Agency Information Collection Activities: Proposed Request and Comment Request, 55080-55083 [E9-25663]
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Federal Register / Vol. 74, No. 205 / Monday, October 26, 2009 / Notices
coordination with persons engaged in
regulating, clearing, settling, processing
information with respect to, and
facilitating transactions in securities, to
remove impediments to and perfect the
mechanism of a free and open market
and a national market system, and, in
general, to protect investors and the
public interest. The NASDAQ OMX
Exchange Subsidiaries believe that the
issuance of Series A Preferred to
existing investors will result in no
substantive change to the corporate
ownership structure of their parent
NASDAQ OMX.
B. Self-Regulatory Organizations’
Statement on Burden on Competition
The NASDAQ OMX Exchange
Subsidiaries do 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, as amended.
C. Self-Regulatory Organizations’
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
The foregoing rule change has become
effective pursuant to Section
19(b)(3)(A)(iii) of the Act 11 and
subparagraph (f)(3) of Rule 19b–4
thereunder.12 At any time within 60
days of the filing of the respective
proposed rule change by the applicable
NASDAQ OMX Exchange Subsidiary,
the Commission may summarily
abrogate such rule change if it appears
to the Commission that such action is
necessary or appropriate in the public
interest, for the protection of investors,
or otherwise in furtherance of the
purposes of the Act.
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:
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Electronic Comments
• Use the Commission’s Internet
comment form (https://www.sec.gov/
rules/sro.shtml); or
• Send an e-mail to rulecomments@sec.gov. Please include File
11 15
12 17
U.S.C. 78s(b)(3)(a)(iii).
CFR 240.19b–4(f)(3).
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15:19 Oct 23, 2009
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Nos. SR–BX–2009–061, SR–NASDAQ–
2009–087, and SR–Phlx–2009–88 on the
subject line.
Paper Comments
SOCIAL SECURITY ADMINISTRATION
Agency Information Collection
Activities: Proposed Request and
Comment Request
• Send paper comments in triplicate
to Elizabeth M. Murphy, Secretary,
Securities and Exchange Commission,
100 F Street, NE., Washington, DC
20549–1090.
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
All submissions should refer to File
Paperwork Reduction Act of 1995,
Nos. SR–BX–2009–061, SR–NASDAQ–
effective October 1, 1995. This notice
2009–087, and SR–Phlx–2009–88. These includes revisions and extensions of
file numbers should be included on the
OMB-approved information collections.
SSA is soliciting comments on the
subject line if e-mail is used. To help the
accuracy of the agency’s burden
Commission process and review your
estimate; the need for the information;
comments more efficiently, please use
only one method. The Commission will its practical utility; ways to enhance its
post all comments on the Commission’s quality, utility, and clarity; and ways to
minimize the burden on respondents,
Internet Web site (https://www.sec.gov/
including the use of automated
rules/sro.shtml). Copies of the
collection techniques or other forms of
submission, all subsequent
information technology. Mail, e-mail, or
amendments, all written statements
fax your comments and
with respect to the proposed rule
recommendations on the information
change that are filed with the
collection(s) to the OMB Desk Officer
Commission, and all written
and the SSA Director for Reports
communications relating to the
Clearance to the addresses or fax
proposed rule change between the
numbers shown below.
Commission and any person, other than
(OMB), Office of Management and
those that may be withheld from the
Budget, Attn: Desk Officer for SSA,
public in accordance with the
Fax: 202–395–6974, E-mail address:
provisions of 5 U.S.C. 552, will be
OIRA_Submion@omb.eop.gov.
available for inspection and copying in
(SSA), Social Security Administration,
the Commission’s Public Reference
DCBFM, Attn: Director, Center for
Room, 100 F Street, NE., Washington,
Reports Clearance, 1333 Annex
DC 20549, on official business days
Building, 6401 Security Blvd.,
between the hours of 10 a.m. and 3 p.m.
Baltimore, MD 21235, Fax: 410–965–
Copies of such filings also will be
0454, E-mail address:
OPLM.RCO@ssa.gov.
available for inspection and copying at
the principal offices of the respective
I. The information collection below is
NASDAQ OMX Exchange Subsidiary.
pending at SSA. SSA will submit it to
OMB within 60 days from the date of
All comments received will be posted
this notice. To be sure we consider your
without change; the Commission does
comments, we must receive them no
not edit personal identifying
later than December 28, 2009.
information from submissions. You
Individuals can obtain copies of the
should submit only information that
collection instrument by calling the SSA
you wish to make available publicly.
Director for Reports Clearance at 410–
All submissions should refer to File
965–0454 or by writing to the above eNos. SR–BX–2009–061, SR–NASDAQ–
mail address.
2009–087, and SR–Phlx–2009–88, and
1. Certificate of Support—20 CFR
should be submitted on or before
404.370, 404.750, 404.408a—0960–
November 16, 2009.
0001. A parent of a deceased, fully
insured worker may be entitled to Title
For the Commission, by the Division of
II benefits on the earnings record of the
Trading and Markets, pursuant to delegated
deceased worker under certain
authority.13
conditions. One of the conditions is the
Florence E. Harmon,
parent must have received at least oneDeputy Secretary.
half support from the deceased worker.
[FR Doc. E9–25708 Filed 10–23–09; 8:45 am]
The one-half support requirement also
BILLING CODE 8011–01–P
applies to a spouse applicant in
determining whether Title II benefits are
subject to Government Pension Offset
(GPO). SSA uses the information from
form SSA–760–F4 to determine whether
13 17 CFR 200.30–3(a)(12).
the parent of a deceased worker or a
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spouse applicant meets the one-half
support requirement. Respondents are
parents of deceased workers or spouses
who may be exempt from GPO.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 18,000.
Frequency of Response: 1.
Average Burden per Response: 15
minutes.
Estimated Annual Burden: 4,500
hours.
2. Physician’s/Medical Officer’s
Statement of Patient’s Capability to
Manage Benefits—20 CFR 404.2015 and
416.615—0960–0024. SSA collects
information on form SSA–787 to
determine an individual’s capability to
handle his or her own benefits. This
information assists SSA in determining
the need for a representative payee. The
respondents are the beneficiary’s
physicians or medical officers of the
institution where the beneficiary
resides.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 120,000.
Frequency of Response: 1.
Average Burden per Response: 10
minutes.
Estimated Annual Burden: 20,000
hours.
3. Reporting Changes that Affect Your
Social Security Payment—20 CFR
404.301–305, .310–311, .330–.333, .335–
.341, .350–.352, .370–.371, .401–.402,
.408(a), .421–.425, .428–.430, .434–.437,
.439–.441, .446–.447, .450–.455, .468—
0960–0073. SSA collects the
information on the SSA–1425 to
determine continuing entitlement to
Title II Social Security benefits and to
determine the proper benefit amount.
The respondents are Social Security
beneficiaries receiving SSA retirement,
disability, or survivor’s auxiliary
benefits who need to report an event
that could affect payments.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 70,000.
Frequency of Response: 1.
Average Burden per Response: 5
minutes.
Estimated Annual Burden: 5,833
hours.
4. Child Relationship Statement—20
CFR 404.355 & 404.731—0960–0116.
SSA collects information on the SSA–
2519 to help determine a child’s
entitlement to Social Security benefits
under section 216(h)(3) of the Social
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15:19 Oct 23, 2009
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Security Act (deemed child provision).
An insured individual’s child may be
deemed his or her child if: (1) The
insured individual is shown by
evidence satisfactory to SSA to be the
child’s parent and was living with or
contributing to the child’s support at
certain specified times; or (2) the
insured individual acknowledged the
child in writing or the court decreed the
individual to be the child’s parent or
ordered the individual to support the
child. Respondents are persons with
knowledge of the relationship between
an individual and his/her alleged
biological child who is filing for
benefits.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden per Response: 15
minutes.
Estimated Annual Burden: 12,500
hours.
5. Pre-1957 Military Service—Federal
Benefit Questionnaire—20 CFR
404.1301–404.1371—0960–0120.
Sections 217(a) through (e) of the Social
Security Act provide for crediting
military service before 1957 to the wage
earner’s record. Form SSA–2512 collects
specific information about other
Federal, military, or civilian benefits the
wage earner may receive when the
applicant indicates both pre-1957
military service and the receipt of a
Federal benefit. SSA uses the data in the
claims adjudication process to grant
gratuitous military wage credits when
applicable, and to solicit sufficient
information to make a determination of
eligibility. Respondents are applicants
for Social Security benefits on a record
where the wage earner has pre-1957
military service.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 5,000.
Frequency of Response: 1.
Average Burden per Response: 10
minutes.
Estimated Annual Burden: 833 hours.
6. Application for Circuit Court Law—
20 CFR 404.985 & 416.1458—0960–
0581. SSA collects certain information
in readjudication requests it receives
from persons claiming the application of
an acquiescence ruling (AR) would
change a prior determination or
decision. SSA uses this information to
determine whether persons are entitled
to readjudication of their claims in
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55081
accordance with Social Security
regulations. SSA reviews the
information in the requests to determine
whether the issue(s) stated in the AR
pertains to the claimant’s case. If
readjudication is appropriate, SSA
considers only those issue(s) the AR
covers. Any new determination or
decision is subject to administrative or
judicial review as specified in
regulations. Respondents are claimants
for Social Security benefits and
Supplemental Security Income (SSI)
payments who request readjudication.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 10,000.
Frequency of Response: 1.
Average Burden per Response: 17
minutes.
Estimated Annual Burden: 2,833
hours.
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 November 25, 2009. You
can obtain a copy of the OMB clearance
packages by calling the SSA Director for
Reports Clearance at 410–965–0454 or
by writing to the above e-mail address.
1. State Supplementation Provisions:
Agreement; Payments—20 CFR
416.2095–416.2098, 416.2099—0960–
0240. Section 1618 of the Social
Security Act contains pass-along
provisions of the Social Security
amendments. These provisions require
states that supplement the Federal SSI
payments to pass along Federal cost-ofliving increases to individuals who are
eligible for state supplemental
payments. If a state fails to keep
payments at the required level, it
becomes ineligible for Medicaid
reimbursement under Title XIX of the
Social Security Act. SSA uses the
information to determine a state’s
eligibility for Medicaid reimbursement.
Respondents are state agencies
administering supplemental programs.
Note: This is a correction notice. We are
revising this notice to include the chart
below that was not in the 60-day Federal
Register Notice published on August 19,
2009, at 74 FR 41959.
Type of Request: Extension of an
OMB-approved information collection.
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Number of
respondents
Reporting method
Frequency of
response
Average
burden per
response
(minutes)
Estimated
annual
burden
(hours)
Total Expenditures ...........................................................................................
Maintenance of Payment Levels .....................................................................
7
23
4
1
60
60
28
23
Total ..........................................................................................................
30
........................
........................
51
2. Vocational Rehabilitation Provider
Claim—20 CFR 404.2108(b),
404.2117(c)(1)&(2), 404.2101(b)&(c),
404.2121(a), 416.2208(b),
416.2217(c)(1)&(2), 416.2201(b)&(c),
416.2221(a)—0960–0310. SSA refers
certain disability beneficiaries to State
Vocational Rehabilitation (VR) agencies.
The State VR agencies use the SSA–199
to make claims for reimbursement of the
costs they incur when providing VR
services for beneficiaries. SSA uses the
information on the SSA–199 to
determine whether or not, and how
Form or
regulation section No. (20 CFR)
Number of
respondents
a. SSA–199 (404.2108 & 416.2208) ....................................
b. (404.2117 & 416.2217) ....................................................
c. (404.2121 & 416.2221) ....................................................
80
80
80
Total ..............................................................................
Frequency of
response
much, to pay the State VR agencies
under SSA’s VR program. Respondents
are State VR agencies who offer
vocational and employment services to
Social Security and SSI recipients.
Type of Request: Revision of an OMBapproved information collection.
Total
responses
160 each/year
1 per year
2–3 per year
* 80
Average
burden per
response
(minutes)
Estimated
annual burden
(hours)
12,800
80
200
23
60
100
4,907
80
333
13,080
........................
5,320
* Same respondents used for each section.
3. Internet Request for Replacement of
Forms SSA–1099/SSA–1042S—20 CFR
401.45—0960–0583. Recipients use the
SSA–1099 and SSA–1042S to determine
if Social Security benefits are taxable
and the amount they need to report to
the Internal Revenue Service. An
individual may use SSA’s Internet
request form to obtain a replacement
SSA–1099 and SSA–1042S. SSA uses
the information from the Internet
request form to verify the identity of the
requestor and to provide replacement
copies of the forms. The Internet option
eliminates the need for phone calls to
the national 800 number or visits to a
local field office. The respondents are
Title II recipients who wish to request
Section No.
(20 CFR)
Note: This is a correction notice. SSA
published this information collection as an
extension on July 10, 2009, at 74 FR 33313.
Since we are revising the Privacy Act
Statement, this is now a revision of an OMBapproved information collection.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 136,455.
Frequency of Response: 1.
Average Burden per Response: 10
minutes.
Estimated Annual Burden: 22,743
hours.
4. Uniform Administrative
Requirements for Grants and
Agreements with Institutions of Higher
Learning, Hospitals and Other NonNumber of
responses
Profit Organizations—20 CFR 435—
0960–0616. The information contained
in 20 CFR 435 of the Code of Federal
Regulations provides SSA’s standards
for administering grants and agreements
it awards to institutions of higher
learning, hospitals, and other non-profit
and/or commercial organizations. The
regulations discuss administrative
guidelines and reporting, recordkeeping,
and disclosure requirements for
recipients of grants and agreements.
SSA uses the information to monitor the
progress and successful completion of
funded projects. Respondents are
recipients of grants and agreements with
SSA.
Type of Request: Extension of an
OMB-approved information collection.
Average
burden per
response
(hours)
Frequency of response
Estimated
annual burden
(hours)
Rec-kp .................................................
Rpt ......................................................
Rpt ......................................................
Rec-kp .................................................
107
127
127
127
Monthly (12) ...................................................
Biannually (2) .................................................
Quarterly (4) ...................................................
Annually (1) ....................................................
1
4
12
8
1,284
1,016
6,096
1,016
Total .........................................................
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435.23
435.25
435.51
435.53
a replacement SSA–1099 or SSA–1042S
via the Internet.
........................
.........................................................................
........................
9,412
5. Certificate of Incapacity—5 CFR
890.302(d)—0960–0739. Rules
governing the Federal Employee Health
Benefits (FEHB) plan require that the
physician verify disability of Federal
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18:16 Oct 23, 2009
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employees’ children ages 22 and over to
retain health benefits under the
employees’ plans. The physician must
verify the adult child has a disability
that meets the following criteria: (1) Pre-
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dates the child’s 22nd birthday; (2) is
very serious; and (3) is expected to last
at least one year. Physicians use Form
SSA–604, the Certificate of Incapacity,
to document and certify the disability of
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children ages 22 and over whose parents
are SSA employees. SSA uses the
information to determine adult
children’s (age 22 and above) eligibility
for coverage under a parent’s FEHB
plan. The respondents are physicians of
SSA employees’ children ages 22 or
over who are seeking to retain health
benefits under their parents’ FEHB
coverage.
Note: This is a correction notice. SSA
published this information collection as a
new information collection on August 19,
2009, at 74 FR 41959. Since we are revising
the Privacy Act Statement, this is now a
revision of an OMB-approved information
collection.
Type of Request: Revision of an OMB
approved information collection.
Number of Respondents: 50.
Frequency of Response: 1.
Average Burden per Response: 45
minutes.
Estimated Annual Burden: 38 hours.
6. Representative Payment Policies
and Administrative Procedures for
Imposing Penalties for False or
Regulation section
(20 CFR)
Misleading Statements or Withholding
of Information—0960–0740. This
information collection request (ICR)
comprises several regulation sections
that provide additional safeguards for
Social Security beneficiaries whose
representative payees receive their
payments. The respondents are
representative payees who receive and
use benefits on behalf of Social Security
beneficiaries.
Type of Collection: Extension of an
OMB-approved information collection.
Number of
respondents
Completion
time
(hours)
Burden
(hours)
404.2035(d) ..................................................................................................................................
404.2035(f) ...................................................................................................................................
416.635(d) ....................................................................................................................................
416.635(f) .....................................................................................................................................
550,000
5,500
300,000
3,000
.083
.083
.083
.083
45,650
457
24,900
249
Total ......................................................................................................................................
858,500
........................
71,256
7. Ticket to Work Program Evaluation
Survey (National Beneficiary Survey)—
0960–0666. The 1999 Ticket to Work
and Work Incentives Improvement Act,
Public Law 106–170, established the
Ticket to Work program (TTW) to create
additional access to services for SSA
beneficiaries through a new system of
public and private Employment
Network (EN) providers. Along with
establishing the TTW program, the
legislation mandated an evaluation of
the program.
In February 2003, SSA began a multiphase evaluation of this program.
Although we had originally planned to
complete the final data collection wave
by 2009, significant changes we made to
the TTW program in 2008 (such as
changes to the way State VR agencies
can provide services) compelled us to
extend the final evaluation to 2010.
Annual
number of
respondents
Instrument
In this ICR, we are seeking clearance
for Round 4 of the National Beneficiary
Survey and two associated experiments
(all three activities will use the same
data). The respondents are Social
Security beneficiaries and TTW
enrollees. As with the previous three
phases of this project, a contractor will
conduct this study for SSA.
Type of Collection: Revision of an
OMB-approved information collection.
Number of responses per respondent
Average
burden hours
per response
Estimated
annual burden
hours
2,400
3,000
1 .....................................................................
1 .....................................................................
.750
.917
1,800
2,751
Grand Total—Burden for NBS:
Grand Total for All ...................................
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National Beneficiary Sample ...........................
Ticket Participant Sample ...............................
5,400
.........................................................................
........................
4,551
8. Continuation of SSI Benefits for the
Temporarily Institutionalized—
Certification of Period and Need to
Maintain Home—20 CFR
416.212(b)(1)—0960–0516. When SSI
recipients (1) enter a public institution
or (2) enter a private medical treatment
facility with Medicaid paying more than
50 percent of expenses, their SSI
payments are reduced to a nominal sum.
However, if this institutionalization is
temporary (defined as a maximum of 3
months), SSA may waive the reduction
of benefits.
Before SSA can waive the benefits
reduction, the agency must obtain the
following documentation: (1) A
physician’s certification the beneficiary
will be institutionalized for a maximum
of 3 months; and (2) certification from
the beneficiary, beneficiary’s family, or
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18:16 Oct 23, 2009
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beneficiary’s friend confirming the need
for SSI payments to maintain the living
arrangements to which the beneficiary
will return post-institutionalization. The
respondents are doctors of SSI
recipients and the recipients or their
family/friends.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 60,000.
Frequency of Response: 1.
Average Burden per Response: 5
minutes.
Estimated Annual Burden: 5,000
hours.
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Dated: October 20, 2009.
Elizabeth A. Davidson,
Director, Center for Reports Clearance, Social
Security Administration.
[FR Doc. E9–25663 Filed 10–23–09; 8:45 am]
BILLING CODE 4191–02–P
DEPARTMENT OF STATE
[Public Notice 6793]
Fine Arts Committee Notice of Meeting
The Fine Arts Committee of the
Department of State will meet on
November 6, 2009 at 10 a.m. in the
Henry Clay Room of the Harry S.
Truman Building, 2201 C Street, NW.,
Washington, DC. The meeting will last
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]]>Agencies
[Federal Register Volume 74, Number 205 (Monday, October 26, 2009)]
[Notices]
[Pages 55080-55083]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E9-25663]
=======================================================================
-----------------------------------------------------------------------
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.
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 recommendations on the information collection(s)
to the OMB Desk Officer and the SSA Director for Reports Clearance to
the addresses or fax numbers shown below.
(OMB), Office of Management and Budget, Attn: Desk Officer for SSA,
Fax: 202-395-6974, E-mail address: OIRA_Submion@omb.eop.gov.
(SSA), Social Security Administration, DCBFM, Attn: Director, Center
for Reports Clearance, 1333 Annex Building, 6401 Security Blvd.,
Baltimore, MD 21235, Fax: 410-965-0454, 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
December 28, 2009. Individuals can obtain copies of the collection
instrument by calling the SSA Director for Reports Clearance at 410-
965-0454 or by writing to the above e-mail address.
1. Certificate of Support--20 CFR 404.370, 404.750, 404.408a--0960-
0001. A parent of a deceased, fully insured worker may be entitled to
Title II benefits on the earnings record of the deceased worker under
certain conditions. One of the conditions is the parent must have
received at least one-half support from the deceased worker. The one-
half support requirement also applies to a spouse applicant in
determining whether Title II benefits are subject to Government Pension
Offset (GPO). SSA uses the information from form SSA-760-F4 to
determine whether the parent of a deceased worker or a
[[Page 55081]]
spouse applicant meets the one-half support requirement. Respondents
are parents of deceased workers or spouses who may be exempt from GPO.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 18,000.
Frequency of Response: 1.
Average Burden per Response: 15 minutes.
Estimated Annual Burden: 4,500 hours.
2. Physician's/Medical Officer's Statement of Patient's Capability
to Manage Benefits--20 CFR 404.2015 and 416.615--0960-0024. SSA
collects information on form SSA-787 to determine an individual's
capability to handle his or her own benefits. This information assists
SSA in determining the need for a representative payee. The respondents
are the beneficiary's physicians or medical officers of the institution
where the beneficiary resides.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 120,000.
Frequency of Response: 1.
Average Burden per Response: 10 minutes.
Estimated Annual Burden: 20,000 hours.
3. Reporting Changes that Affect Your Social Security Payment--20
CFR 404.301-305, .310-311, .330-.333, .335-.341, .350-.352, .370-.371,
.401-.402, .408(a), .421-.425, .428-.430, .434-.437, .439-.441,
.446-.447, .450-.455, .468--0960-0073. SSA collects the information on
the SSA-1425 to determine continuing entitlement to Title II Social
Security benefits and to determine the proper benefit amount. The
respondents are Social Security beneficiaries receiving SSA retirement,
disability, or survivor's auxiliary benefits who need to report an
event that could affect payments.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 70,000.
Frequency of Response: 1.
Average Burden per Response: 5 minutes.
Estimated Annual Burden: 5,833 hours.
4. Child Relationship Statement--20 CFR 404.355 & 404.731--0960-
0116. SSA collects information on the SSA-2519 to help determine a
child's entitlement to Social Security benefits under section 216(h)(3)
of the Social Security Act (deemed child provision). An insured
individual's child may be deemed his or her child if: (1) The insured
individual is shown by evidence satisfactory to SSA to be the child's
parent and was living with or contributing to the child's support at
certain specified times; or (2) the insured individual acknowledged the
child in writing or the court decreed the individual to be the child's
parent or ordered the individual to support the child. Respondents are
persons with knowledge of the relationship between an individual and
his/her alleged biological child who is filing for benefits.
Type of Request: Revision of an OMB-approved information
collection.
Number of Respondents: 50,000.
Frequency of Response: 1.
Average Burden per Response: 15 minutes.
Estimated Annual Burden: 12,500 hours.
5. Pre-1957 Military Service--Federal Benefit Questionnaire--20 CFR
404.1301-404.1371--0960-0120. Sections 217(a) through (e) of the Social
Security Act provide for crediting military service before 1957 to the
wage earner's record. Form SSA-2512 collects specific information about
other Federal, military, or civilian benefits the wage earner may
receive when the applicant indicates both pre-1957 military service and
the receipt of a Federal benefit. SSA uses the data in the claims
adjudication process to grant gratuitous military wage credits when
applicable, and to solicit sufficient information to make a
determination of eligibility. Respondents are applicants for Social
Security benefits on a record where the wage earner has pre-1957
military service.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 5,000.
Frequency of Response: 1.
Average Burden per Response: 10 minutes.
Estimated Annual Burden: 833 hours.
6. Application for Circuit Court Law--20 CFR 404.985 & 416.1458--
0960-0581. SSA collects certain information in readjudication requests
it receives from persons claiming the application of an acquiescence
ruling (AR) would change a prior determination or decision. SSA uses
this information to determine whether persons are entitled to
readjudication of their claims in accordance with Social Security
regulations. SSA reviews the information in the requests to determine
whether the issue(s) stated in the AR pertains to the claimant's case.
If readjudication is appropriate, SSA considers only those issue(s) the
AR covers. Any new determination or decision is subject to
administrative or judicial review as specified in regulations.
Respondents are claimants for Social Security benefits and Supplemental
Security Income (SSI) payments who request readjudication.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 10,000.
Frequency of Response: 1.
Average Burden per Response: 17 minutes.
Estimated Annual Burden: 2,833 hours.
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 November 25, 2009. You can obtain a copy of
the OMB clearance packages by calling the SSA Director for Reports
Clearance at 410-965-0454 or by writing to the above e-mail address.
1. State Supplementation Provisions: Agreement; Payments--20 CFR
416.2095-416.2098, 416.2099--0960-0240. Section 1618 of the Social
Security Act contains pass-along provisions of the Social Security
amendments. These provisions require states that supplement the Federal
SSI payments to pass along Federal cost-of-living increases to
individuals who are eligible for state supplemental payments. If a
state fails to keep payments at the required level, it becomes
ineligible for Medicaid reimbursement under Title XIX of the Social
Security Act. SSA uses the information to determine a state's
eligibility for Medicaid reimbursement. Respondents are state agencies
administering supplemental programs.
Note: This is a correction notice. We are revising this notice
to include the chart below that was not in the 60-day Federal
Register Notice published on August 19, 2009, at 74 FR 41959.
Type of Request: Extension of an OMB-approved information
collection.
[[Page 55082]]
----------------------------------------------------------------------------------------------------------------
Average
Number of Frequency of burden per Estimated
Reporting method respondents response response annual burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
Total Expenditures.............................. 7 4 60 28
Maintenance of Payment Levels................... 23 1 60 23
---------------------------------------------------------------
Total....................................... 30 .............. .............. 51
----------------------------------------------------------------------------------------------------------------
2. Vocational Rehabilitation Provider Claim--20 CFR 404.2108(b),
404.2117(c)(1)&(2), 404.2101(b)&(c), 404.2121(a), 416.2208(b),
416.2217(c)(1)&(2), 416.2201(b)&(c), 416.2221(a)--0960-0310. SSA refers
certain disability beneficiaries to State Vocational Rehabilitation
(VR) agencies. The State VR agencies use the SSA-199 to make claims for
reimbursement of the costs they incur when providing VR services for
beneficiaries. SSA uses the information on the SSA-199 to determine
whether or not, and how much, to pay the State VR agencies under SSA's
VR program. Respondents are State VR agencies who offer vocational and
employment services to Social Security and SSI recipients.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average
Form or regulation section Number of Frequency of Total burden per Estimated
No. (20 CFR) respondents response responses response annual burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
a. SSA-199 (404.2108 & 80 160 each/year 12,800 23 4,907
416.2208).
b. (404.2117 & 416.2217)..... 80 1 per year 80 60 80
c. (404.2121 & 416.2221)..... 80 2-3 per year 200 100 333
----------------------------------------------------------------------------------
Total.................... * 80 ................. 13,080 .............. 5,320
----------------------------------------------------------------------------------------------------------------
* Same respondents used for each section.
3. Internet Request for Replacement of Forms SSA-1099/SSA-1042S--20
CFR 401.45--0960-0583. Recipients use the SSA-1099 and SSA-1042S to
determine if Social Security benefits are taxable and the amount they
need to report to the Internal Revenue Service. An individual may use
SSA's Internet request form to obtain a replacement SSA-1099 and SSA-
1042S. SSA uses the information from the Internet request form to
verify the identity of the requestor and to provide replacement copies
of the forms. The Internet option eliminates the need for phone calls
to the national 800 number or visits to a local field office. The
respondents are Title II recipients who wish to request a replacement
SSA-1099 or SSA-1042S via the Internet.
Note: This is a correction notice. SSA published this
information collection as an extension on July 10, 2009, at 74 FR
33313. Since we are revising the Privacy Act Statement, this is now
a revision of an OMB-approved information collection.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 136,455.
Frequency of Response: 1.
Average Burden per Response: 10 minutes.
Estimated Annual Burden: 22,743 hours.
4. Uniform Administrative Requirements for Grants and Agreements
with Institutions of Higher Learning, Hospitals and Other Non-Profit
Organizations--20 CFR 435--0960-0616. The information contained in 20
CFR 435 of the Code of Federal Regulations provides SSA's standards for
administering grants and agreements it awards to institutions of higher
learning, hospitals, and other non-profit and/or commercial
organizations. The regulations discuss administrative guidelines and
reporting, recordkeeping, and disclosure requirements for recipients of
grants and agreements. SSA uses the information to monitor the progress
and successful completion of funded projects. Respondents are
recipients of grants and agreements with SSA.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average
Number of burden per Estimated
Section No. (20 CFR) responses Frequency of response response annual burden
(hours) (hours)
----------------------------------------------------------------------------------------------------------------
435.23 Rec-kp......................... 107 Monthly (12)............ 1 1,284
435.25 Rpt............................ 127 Biannually (2).......... 4 1,016
435.51 Rpt............................ 127 Quarterly (4)........... 12 6,096
435.53 Rec-kp......................... 127 Annually (1)............ 8 1,016
-------------------------------------------------------------------------
Total............................. .............. ........................ .............. 9,412
----------------------------------------------------------------------------------------------------------------
5. Certificate of Incapacity--5 CFR 890.302(d)--0960-0739. Rules
governing the Federal Employee Health Benefits (FEHB) plan require that
the physician verify disability of Federal employees' children ages 22
and over to retain health benefits under the employees' plans. The
physician must verify the adult child has a disability that meets the
following criteria: (1) Pre-dates the child's 22nd birthday; (2) is
very serious; and (3) is expected to last at least one year. Physicians
use Form SSA-604, the Certificate of Incapacity, to document and
certify the disability of
[[Page 55083]]
children ages 22 and over whose parents are SSA employees. SSA uses the
information to determine adult children's (age 22 and above)
eligibility for coverage under a parent's FEHB plan. The respondents
are physicians of SSA employees' children ages 22 or over who are
seeking to retain health benefits under their parents' FEHB coverage.
Note: This is a correction notice. SSA published this
information collection as a new information collection on August 19,
2009, at 74 FR 41959. Since we are revising the Privacy Act
Statement, this is now a revision of an OMB-approved information
collection.
Type of Request: Revision of an OMB approved information
collection.
Number of Respondents: 50.
Frequency of Response: 1.
Average Burden per Response: 45 minutes.
Estimated Annual Burden: 38 hours.
6. Representative Payment Policies and Administrative Procedures
for Imposing Penalties for False or Misleading Statements or
Withholding of Information--0960-0740. This information collection
request (ICR) comprises several regulation sections that provide
additional safeguards for Social Security beneficiaries whose
representative payees receive their payments. The respondents are
representative payees who receive and use benefits on behalf of Social
Security beneficiaries.
Type of Collection: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Number of Completion
Regulation section (20 CFR) respondents time (hours) Burden (hours)
----------------------------------------------------------------------------------------------------------------
404.2035(d)..................................................... 550,000 .083 45,650
404.2035(f)..................................................... 5,500 .083 457
416.635(d)...................................................... 300,000 .083 24,900
416.635(f)...................................................... 3,000 .083 249
-----------------------------------------------
Total....................................................... 858,500 .............. 71,256
----------------------------------------------------------------------------------------------------------------
7. Ticket to Work Program Evaluation Survey (National Beneficiary
Survey)--0960-0666. The 1999 Ticket to Work and Work Incentives
Improvement Act, Public Law 106-170, established the Ticket to Work
program (TTW) to create additional access to services for SSA
beneficiaries through a new system of public and private Employment
Network (EN) providers. Along with establishing the TTW program, the
legislation mandated an evaluation of the program.
In February 2003, SSA began a multi-phase evaluation of this
program. Although we had originally planned to complete the final data
collection wave by 2009, significant changes we made to the TTW program
in 2008 (such as changes to the way State VR agencies can provide
services) compelled us to extend the final evaluation to 2010.
In this ICR, we are seeking clearance for Round 4 of the National
Beneficiary Survey and two associated experiments (all three activities
will use the same data). The respondents are Social Security
beneficiaries and TTW enrollees. As with the previous three phases of
this project, a contractor will conduct this study for SSA.
Type of Collection: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Annual number Average Estimated
Instrument of Number of responses per burden hours annual burden
respondents respondent per response hours
----------------------------------------------------------------------------------------------------------------
National Beneficiary Sample........... 2,400 1....................... .750 1,800
Ticket Participant Sample............. 3,000 1....................... .917 2,751
-------------------------------------------------------------------------
Grand Total--Burden for NBS:
Grand Total for All............... 5,400 ........................ .............. 4,551
----------------------------------------------------------------------------------------------------------------
8. Continuation of SSI Benefits for the Temporarily
Institutionalized--Certification of Period and Need to Maintain Home--
20 CFR 416.212(b)(1)--0960-0516. When SSI recipients (1) enter a public
institution or (2) enter a private medical treatment facility with
Medicaid paying more than 50 percent of expenses, their SSI payments
are reduced to a nominal sum. However, if this institutionalization is
temporary (defined as a maximum of 3 months), SSA may waive the
reduction of benefits.
Before SSA can waive the benefits reduction, the agency must obtain
the following documentation: (1) A physician's certification the
beneficiary will be institutionalized for a maximum of 3 months; and
(2) certification from the beneficiary, beneficiary's family, or
beneficiary's friend confirming the need for SSI payments to maintain
the living arrangements to which the beneficiary will return post-
institutionalization. The respondents are doctors of SSI recipients and
the recipients or their family/friends.
Type of Request: Extension of an OMB-approved information
collection.
Number of Respondents: 60,000.
Frequency of Response: 1.
Average Burden per Response: 5 minutes.
Estimated Annual Burden: 5,000 hours.
Dated: October 20, 2009.
Elizabeth A. Davidson,
Director, Center for Reports Clearance, Social Security Administration.
[FR Doc. E9-25663 Filed 10-23-09; 8:45 am]
BILLING CODE 4191-02-P
