Agency Information Collection Activities: Proposed Request and Comment Request, 55080-55083 [E9-25663]

Download as PDF 55080 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: mstockstill on DSKH9S0YB1PROD with NOTICES Electronic Comments • Use the Commission’s Internet comment form (http://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). VerDate Nov<24>2008 15:19 Oct 23, 2009 Jkt 220001 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 (http://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 PO 00000 Frm 00131 Fmt 4703 Sfmt 4703 E:\FR\FM\26OCN1.SGM 26OCN1 mstockstill on DSKH9S0YB1PROD with NOTICES Federal Register / Vol. 74, No. 205 / Monday, October 26, 2009 / Notices 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 VerDate Nov<24>2008 15:19 Oct 23, 2009 Jkt 220001 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 PO 00000 Frm 00132 Fmt 4703 Sfmt 4703 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. E:\FR\FM\26OCN1.SGM 26OCN1 55082 Federal Register / Vol. 74, No. 205 / Monday, October 26, 2009 / Notices 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 ......................................................... mstockstill on DSKH9S0YB1PROD with NOTICES 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 VerDate Nov<24>2008 18:16 Oct 23, 2009 Jkt 220001 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- PO 00000 Frm 00133 Fmt 4703 Sfmt 4703 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 E:\FR\FM\26OCN1.SGM 26OCN1 55083 Federal Register / Vol. 74, No. 205 / Monday, October 26, 2009 / Notices 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 ................................... mstockstill on DSKH9S0YB1PROD with NOTICES 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 VerDate Nov<24>2008 18:16 Oct 23, 2009 Jkt 220001 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. PO 00000 Frm 00134 Fmt 4703 Sfmt 4703 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 E:\FR\FM\26OCN1.SGM 26OCN1

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]


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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.
    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