Agency Information Collection Activities: Proposed Request and Comment Request, 59180-59182 [2011-24437]

Download as PDF 59180 Federal Register / Vol. 76, No. 185 / Friday, September 23, 2011 / Notices Incident: Hurricane Irene. Incident Period: 08/21/2011 Through 08/24/2011. Effective Date: 09/13/2011. Physical Loan Application Deadline Date: 10/26/2011. EIDL Loan Application Deadline Date: 05/28/2012. ADDRESSES: Submit completed loan applications to: U.S. Small Business Administration, Processing and Disbursement Center, 14925 Kingsport Road, Fort Worth, TX 76155. FOR FURTHER INFORMATION CONTACT: A. Escobar, Office of Disaster Assistance, U.S. Small Business Administration, 409 3rd Street, SW., Suite 6050, Washington, DC 20416. SUPPLEMENTARY INFORMATION: The notice of the Presidential disaster declaration for the Commonwealth of PUERTO RICO, dated 08/27/2011 is hereby amended to include the following areas as adversely affected by the disaster: Primary Counties: (Physical Damage and Economic Injury Loans): Fajardo, Gurabo, Las Piedras, Naguabo, Naranjito, Rio Grande, San Lorenzo, Trujillo Alto, Vega Baja, Vieques, Villalba. Contiguous Counties: (Economic Injury Loans Only): Puerto Rico: Manati, Toa Alta, Vega Alta. Effective Date: 09/13/2011. Physical Loan Application Deadline Date: 10/31/2011. Economic Injury (EIDL) Loan Application Deadline Date: 06/01/2012. ADDRESSES: Submit completed loan applications to: U.S. Small Business Administration, Processing and Disbursement Center, 14925 Kingsport Road, Fort Worth, TX 76155. FOR FURTHER INFORMATION CONTACT: A. Escobar, Office of Disaster Assistance, U.S. Small Business Administration, 409 3rd Street, SW., Suite 6050, Washington, DC 20416. SUPPLEMENTARY INFORMATION: The notice of the President’s major disaster declaration for Private Non-Profit organizations in the State of North Carolina, dated 09/01/2011, is hereby amended to include the following areas as adversely affected by the disaster. Primary Counties: Vance. All other information in the original declaration remains unchanged. All other information in the original declaration remains unchanged. SOCIAL SECURITY ADMINISTRATION (Catalog of Federal Domestic Assistance Numbers 59002 and 59008) James E. Rivera, Associate Administrator for Disaster Assistance. [FR Doc. 2011–24425 Filed 9–22–11; 8:45 am] BILLING CODE 8025–01–P SMALL BUSINESS ADMINISTRATION [Disaster Declaration #12790 and #12791] North Carolina Disaster Number NC–00037 sroberts on DSK5SPTVN1PROD with NOTICES AGENCY: U.S. Small Business Administration. ACTION: Amendment 3. SUMMARY: This is an amendment of the Presidential declaration of a major disaster for Public Assistance Only for the State of North Carolina (FEMA– 4019–DR), dated 09/01/2011. Incident: Hurricane Irene. Incident Period: 08/25/2011 through 09/01/2011. VerDate Mar<15>2010 16:41 Sep 22, 2011 Jkt 223001 (Catalog of Federal Domestic Assistance Numbers 59002 and 59008) James E. Rivera, Associate Administrator for Disaster Assistance. [FR Doc. 2011–24426 Filed 9–22–11; 8:45 am] BILLING CODE 8025–01–P 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 extensions and revisions of OMB-approved information collections, and an information collection in use without an OMB number. 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 burden on respondents, including the use of automated collection techniques or other forms of information technology. Mail, email, or fax your comments and recommendations on the information collection(s) to the OMB Desk Officer PO 00000 Frm 00072 Fmt 4703 Sfmt 4703 and SSA Reports Clearance Officer at the following addresses or fax numbers. (OMB) Office of Management and Budget, Attn: Desk Officer for SSA, Fax: 202– 395–6974, E-mail address: OIRA_ Submission@omb.eop.gov. (SSA) Social Security Administration, DCBFM, Attn: Reports Clearance Officer, 1333 Annex Building, 6401 Security Blvd., Baltimore, MD 21235, E-mail address: OPLM.RCO@ssa.gov. I. The information collections below are pending at SSA. SSA will submit them 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 November 22, 2011. Individuals can obtain copies of the collection instruments by calling the SSA Reports Clearance Officer at 410– 965–8783 or by writing to the above email address. 1. Incoming and Outgoing Intergovernmental Personnel Act Assignment Agreement—5 CFR 334— 0960–NEW. The Intergovernmental Personnel Act (IPA) mobility program provides for the temporary assignment of civilian personnel between the Federal Government and state and local governments, colleges and universities, Indian tribal governments, federally funded research and development centers, and other eligible organizations. The Office of Personnel Management (OPM) created a generic form, the OF– 69, for agencies to use as a template when collecting information for the IPA assignment. The OF–69 collects specific information about the agreement including the name, social security number, job title, salary, classification, and address of the employee enrolled in the program, as well as the type of assignment, reimbursement arrangement, and explanation as to how the assignment will benefit both SSA and the non-federal organization involved in the exchange. OPM directs agencies to use their own forms for recording these agreements. Therefore, SSA modified the OF–69 to meet our needs, creating the SSA–187 for incoming employees, and the SSA– 188 for outgoing employees. Respondents are the individuals we describe above who participate in the IPA exchange with SSA. Type of Request: Existing collection in use without an OMB number. E:\FR\FM\23SEN1.SGM 23SEN1 59181 Federal Register / Vol. 76, No. 185 / Friday, September 23, 2011 / Notices Number of respondents Respondent type Average burden per response (minutes) Frequency of response Estimated total annual burden (hours) Non-federal employee, SSA–187 .................................................... Non-federal employer signers, both SSA–187 & SSA–188 ............ 10 20 1 1 30 5 5 2 Totals ........................................................................................ 30 ............................ ............................ 7 2. Coverage of Employees of State and Local Governments—20 CFR 404, Subpart M—0960–0425. The Code of Federal Regulations at 20 CFR part 404, Subpart M, prescribes the rules for states submitting reports of deposits and recordkeeping to SSA. States (and interstate instrumentalities) are required to provide wage and deposit contribution information for pre-1987 periods. Not all the states have completely satisfied their pending wage report and contribution liability with SSA for pre-1987 tax years. These regulations are needed until all pending items with all states are closed out, and Regulation section Number of respondents to provide for collection of this information in the future, if necessary. The respondents are state and local governments or interstate instrumentalities. Type of Request: Revision of an OMBapproved information collection. Average burden per response (hours) Frequency of response Estimated total annual burden (hours) 404. 1204 (a) & (b) .......................................................................... 404.1215 .......................................................................................... 404. 1216 (a) & (b) .......................................................................... 52 52 52 1 1 1 0.5 1 1 26 52 52 Total .......................................................................................... 156 ............................ ............................ 130 3. Medical Report on Adult with Allegation of Human Immunodeficiency Virus Infection; Medical Report on Child with Allegation of Human Immunodeficiency Virus Infection—20 CFR 416.993–416.994—0960–0500. SSA or state agencies (Disability Determination Services) use Forms SSA–4814–F5 and SSA–4815–F6 to collect information necessary to determine if an individual with the human immunodeficiency virus infection, who is applying for Supplemental Security Income (SSI), Number of respondents Form meets the requirements for presumptive disability payments. The respondents are the medical sources of the applicants for SSI disability payments. Type of Request: Revision of an OMBapproved information collection. Frequency of response Response time (minutes) Estimated total annual burden (hours) 46,200 12,900 1 1 10 10 7,700 2,150 Totals ........................................................................................ sroberts on DSK5SPTVN1PROD with NOTICES SSA–4814–F5 .................................................................................. SSA–4815–F6 .................................................................................. 59,100 ............................ ............................ 9,850 4. Public Information Campaign— 0960–0544. Periodically, SSA sends various public information materials, including public service announcements, news releases, and educational tapes, to public broadcasting systems so they can inform the public about the various programs and activities SSA conducts. SSA frequently sends follow-up business reply cards for these public information materials to obtain suggestions for improving them. The respondents are broadcast television sources. Type of Request: Revision of an OMBapproved information collection. Number of Respondents: 1,000. Frequency of Response: 2. VerDate Mar<15>2010 16:41 Sep 22, 2011 Jkt 223001 Average Burden per Response: 1 minute. Estimated Total Annual Burden: 33 hours. 5. Redetermination of Eligibility for Help with Medicare Prescription Drug Plan Costs—0960–0723. As per the requirements of the Medicare Modernization Act of 2003 (Pub. L. 108– 173), SSA conducts low-income subsidy eligibility redeterminations for Medicare beneficiaries who currently receive the Medicare Part D subsidy and who meet certain criteria. Respondents complete Form SSA–1026–REDE under the following circumstances: (1) When individuals became entitled to the Medicare Part D subsidy during the past 12 months; (2) if they were eligible for PO 00000 Frm 00073 Fmt 4703 Sfmt 4703 the Part D subsidy for more than 12 months; or (3) if they reported a change in income, resources, or household size. Part D beneficiaries complete the SSA–1026–SCE when they need to report a potentially subsidychanging event, including the following: (1) Marriage, (2) spousal separation, (3) divorce, (4) annulment of a marriage, (5) spousal death, or (6) moving back in with one’s spouse following a separation. The respondents are current recipients of the Medicare Part D lowincome subsidy who will undergo an eligibility redetermination for one of the reasons mentioned above. Type of Request: Extension of an OMB-approved information collection. E:\FR\FM\23SEN1.SGM 23SEN1 59182 Federal Register / Vol. 76, No. 185 / Friday, September 23, 2011 / Notices Number of respondents Form Average burden per response (minutes) Frequency of response Estimated total annual burden (hours) 11,400 225,000 1 1 18 18 3,420 67,500 Total .......................................................................................... sroberts on DSK5SPTVN1PROD with NOTICES SSA–1026–OCR–MS–SCE ............................................................. SSA–1026–OCR–SM–REDE .......................................................... 236,400 ............................ ............................ 70,920 II. SSA submitted the information collection below to OMB for clearance. Your comments regarding the information collection 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 October 24, 2011. Individuals can obtain copies of the OMB clearance package by calling the SSA Reports Clearance Officer at 410– 965–8783 or by writing to the above email address. Statement of Claimant or Other Person—Medical Resident FICA Refund Claims—20 CFR 404.702 and 416.570— 0960–0786. The Internal Revenue Service (IRS) is contacting medical residents (and their employers) who filed Federal Insurance Contributions Act (FICA) refund claims from 1993 through 2005. Those medical residents who claimed their residencies were actually training, not employment, should not have been subject to FICA tax. The IRS made a decision to honor these claims and issue a full refund of FICA tax, plus statutory interest, to those who wish to participate in the refund resolution. SSA will remove wages from the participating residents’ earnings records for the period of the refund requests, which will cause the residents’ recorded earnings to decrease. This not only affects earnings for future retirement benefits, but also could adversely affect those residents (or their beneficiaries) who are currently receiving Social Security benefits. To ensure they understand the potential impact on their benefits, SSA will call those residents who will be adversely affected and explain the effect on their Social Security benefits if they accept the IRS FICA refund. If SSA cannot reach the resident by phone, we will send a contact letter and the SSA– 795–OP2 to the resident to complete and return to SSA to document the decision. Once we have the information, we will forward the signed forms to the IRS for the residents who no longer want the FICA refund. Type of Request: Revision of an OMBapproved information collection. Number of Respondents: 496. Frequency of Response: 1. VerDate Mar<15>2010 16:41 Sep 22, 2011 Jkt 223001 Average Burden per Response: 4 minutes. Estimated Total Annual Burden: 33 hours. Dated: September 20, 2011. Faye Lipsky, Reports Clearance Officer, Center for Reports Clearance, Social Security Administration. [FR Doc. 2011–24437 Filed 9–22–11; 8:45 am] State, SA–5, L/PD, Fifth Floor (Suite 5H03), Washington, DC 20522–0505. Dated: September 19, 2011. J. Adam Ereli, Principal Deputy Assistant Secretary, Bureau of Educational and Cultural Affairs, Department of State. [FR Doc. 2011–24540 Filed 9–22–11; 8:45 am] BILLING CODE 4710–05–P BILLING CODE 4191–02–P DEPARTMENT OF STATE DEPARTMENT OF STATE [Public Notice: 7609] [Public Notice: 7610] Bureau of Educational and Cultural Affairs; Exchange Visitor Program; Summer Work Travel Program Sponsor On-Site Reviews Culturally Significant Objects Imported for Exhibition Determinations: ‘‘Impressionism: Masterworks on Paper’’ Notice is hereby given of the following determinations: Pursuant to the authority vested in me by the Act of October 19, 1965 (79 Stat. 985; 22 U.S.C. 2459), Executive Order 12047 of March 27, 1978, the Foreign Affairs Reform and Restructuring Act of 1998 (112 Stat. 2681, et seq.; 22 U.S.C. 6501 note, et seq.), Delegation of Authority No. 234 of October 1, 1999, Delegation of Authority No. 236–3 of August 28, 2000 (and, as appropriate, Delegation of Authority No. 257 of April 15, 2003), I hereby determine that the objects to be included in the exhibition ‘‘Impressionism: Masterworks on Paper’’ imported from abroad for temporary exhibition within the United States, are of cultural significance. The objects are imported pursuant to loan agreements with the foreign owners or custodians. I also determine that the exhibition or display of the exhibit objects at the Milwaukee Art Museum, Milwaukee, WI, from on or about October 15, 2011, until on or about January 8, 2012, and at possible additional exhibitions or venues yet to be determined, is in the national interest. I have ordered that Public Notice of these Determinations be published in the Federal Register. FOR FURTHER INFORMATION CONTACT: For further information, including a list of the exhibit objects, contact Julie Simpson, Attorney-Adviser, Office of the Legal Adviser, U.S. Department of State (telephone: 202–632–6467). The mailing address is U.S. Department of SUMMARY: PO 00000 Frm 00074 Fmt 4703 Sfmt 4703 ACTION: Notice. SUMMARY: Pursuant to the Mutual Educational and Cultural Exchange Act of 1961 (the ‘‘Act’’), the Department of State (Department) is authorized to facilitate and direct educational and cultural exchange activities in order to develop and promote mutual understanding between the people of the United States and the people of other countries by means of educational and cultural exchanges. These exchanges, conducted by Departmentdesignated sponsors assist the Department in furthering the foreign policy objectives of the United States. By this Notice, and in order to enhance its continued oversight and monitoring of designated sponsors, the Department announces its intent to conduct on-site reviews of sponsors in the Summer Work Travel Program to evaluate regulatory compliance with Program regulations set forth at 22 CFR Part 62. The Summer Work Travel Program provides foreign college and university students the opportunity to work and travel in the United States during their extended academic break (i.e., summer vacation) for a period not to exceed four months. On April 26, 2011, the Department published in the Federal Register, an Interim Final Rule governing the Summer Work Travel category of the Exchange Visitor Program. In that rulemaking, the Department explained its three-step approach to addressing a number of concerns regarding sponsor E:\FR\FM\23SEN1.SGM 23SEN1

Agencies

[Federal Register Volume 76, Number 185 (Friday, September 23, 2011)]
[Notices]
[Pages 59180-59182]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-24437]


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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 extensions and revisions of OMB-approved 
information collections, and an information collection in use without 
an OMB number.
    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 burden 
on respondents, including the use of automated collection techniques or 
other forms of information technology. Mail, email, or fax your 
comments and recommendations on the information collection(s) to the 
OMB Desk Officer and SSA Reports Clearance Officer at the following 
addresses or fax numbers.

(OMB)

    Office of Management and Budget, Attn: Desk Officer for SSA, Fax: 
202-395-6974, E-mail address: OIRA_Submission@omb.eop.gov.

(SSA)

    Social Security Administration, DCBFM, Attn: Reports Clearance 
Officer, 1333 Annex Building, 6401 Security Blvd., Baltimore, MD 21235, 
E-mail address: OPLM.RCO@ssa.gov.
    I. The information collections below are pending at SSA. SSA will 
submit them 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 
November 22, 2011. Individuals can obtain copies of the collection 
instruments by calling the SSA Reports Clearance Officer at 410-965-
8783 or by writing to the above email address.
    1. Incoming and Outgoing Intergovernmental Personnel Act Assignment 
Agreement--5 CFR 334--0960-NEW. The Intergovernmental Personnel Act 
(IPA) mobility program provides for the temporary assignment of 
civilian personnel between the Federal Government and state and local 
governments, colleges and universities, Indian tribal governments, 
federally funded research and development centers, and other eligible 
organizations. The Office of Personnel Management (OPM) created a 
generic form, the OF-69, for agencies to use as a template when 
collecting information for the IPA assignment. The OF-69 collects 
specific information about the agreement including the name, social 
security number, job title, salary, classification, and address of the 
employee enrolled in the program, as well as the type of assignment, 
reimbursement arrangement, and explanation as to how the assignment 
will benefit both SSA and the non-federal organization involved in the 
exchange.
    OPM directs agencies to use their own forms for recording these 
agreements. Therefore, SSA modified the OF-69 to meet our needs, 
creating the SSA-187 for incoming employees, and the SSA-188 for 
outgoing employees. Respondents are the individuals we describe above 
who participate in the IPA exchange with SSA.
    Type of Request: Existing collection in use without an OMB number.

[[Page 59181]]



----------------------------------------------------------------------------------------------------------------
                                                                               Average burden    Estimated total
             Respondent type                  Number of       Frequency of      per response      annual burden
                                             respondents        response          (minutes)          (hours)
----------------------------------------------------------------------------------------------------------------
Non-federal employee, SSA-187...........                10                 1                30                 5
Non-federal employer signers, both SSA-                 20                 1                 5                 2
 187 & SSA-188..........................
                                         -----------------------------------------------------------------------
    Totals..............................                30  ................  ................                 7
----------------------------------------------------------------------------------------------------------------

    2. Coverage of Employees of State and Local Governments--20 CFR 
404, Subpart M--0960-0425. The Code of Federal Regulations at 20 CFR 
part 404, Subpart M, prescribes the rules for states submitting reports 
of deposits and recordkeeping to SSA. States (and interstate 
instrumentalities) are required to provide wage and deposit 
contribution information for pre-1987 periods. Not all the states have 
completely satisfied their pending wage report and contribution 
liability with SSA for pre-1987 tax years. These regulations are needed 
until all pending items with all states are closed out, and to provide 
for collection of this information in the future, if necessary. The 
respondents are state and local governments or interstate 
instrumentalities.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                               Average burden    Estimated total
           Regulation  section                Number of       Frequency of      per response      annual burden
                                             respondents        response           (hours)           (hours)
----------------------------------------------------------------------------------------------------------------
404. 1204 (a) & (b).....................                52                 1               0.5                26
404.1215................................                52                 1                 1                52
404. 1216 (a) & (b).....................                52                 1                 1                52
                                         -----------------------------------------------------------------------
    Total...............................               156  ................  ................               130
----------------------------------------------------------------------------------------------------------------

    3. Medical Report on Adult with Allegation of Human 
Immunodeficiency Virus Infection; Medical Report on Child with 
Allegation of Human Immunodeficiency Virus Infection--20 CFR 416.993-
416.994--0960-0500. SSA or state agencies (Disability Determination 
Services) use Forms SSA-4814-F5 and SSA-4815-F6 to collect information 
necessary to determine if an individual with the human immunodeficiency 
virus infection, who is applying for Supplemental Security Income 
(SSI), meets the requirements for presumptive disability payments. The 
respondents are the medical sources of the applicants for SSI 
disability payments.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                                 Estimated total
                  Form                        Number of       Frequency of      Response time     annual burden
                                             respondents        response          (minutes)          (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4814-F5.............................            46,200                 1                10             7,700
SSA-4815-F6.............................            12,900                 1                10             2,150
                                         -----------------------------------------------------------------------
    Totals..............................            59,100  ................  ................             9,850
----------------------------------------------------------------------------------------------------------------

    4. Public Information Campaign--0960-0544. Periodically, SSA sends 
various public information materials, including public service 
announcements, news releases, and educational tapes, to public 
broadcasting systems so they can inform the public about the various 
programs and activities SSA conducts. SSA frequently sends follow-up 
business reply cards for these public information materials to obtain 
suggestions for improving them. The respondents are broadcast 
television sources.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 1,000.
    Frequency of Response: 2.
    Average Burden per Response: 1 minute.
    Estimated Total Annual Burden: 33 hours.
    5. Redetermination of Eligibility for Help with Medicare 
Prescription Drug Plan Costs--0960-0723. As per the requirements of the 
Medicare Modernization Act of 2003 (Pub. L. 108-173), SSA conducts low-
income subsidy eligibility redeterminations for Medicare beneficiaries 
who currently receive the Medicare Part D subsidy and who meet certain 
criteria. Respondents complete Form SSA-1026-REDE under the following 
circumstances: (1) When individuals became entitled to the Medicare 
Part D subsidy during the past 12 months; (2) if they were eligible for 
the Part D subsidy for more than 12 months; or (3) if they reported a 
change in income, resources, or household size. Part D beneficiaries 
complete the SSA-1026-SCE when they need to report a potentially 
subsidy-changing event, including the following: (1) Marriage, (2) 
spousal separation, (3) divorce, (4) annulment of a marriage, (5) 
spousal death, or (6) moving back in with one's spouse following a 
separation. The respondents are current recipients of the Medicare Part 
D low-income subsidy who will undergo an eligibility redetermination 
for one of the reasons mentioned above.
    Type of Request: Extension of an OMB-approved information 
collection.

[[Page 59182]]



----------------------------------------------------------------------------------------------------------------
                                                                               Average burden    Estimated total
                  Form                        Number of       Frequency of      per response      annual burden
                                             respondents        response          (minutes)          (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1026-OCR-MS-SCE.....................            11,400                 1                18             3,420
SSA-1026-OCR-SM-REDE....................           225,000                 1                18            67,500
                                         -----------------------------------------------------------------------
    Total...............................           236,400  ................  ................            70,920
----------------------------------------------------------------------------------------------------------------

    II. SSA submitted the information collection below to OMB for 
clearance. Your comments regarding the information collection 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 October 24, 2011. Individuals can obtain copies of 
the OMB clearance package by calling the SSA Reports Clearance Officer 
at 410-965-8783 or by writing to the above e-mail address.
    Statement of Claimant or Other Person--Medical Resident FICA Refund 
Claims--20 CFR 404.702 and 416.570--0960-0786. The Internal Revenue 
Service (IRS) is contacting medical residents (and their employers) who 
filed Federal Insurance Contributions Act (FICA) refund claims from 
1993 through 2005. Those medical residents who claimed their 
residencies were actually training, not employment, should not have 
been subject to FICA tax. The IRS made a decision to honor these claims 
and issue a full refund of FICA tax, plus statutory interest, to those 
who wish to participate in the refund resolution. SSA will remove wages 
from the participating residents' earnings records for the period of 
the refund requests, which will cause the residents' recorded earnings 
to decrease. This not only affects earnings for future retirement 
benefits, but also could adversely affect those residents (or their 
beneficiaries) who are currently receiving Social Security benefits.
    To ensure they understand the potential impact on their benefits, 
SSA will call those residents who will be adversely affected and 
explain the effect on their Social Security benefits if they accept the 
IRS FICA refund. If SSA cannot reach the resident by phone, we will 
send a contact letter and the SSA-795-OP2 to the resident to complete 
and return to SSA to document the decision. Once we have the 
information, we will forward the signed forms to the IRS for the 
residents who no longer want the FICA refund.
    Type of Request: Revision of an OMB-approved information 
collection.
    Number of Respondents: 496.
    Frequency of Response: 1.
    Average Burden per Response: 4 minutes.
    Estimated Total Annual Burden: 33 hours.

    Dated: September 20, 2011.
Faye Lipsky,
Reports Clearance Officer, Center for Reports Clearance, Social 
Security Administration.
[FR Doc. 2011-24437 Filed 9-22-11; 8:45 am]
BILLING CODE 4191-02-P
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