is not a party. The request,
which must be in writing to the
Commissioner, must fully set out the
nature and relevance of the sought
testimony. Respondents are individuals
or entities who request testimony from
SSA employees in a legal proceeding.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 100.
Frequency of Response: 1.
Average Burden per Response: 60
minutes.
Estimated Annual Burden: 100 hours.
8. Authorization for the Social
Security Administration To Obtain
Account Records from a Financial
Institution and Request for Records
(Medicare Low-Income Subsidy)—0960–
0729. Under the aegis of the Medicare
Modernization Act of 2003, Medicare
beneficiaries can apply for a subsidy for
the Medicare Prescription Drug Plan
(Part D) program. In some cases, SSA
will verify the details of applicants’
accounts at financial institutions to
determine if they are eligible for the
subsidy. Form SSA–4640 gives SSA the
authority to contact financial
institutions about applicants’ accounts.
Financial institutions will also use the
form to verify the information SSA
requested. The respondents are
applicants for the Medicare Part D
program subsidy and financial
institutions where applicants have
accounts.
Type of Request: Extension of an
OMB-approved information collection.
Medicare part D subsidy
applicants
Number of Respondents ..........................................................
Frequency of Response ..........................................................
Average Burden per Response (minutes) ...............................
Estimated Annual Burden (hours) ...........................................
Total Estimated Annual Burden: 834
hours.
9. Request To Pay Civil Monetary
Penalty by Installment Agreement—20
CFR 498–0960–NEW. SSA uses Form
SSA–640 to obtain the information
necessary to determine a repayment rate
for individuals who have a civil
monetary penalty imposed on them for
fraudulent conduct related to SSAadministered programs. SSA needs this
financial information to ensure the
repayment rate is in the best interest of
both the individual and the agency. The
respondents are recipients of Social
Security benefits and non-entitled
individuals who must pay a civil
monetary penalty.
Type of Request: New information
collection.
Number of Respondents: 400.
Frequency of Response: 1.
Average Burden per Response: 120
minutes.
Estimated Annual Burden: 800 hours.
Dated: April 17, 2009.
John Biles,
Reports Clearance Officer, Center for Reports
Clearance, Social Security Administration.
[FR Doc. E9–9318 Filed 4–23–09; 8:45 am]
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BILLING CODE 4191–02–P
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Financial institutions
10,000 ....................................
1 .............................................
1 minute .................................
167 hours ...............................
10,000 ....................................
1 .............................................
4 minutes ...............................
667 hours ...............................
DEPARTMENT OF STATE
[Public Notice 6592]
Bureau of Educational and Cultural
Affairs (ECA) Request for Grant
Proposals: E-Teacher Scholarship
Program and Professional
Development Workshop
Announcement Type: New
Cooperative Agreement.
Funding Opportunity Number: ECA/
A/L–09–04.
Catalog of Federal Domestic
Assistance Number: 00.000.
Key Dates: (Pending award of funds).
Anticipated Award Date: September
1, 2009.
Anticipated Program Start Date:
September 14, 2009.
Anticipated Program End Date:
December 31, 2010.
Application Deadline: June 8, 2009.
Executive Summary: The Office of
English Language Programs of the
Bureau of Educational and Cultural
Affairs (ECA/A/L) announces an open
competition for the E-Teacher
Scholarship Program and Professional
Development Workshop. Accredited
U.S. post-secondary educational
institutions or consortia of such
institutions meeting the provisions
described in Internal Revenue Code
section 26 USC 501(c)(3) may submit
proposals to implement the following
two components: (1) Seven different
ten- to twelve-week Online, university
level English as a Foreign Language
(EFL) professional development courses
for a total of approximately five
hundred EFL teachers from throughout
the world, and (2) a three-week
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Sfmt 4703
Totals
20,000.
1.
5 minutes.
834 hours.
professional development workshop for
approximately twenty-six EFL
professionals from diverse geographic
regions of the world. For the Online
courses, participants will receive
university level instruction in the most
recent English language teaching
methods and techniques as well as an
introduction to U.S. educational values
and will interact with U.S. experts via
innovative distance learning. The
professional development workshop
will provide the participants a basis for
their continuing contact with U.S.
counterparts in order to promote mutual
understanding between the people of
the U.S. and other countries.
Post-secondary educational
institutions are encouraged to apply in
a consortium with other post-secondary
institutions, although they may apply
independently. The E-Teacher
Scholarship Program and Professional
Development Workshop advance the
U.S. Department of State’s goals by
improving the quality of English
language teaching throughout the world.
ECA will award one Cooperative
Agreement for the administration of
these two program components to be
implemented during the academic year
2009–2010. The total funding available
for program and administrative
purposes is anticipated to be
approximately $750,000.
I. Funding Opportunity Description
Authority: Overall grant making authority
for this program is contained in the Mutual
Educational and Cultural Exchange Act of
1961, Public Law 87–256, as amended, also
known as the Fulbright-Hays Act. The
purpose of the Act is ‘‘to enable the
E:\FR\FM\24APN1.SGM
24APN1
]]>Agencies
[Federal Register Volume 74, Number 78 (Friday, April 24, 2009)]
[Notices]
[Pages 18782-18786]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E9-9318]
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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 requiring clearance by the Office of
Management and Budget (OMB) in compliance with Public Law (Pub. L.)
104-13, the Paperwork Reduction Act of 1995, effective October 1, 1995.
This notice includes revisions and extensions of OMB-approved
Information Collections and a new collection.
SSA is soliciting comments on the accuracy of the agency's burden
estimate; the need for the information; its practical utility; ways to
enhance its quality, utility, and clarity; and ways to minimize the
burden on respondents, including the use of automated collection
techniques or other forms of information technology. Mail, e-mail, or
fax your comments and
[[Page 18783]]
recommendations on the information collection(s) to the OMB Desk
Officer and the SSA Reports Clearance Officer to the addresses or 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, 1332 Annex Building, 6401 Security Blvd., Baltimore, MD 21235.
Fax: 410-965-6400. E-mail address: OPLM.RCO@ssa.gov.
I. The information collection below is pending at SSA. SSA will
submit it to OMB within 60 days from the date of this notice. To be
sure we consider your comments, we must receive them no later than June
23, 2009. Individuals can obtain copies of the collection instrument by
calling the SSA Reports Clearance Officer at 410-965-3758 or by writing
to the e-mail address listed above.
1. Social Security Benefits Application--20 CFR 404.310-.311,
.315-.322, .330-.333, .601-.603, and .1501-.1512--0960-0618. This
collection comprises the various application modalities for retirement,
survivors, and disability benefits. These modalities include paper
forms (SSA Forms SSA-1, SSA-2, and SSA-16), Modernized Claims System
(MCS) screens for in-person field office interview applications, and
the Internet-based iClaim application. This information collection
request (ICR) will expand the potential user base for the iClaim.
Type of Collection: Revision to an existing OMB-approved
information collection.
Paper Forms/Accompanying MCS Screens Burden Information:
Form SSA-1
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Collection method Number of Frequency of per response annual burden
respondents response (min) (hours)
----------------------------------------------------------------------------------------------------------------
MCS............................................. 172,200 1 11 31,570
MCS/Signature Proxy............................. 1,549,800 1 10 258,300
Paper........................................... 21,000 1 11 3,850
Medicare-only MCS............................... 299,000 1 7 34,883
Medicare-only Paper............................. 1,000 1 7 117
---------------------------------------------------------------
Totals...................................... 2,043,000 .............. .............. 328,720
----------------------------------------------------------------------------------------------------------------
Form SSA-2
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Collection method Number of Frequency of per response annual burden
respondents response (min) (hours)
----------------------------------------------------------------------------------------------------------------
MCS............................................. 36,860 1 15 9,215
MCS/Signature Proxy............................. 331,740 1 14 77,406
Paper........................................... 3,800 1 15 950
---------------------------------------------------------------
Totals...................................... 372,400 .............. .............. 87,571
----------------------------------------------------------------------------------------------------------------
Form SSA-16
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Collection method Number of Frequency of per response annual burden
respondents response (min) (hours)
----------------------------------------------------------------------------------------------------------------
MCS............................................. 218,657 1 20 72,886
MCS/Signature Proxy............................. 1,967,913 1 19 623,172
Paper........................................... 24,161 1 20 8,054
---------------------------------------------------------------
Totals...................................... 2,210,731 .............. .............. 704,112
----------------------------------------------------------------------------------------------------------------
iClaim Burden Information
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Form type Number of Frequency of per response annual burden
respondents response (min) (hours)
----------------------------------------------------------------------------------------------------------------
iClaim 3rd Party................................ 28,118 1 15 7,030
iClaim Applicant after 3rd Party Completion..... 28,118 1 5 2,343
First Party iClaim.............................. 541,851 1 15 135,463
Medicare-only iClaim............................ 200,000 1 10 33,333
---------------------------------------------------------------
Totals...................................... 798,087 .............. .............. 178,169
----------------------------------------------------------------------------------------------------------------
[[Page 18784]]
Aggregate Public Reporting Burden: 1,298,572 hours.
2. Electronic Records Express (Third Parties)--20 CFR 404.1700-
404.1715--0960-0767. Electronic Records Express is an online system
that enables medical providers and various third party representatives
to submit disability claimant information electronically to SSA as part
of the disability application process. We are revising this OMB number
to add new functionality for third parties who use this system.
Type of Request: Revision of an existing OMB-approved information
collection.
Number of Respondents: 66,000.
Frequency of Response: 40.
Average Burden per Response: 1 minute.
Estimated Annual Burden: 44,000 hours.
3. Registration of Individual for Appointed Representative
Services--0960-0732. SSA uses Form SSA-1699 to register the following
people:
Individuals appointed as representatives;
Individuals who will perform advocacy services on behalf
of an appointed representative;
Individuals who will act on behalf of an appointed
representative and want access to our electronic services;
Individuals who will serve as administrators for an entity
appointed as a representative.
By registering these individuals, SSA: (1) Authenticates and authorizes
them to do business with us; (2) allows them access to our records for
the claimants they represent; (3) facilitates direct payment of
authorized fees to appointed representatives; and (4) collects
information needed to meet Internal Revenue Service (IRS) requirements
to issue specific IRS forms, if we pay these representatives in excess
of a specific amount ($600).
This ICR is for changes we will implement later in the year. The
respondents are appointed claimant representatives.
Type of Request: Revision to an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Collection method Number of Frequency of per response annual burden
respondents response (min) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1699 (paper form)........................... 52,800 1 30 26,400
Internet-based SSA-1699......................... 13,200 1 22 4,840
---------------------------------------------------------------
Totals...................................... 66,000 .............. .............. 31,240
----------------------------------------------------------------------------------------------------------------
4. State Agency Report of Obligations for SSA Disability Programs
(SSA-4513); Time Report of Personnel Services for Disability
Determination Services (SSA-4514); State Agency Schedule of Equipment
Purchased for SSA Disability Programs (SSA-871)--20 CFR 404.1626--0960-
0421. SSA uses Forms SSA-4513, SSA-4514, and SSA-871 to collect data
necessary for detailed analysis and evaluation of costs State
Disability Determination Services (DDS) incur in making disability
determinations for SSA. SSA also utilizes the data to determine funding
levels for each DDS. Respondents are State DDSs.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 54.
Estimated Annual Burden: 756 hours.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Average burden Estimated
Respondents Frequency of Total annual per response annual burden
response responses (min) (hours)
--------------------------------------------------------------------------------------------------------------------------------------------------------
SSA-4513 & Addendum........................................... 54 4 216 90 324
SSA-4514...................................................... 54 4 216 90 324
SSA-871....................................................... 54 4 216 30 108
-----------------------------------------------------------------------------------------
Total..................................................... 162 ................ ................ ................ 756
--------------------------------------------------------------------------------------------------------------------------------------------------------
5. Application for Special Benefits for World War II Veterans--20
CFR 408, Subparts B, C and D--0960-0615. Title VIII of the Social
Security Act (Special Benefits for Certain World War II Veterans)
allows a qualified World War II veteran who resides outside the United
States to receive monthly payments. The regulations set out the
requirements an individual needs to meet to qualify for and become
entitled to Special Veterans Benefits (SVB). SSA uses Form SSA-2000-F6
to elicit the information necessary to determine entitlement to SVB.
The respondents are individuals who are applying for SVB under Title
VIII of the Social Security Act.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Section No. Number of Frequency of per response annual burden
respondents response (min) (hours)
----------------------------------------------------------------------------------------------------------------
Sec. 408.202(d); Sec. 408.210; Sec. 100 1 20 33
408.230(a); Sec. 408.305; Sec. Sec.
408.310-.315.........................
Sec. 408.232(a)....................... 1 1 15 0
Sec. 408.320.......................... 1 1 15 0
Sec. 408.340.......................... 1 1 15 0
Sec. 408.345.......................... 1 1 15 0
Sec. 408.351(d) & (f)................. 1 1 30 1
Sec. 408.355(a)....................... 1 1 15 0
Sec. 408.360(a)....................... 1 1 15 0
Sec. 408.404(c)....................... 6 1 15 2
Sec. Sec. 408.410-.412............... 6 1 15 2
[[Page 18785]]
Sec. 408.420(a), (b).................. 71 1 15 18
Sec. Sec. 408.430 & .432............. 66 1 30 33
Sec. 408.435(a), (b), (c)............. 71 1 15 18
Sec. 408.437(b), (c), (d)............. 6 1 30 3
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Totals.............................. 333 ................ ................ 110
----------------------------------------------------------------------------------------------------------------
II. SSA has submitted the information collections listed below to
OMB for clearance. Your comments on the information collections would
be most useful if OMB and SSA receive them within 30 days from the date
of this publication. To be sure we consider your comments, we must
receive them no later than May 26, 2009. You can obtain a copy of the
OMB clearance packages by calling the SSA Reports Clearance Officer at
410-965-3758 or by writing to the above e-mail address.
1. Request for Withdrawal of Application--20 CFR 404.640--0960-
0015. Individuals complete Form SSA-521 to request withdrawal of an
application for benefits. SSA uses the information from Form SSA-521 to
process the request for withdrawal. The respondents are applicants for
Old Age, Survivors, and Disability Insurance (OASDI) benefits.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 100,000.
Frequency of Response: 1.
Average Burden per Response: 5 minutes.
Estimated Annual Burden: 8,333 hours.
2. Application for Search of Census Records for Proof of Age--20
CFR 404.716--0960-0097. SSA uses the information from Form SSA-1535-U3
to provide the Census Bureau with identification information sufficient
to allow an accurate search of census records to establish proof of age
for an individual applying for Social Security benefits. When preferred
evidence of age is not available and the available evidence is not
convincing, SSA may request the U.S. Department of Commerce, Bureau of
the Census, to search its records to establish a claimant's date of
birth. The Census Bureau uses the information from a completed, signed
SSA-1535-U3 to bill SSA for the search. The respondents are applicants
for Social Security benefits who need to establish their date of birth
as a factor of entitlement.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 18,030.
Frequency of Response: 1.
Average Burden per Response: 12 minutes.
Estimated Annual Burden: 3,606 hours.
3. Workers' Compensation/Public Disability Questionnaire--20 CFR
404.408--0960-0247. Section 224 of the Social Security Act provides for
the reduction of disability insurance benefits (DIB) when the
combination of DIB and any workers' compensation (WC) and/or certain
Federal, State, or local public disability benefits (PDB) exceeds 80
percent of the worker's average current earnings. SSA uses Form SSA-546
to collect the data necessary to determine if the worker's receipt of
WC/PDB payments will cause a reduction of DIB. The respondents are
applicants for Title II DIB.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 100,000.
Frequency of Response: 1.
Average Burden per Response: 15 minutes.
Estimated Annual Burden: 25,000 hours.
4. Claimant's Medication--20 CFR 404.1512, 416.912--0960-0289. In
cases where a claimant is requesting a hearing after denial of his or
her claim for Social Security benefits, SSA uses Form HA-4632 to
request information from the claimant regarding the medications he or
she is using. This information helps the Administrative Law Judge
hearing the case to inquire fully into the medical treatment the
claimant is receiving and the effect of medications on the claimant's
medical impairments and functional capacity. Respondents are applicants
for OASDI benefits and/or Supplemental Security Income (SSI) payments.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 200,000.
Frequency of Response: 1.
Average Burden per Response: 15 minutes.
Estimated Annual Burden: 50,000 hours.
5. Statement of Funds You Provided to Another and Statement of
Funds You Received--20 CFR 416.1103(f)--0960-0481. Forms SSA-2854 and
SSA-2855 collect information on an SSI beneficiary's allegations that
he or she borrowed funds informally from a non-commercial lender; e.g.,
a relative or friend. The borrower/beneficiary and the lender of the
funds complete these statements. SSA requires information from Forms
SSA-2854 and SSA-2855 to determine whether the proceeds from the
transaction are income to the borrower. If the transaction constitutes
a bona fide loan, the proceeds are not income to the borrower. Form
SSA-2855 (Statement of Funds You Received) requests information from
the SSI applicant/recipient by personal interview. Form SSA-2854
(Statement of Funds You Provided to Another) requests information by
mail from the other party to the transaction. The respondents are SSI
recipients who informally borrow money and those persons who lend the
funds.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 40,000.
Frequency of Response: 1.
Average Burden per Response: 10 minutes.
Estimated Annual Burden: 6,667 hours.
6. Self-Employment/Corporate Officer Questionnaire--20 CFR
404.435(e), 404.446--0960-0487. SSA uses Form SSA-4184 to develop
earnings and corroborate the claimant's allegations of retirement when
the claimant is self-employed or a corporate officer. SSA uses the
information to determine an individual's OASDI benefit amount. The
respondents are self-employed individuals or corporate officers who
apply for OASDI benefits.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden per Response: 20 minutes.
Estimated Annual Burden: 16,667 hours.
Note: This is a correction notice. SSA published this
information collection as an extension on February 17, 2009 at 74 FR
7506. Since we are revising the Privacy Act Statement, this is now a
revision.
7. Application for SSA Employee Testimony--20 CFR 403.100-155--
[[Page 18786]]
0960-0619. SSA regulations at 20 CFR 403.100-155 establish policies and
procedures for an individual, organization, or governmental entity to
request official agency information, records, or testimony of an agency
employee in a legal proceeding when the agency is not a party. The
request, which must be in writing to the Commissioner, must fully set
out the nature and relevance of the sought testimony. Respondents are
individuals or entities who request testimony from SSA employees in a
legal proceeding.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 100.
Frequency of Response: 1.
Average Burden per Response: 60 minutes.
Estimated Annual Burden: 100 hours.
8. Authorization for the Social Security Administration To Obtain
Account Records from a Financial Institution and Request for Records
(Medicare Low-Income Subsidy)--0960-0729. Under the aegis of the
Medicare Modernization Act of 2003, Medicare beneficiaries can apply
for a subsidy for the Medicare Prescription Drug Plan (Part D) program.
In some cases, SSA will verify the details of applicants' accounts at
financial institutions to determine if they are eligible for the
subsidy. Form SSA-4640 gives SSA the authority to contact financial
institutions about applicants' accounts. Financial institutions will
also use the form to verify the information SSA requested. The
respondents are applicants for the Medicare Part D program subsidy and
financial institutions where applicants have accounts.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Medicare part D
subsidy applicants Financial institutions Totals
----------------------------------------------------------------------------------------------------------------
Number of Respondents.............. 10,000................ 10,000................ 20,000.
Frequency of Response.............. 1..................... 1..................... 1.
Average Burden per Response 1 minute.............. 4 minutes............. 5 minutes.
(minutes).
Estimated Annual Burden (hours).... 167 hours............. 667 hours............. 834 hours.
----------------------------------------------------------------------------------------------------------------
Total Estimated Annual Burden: 834 hours.
9. Request To Pay Civil Monetary Penalty by Installment Agreement--
20 CFR 498-0960-NEW. SSA uses Form SSA-640 to obtain the information
necessary to determine a repayment rate for individuals who have a
civil monetary penalty imposed on them for fraudulent conduct related
to SSA-administered programs. SSA needs this financial information to
ensure the repayment rate is in the best interest of both the
individual and the agency. The respondents are recipients of Social
Security benefits and non-entitled individuals who must pay a civil
monetary penalty.
Type of Request: New information collection.
Number of Respondents: 400.
Frequency of Response: 1.
Average Burden per Response: 120 minutes.
Estimated Annual Burden: 800 hours.
Dated: April 17, 2009.
John Biles,
Reports Clearance Officer, Center for Reports Clearance, Social
Security Administration.
[FR Doc. E9-9318 Filed 4-23-09; 8:45 am]
BILLING CODE 4191-02-P
