Agency Information Collection Activities: Proposed Request and Comment Request, 78068-78072 [2011-32145]
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Federal Register / Vol. 76, No. 241 / Thursday, December 15, 2011 / Notices
Paper Comments
• Send paper comments in triplicate
to Elizabeth M. Murphy, Secretary,
Securities and Exchange Commission,
100 F Street NE., Washington, DC
20549–1090.
All submissions should refer to File
Number SR–NYSEArca–2011–91. This
file number should be included on the
subject line if email is used. To help the
Commission process and review your
comments more efficiently, please use
only one method. The Commission will
post all comments on the Commission’s
Internet Web site (https://www.sec.gov/
rules/sro.shtml). Copies of the
submission, all subsequent
amendments, all written statements
with respect to the proposed rule
change that are filed with the
Commission, and all written
communications relating to the
proposed rule change between the
Commission and any person, other than
those that may be withheld from the
public in accordance with the
provisions of 5 U.S.C. 552, will be
available for Web site viewing and
printing in the Commission’s Public
Reference Room, 100 F Street NE.,
Washington, DC 20549, on official
business days between the hours of 10
a.m. and 3 p.m. Copies of the filing also
will be available for inspection and
copying at the principal office of the
Exchange. All comments received will
be posted without change; the
Commission does not edit personal
identifying information from
submissions. You should submit only
information that you wish to make
available publicly. All submissions
should refer to File Number SR–
Fax: (202) 395–6974, Email address:
OIRA_Submission@omb.eop.gov.
(SSA), Social Security Administration,
DCRDP, Attn: Reports Clearance
Officer, 107 Altmeyer Building, 6401
Security Blvd., Baltimore, MD 21235,
Fax No.: (410) 966–2830, Email
address: OPLM.RCO@ssa.gov.
NYSEArca–2011–91 and should be
submitted on or before January 5, 2012.
For the Commission, by the Division of
Trading and Markets, pursuant to delegated
authority.9
Kevin M. O’Neill,
Deputy Secretary.
[FR Doc. 2011–32138 Filed 12–14–11; 8:45 am]
BILLING CODE 8011–01–P
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 February 13,
2012. 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. Application for Mother’s or Father’s
Insurance Benefits—20 CFR 404.339–
404.342, 20 CFR 404.601–404.603—
0960–0003. Section 202(g) of the Social
Security Act (Act) provides for the
payment of monthly benefits to the
widow or widower of an insured
individual if the surviving spouse is
caring for the deceased worker’s child
(who is entitled to Social Security
benefits). SSA uses the information on
Form SSA–5–F6 to determine an
individual’s eligibility for mother’s or
father’s insurance benefits. The
respondents are individuals caring for a
child of the deceased worker who is
applying for mother’s or father’s
insurance benefits under the Old Age,
Survivors, and Disability Insurance
(OASDI) program.
Type of Request: Revision of an OMBapproved information collection.
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 to
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 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,
Number of
respondents
Collection instrument
Average burden
per response
(minutes)
Frequency of
response
Estimated total
annual burden
(hours)
SSA–5–F6 (paper) ...........................................................................
MCS .................................................................................................
MCS/Signature Proxy ......................................................................
1,611
26,045
26,044
1
1
1
15
15
15
403
6,511
6,511
Total ..........................................................................................
53,700
............................
............................
13,425
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2. Letter to Employer Requesting
Information About Wages Earned by
Beneficiary—20 CFR 416.703 &
404.801—0960–0034. SSA uses
information from Form SSA–L725 to
verify a beneficiary’s wages when SSA
has incomplete or questionable wage
data. SSA uses the information to
calculate the correct amount of benefits
payable, and to maintain an accurate
record of earnings for the beneficiary.
Respondents are employers who
provide information SSA needs to
establish specific monthly earnings.
Type of Request: Extension of an
OMB-approved information collection.
Collection instrument
Number of
respondents
Frequency of
response
Average burden
per response
(minutes)
Estimated total
annual burden
(hours)
SSA–L725 ........................................................................................
150,000
1
40
100,000
9 17
CFR 200.30–3(a)(12).
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3. Student Reporting Form—20 CFR
404.367 & 20 CFR 404.368—0960–0088.
Sections 20 CFR 404.367 and 20 CFR
404.368 mandate that a student
beneficiary be in full-time attendance at
an educational institution to qualify for
student Social Security benefits. SSA
the information to determine the correct
benefit amounts for student
beneficiaries. The respondents are
Social Security student beneficiaries.
Type of Request: Revision of an OMBapproved information collection.
requires beneficiaries to report events
that may cause a reduction, termination,
or suspension of their benefits. Using
the information from Form SSA–1383,
SSA determines if the change or event
reported affects continuing entitlement
to SSA benefits. In addition, SSA uses
Number of
respondents
Collection instrument
Average burden
per response
(minutes)
Frequency of
response
Estimated total
annual burden
(hours)
SSA–1383 ........................................................................................
SSA–1383–FC .................................................................................
74,887
113
1
1
6
6
7,489
11
Total ..........................................................................................
75,000
............................
............................
7,500
respondents are employers of SSI
applicants and recipients.
Type of Request: Revision of an OMBapproved information collection.
determining SSI eligibility and payment
amounts. SSA uses Form SSA–L4201 to
collect this information. SSA uses the
information to determine eligibility and
proper payment amounts for SSI
applicants and recipients. The
4. Letter to Employer Requesting
Wage Information—20 CFR 404.726—
0960–0138. SSA must establish and
verify wage information for
Supplemental Security Income (SSI)
applicants and recipients when
Collection instrument
Number of
respondents
Frequency of
response
Average burden
per response
(minutes)
Estimated total
annual burden
(hours)
SSA–L4201 ......................................................................................
133,000
1
30
66,500
5. Claimant’s Recent Medical
Treatment—20 CFR 404.1512 and
416.912—0960–0292. When Disability
Determination Services deny a claim at
the reconsideration level, the claimant
has a right to request a hearing before
an administrative law judge (ALJ). For
the hearing, SSA asks the claimant to
complete and return the HA–4631 if the
claimant’s file does not reflect a current,
complete medical history as the
During the hearing, the ALJs offer any
completed questionnaires as exhibits
and may use them to refresh the
claimant’s memory and to shape their
questions. The respondents are
claimants requesting hearings on
entitlement to Old Age, Survivors, and
Disability Insurance (OASDI) benefits or
SSI payments.
Type of Request: Extension of an
OMB-approved information collection.
claimant proceeds through the appeals
process. ALJs must obtain the
information to update and complete the
record and to verify the accuracy of the
information. Through this process, ALJs
can ascertain whether the claimant’s
situation has changed. The ALJs and
hearing office staff use the response to
make arrangements for consultative
examination(s) and the attendance of an
expert witness(es), if appropriate.
Collection instrument
Number of
respondents
Frequency of
response
Average burden
per response
(minutes)
Estimated total
annual burden
(hours)
HA–4631 ..........................................................................................
200,000
1
10
33,333
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6. You Can Make Your Payment by
Credit Card—0960–0462. Using
information from Form SSA–4588 and
its electronic application, form SSA–
4589, SSA updates individuals’ Social
Security records to reflect payments
made on their overpayments. In
addition, SSA uses this information to
process payments through the
appropriate credit card company. SSA
provides the SSA–4588 when we inform
an individual that we detected an
overpayment. Individuals may choose to
make a one-time payment or recurring
monthly payments by completing and
submitting the SSA–4588.
SSA uses the SSA–4589 electronic
intranet application only when
individuals choose to telephone the
Program Service Centers to make a oneNumber of
respondents
Collection instrument
time payment in lieu of completing
Form SSA–4588. An SSA debtor contact
representative completes the SSA–4589
electronic intranet application.
Respondents are OASDI beneficiaries
and SSI recipients who owe outstanding
overpayments to SSA.
Type of Request: Revision of an OMBapproved information collection.
Average burden
per response
(minutes)
Frequency of
response
Estimated total
annual burden
(hours)
SSA–4588 Paper Form ...................................................................
SSA–4589 Electronic Intranet Application .......................................
13,200
171,320
1
1
10
5
2,200
14,277
Total ..........................................................................................
184,520
............................
............................
16,477
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7. Request for Internet Services—
Password Authentication—20 CFR
401.45—0960–0632. SSA uses a
password infrastructure and process to
verify the identity of individuals who
choose to use the Internet to conduct
personal business with SSA
electronically. To obtain a password
from SSA’s Individual Password
Services, we ask an individual for
certain information prescribed by SSA.
SSA uses the information to
authenticate individuals prior to issuing
a temporary password. Once SSA
authenticates individuals, and these
individuals create a permanent
Number of
respondents
Collection instrument
Internet Requestors .........................................................................
II. SSA submitted the information
collections below to OMB for clearance.
Your comments regarding 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 January 17, 2012.
Individuals can obtain copies of the
OMB clearance packages by calling the
SSA Reports Clearance Officer at (410)
Average burden
per response
(minutes)
Frequency of
response
3,092,069
1
965–8783 or by writing to the above
email address.
1. Coverage of Employees of State and
Local Governments—20 CFR 404,
Subpart M—0960–0425. Regulation
section 20 CFR 404, Subpart M,
prescribes the rules for states submitting
reports of deposits and recordkeeping to
SSA. SSA requires states (and interstate
instrumentalities) to provide wage and
deposit contribution information for
pre-1987 periods. Not all states have
Number of
respondents
Regulation section
password, they may use SSA’s password
protected services, e.g., account status,
change of address, direct deposit
elections, or changes. The respondents
are individuals electing to do personal
business with SSA electronically.
Type of Request: Extension of an
OMB-approved information collection.
10
Estimated total
annual burden
(hours)
515,345
completely satisfied their pending wage
report and contribution liability with
SSA for pre-1987 tax years. SSA needs
these regulations 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 OMBapproved information collection.
Average burden
per response
(minutes)
Frequency of
response
Estimated total
annual burden
(hours)
52
52
52
1
1
1
30
60
60
26
52
52
Total ..........................................................................................
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404.1204(a) & (b) ............................................................................
404.1215 ..........................................................................................
404.1216(a) & (b) ............................................................................
156
............................
............................
130
2. SSI Notice of Interim Assistance
Reimbursement (IAR)—0960–0546.
Section 1631(g) of the Act authorizes
SSA to reimburse an IAR agency from
an individual’s retroactive SSI payment
for assistance the IAR agency gave the
individual for meeting basic needs
while an SSI claim was pending or SSI
payments were suspended or
terminated. The State or local agency
needs an IAR agreement with SSA to
participate in the IAR program. The
individual receiving the IAR payment
signs an authorization form with an IAR
agency to allow SSA to repay the IAR
agency for funds paid in advance prior
to SSA’s determination on the
individual’s claim. The authorization
represents the individual’s intent to file
for SSI, if they did not file an
application prior to SSA receiving the
authorization. Agencies who wish to
enter into an IAR agreement with SSA
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need to meet the following
requirements:
(a) Reporting Requirements—Each
IAR agency agrees to:
(1) Notify SSA of receipt of an
authorization for initial claims or cases
they are appealing, and submit a copy
of that authorization either through a
manual or electronic process;
(2) Inform SSA of the amount of
reimbursement;
(3) Submit a written request for
dispute resolution on a determination;
(4) Notify SSA of interim assistance
paid (using the SSA–8125 or the
SSA–L8125–F6);
(5) Inform SSA of any deceased
claimants who participated in the IAR
program and;
(6) Review and sign an agreement
with SSA.
(b) Recordkeeping Requirements—
The IAR agencies agree to retain all
notices, agreement, authorizations, and
accounting forms for the period defined
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in the IAR agreement for the purposes
of SSA verifying transactions covered
under the agreement.
(c) Third Party Disclosure
Requirements—Each participating IAR
agency agrees to send written notices
from the IAR agency to the recipient
regarding payment amounts and appeal
rights.
(d) Periodic Review of Agency
Accounting Process—The IAR agency
makes the IAR accounting records of
paid cases available for SSA review and
verification. SSA conducts reviews
either onsite or through the mail of the
authorization forms, notices to the
claimant, and accounting forms. Upon
completion of the review, SSA provides
a written report of findings to the IAR
agency director.
The respondents are State IAR
officers.
Type of Request: Revision of an OMBapproved information collection.
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Type of request
Number of respondents
Frequency of response
Number of responses
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
Reporting Requirements
(a) State notification of receipt of
authorization (electronic process).
(b) State submission of copy of
authorization (manual process).
(c) State submission of amount
of IA paid to recipients (using
eIAR).
(d) State request for determination—dispute resolution.
(e) State computation of reimbursement due form SSA
using paper Form
SSA-L8125–F6.
(f) State notification to SSA of
deceased claimant.
11 ................................
Once per SSI Claimant
97,330 .........................
1
1,622
27 ................................
Once per SSI Claimant
68,405 .........................
3
3,420
38 ................................
Once per SSI Claimant
101,352 .......................
8
13,514
Average is about 2
States per year.
38 ................................
As needed ...................
2 ..................................
30
1
Once per SSI Claimant
1,524 ...........................
30
762
40 ................................
15
10
(g) State reviewing/signing of
IAR Agreement.
38 ................................
As needed when SSI
claimant dies while
claim is pending.
Once during life of the
IAR agreement.
38 ................................
12
456
3
8,287
3
5,068
7
11,824
12 ................................
3 hours
36
12 ................................
16 hours
192
6 ..................................
4 hours
24
varies
45,216
20 ................................
Recordkeeping Requirements
(h) Maintenance of authorization
forms.
38 ................................
One form per SSI
claimant.
(i) Maintenance of accounting
forms and notices.
38 ................................
165,735 (includes both
denied and approved
SSI claims).
101,352 .......................
One set per SSI claimant.
Third Party Disclosure Requirements
(j) Written notice from State to
recipient regarding amount of
payment.
38 ................................
Once per SSI claimant
101,352 .......................
Periodic Review of Agency Accounting Process
(k) Retrieve and consolidate authorization and accounting
forms.
12 ................................
(l) Participate in periodic review
12 ................................
(m) Correct administrative and
accounting discrepancies.
6 ..................................
One set of forms per
SSI claimant for review by SSA once
every 2 to 3 years.
For review by SSA
once every 2 to 3
years.
To correct errors discovered by SSA in
periodic review.
Total Administrative Burden
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Total .....................................
38 ................................
3. 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
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varies ...........................
637,160 .......................
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
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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.
Note: This is a correction notice. SSA
published this information collection as an
extension on September 23, 2011 at 76 FR
59180. Since we are revising the Privacy Act
Statement, this is now a revision of an OMBapproved information collection. Type of
Request: Revision of an OMB-approved
information collection.
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Number of
respondents
Collection instrument
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–1026–OCR–MS–SCE .............................................................................
SSA–1026–OCR–SM–REDE ..........................................................................
11,400
225,000
1
1
18
18
3,420
67,500
Total ..........................................................................................................
236,400
........................
........................
70,920
Dated: December 12, 2011.
Faye Lipsky,
Reports Clearance Officer, Center for Reports
Clearance, Social Security Administration.
[FR Doc. 2011–32145 Filed 12–14–11; 8:45 am]
BILLING CODE 4191–02–P
DEPARTMENT OF STATE
[Public Notice 7729]
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Bureau of Educational and Cultural
Affairs (ECA) Request for Grant
Proposals (RFGP): International Sports
Programming Initiative (ISPI)
Announcement Type: New Grant.
Funding Opportunity Number: ECA/
PE/C/SU–12–15.
Catalog of Federal Domestic
Assistance Number: 19.415.
DATES: Key Dates:
Application Deadline: Friday,
February 3, 2012.
Executive Summary: The Office of
Citizen Exchanges of the Bureau of
Educational and Cultural Affairs
announces an open competition for the
International Sports Programming
Initiative. Public and private non-profit
organizations meeting the provisions
described in Internal Revenue Code
section 26 U.S.C. 501(c)(3) may submit
proposals for projects designed to reach
out to youth and promote mutual
understanding by increasing the
professional capacity of those who
design and manage youth sports
programs in select countries in Africa,
East Asia and the Pacific, the Near East
and North Africa, South and Central
Asia, Europe, and the Western
Hemisphere. The focus of all programs
must be on reaching out to both male
and female youth ages 7–17 and/or their
coaches/administrators. Programs
designed to train elite athletes or
coaches will not be considered. Eligible
countries and territories in each region
are:
Africa: Botswana, Cote d’Ivoire,
Kenya, Mali, and Nigeria;
East Asia and the Pacific: China,
Malaysia, or a multi-country program
that MUST include AT LEAST TWO of
the following—Cambodia, Laos,
Thailand, and/or Vietnam;
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Near East and North Africa: Egypt,
Tunisia, or a program that MUST
include both Israel and West Bank/Gaza;
South and Central Asia: Bangladesh,
Nepal, Sri Lanka, and Turkmenistan;
Europe: Bosnia and Turkey; and the
Western Hemisphere: Belize, Brazil,
Mexico, Nicaragua, Panama, and
Uruguay.
Proposals may address multiple
countries, but all the countries must
then be in the same region. Please see
Section III.3. Other Eligibility
Requirements for more information on
eligibility requirements. Funding Under
this Competition is pending the
availability of FY 2012 funds.
sport coaches, sport administrators,
and/or sport officials participating in
the program. The role that sports can
play in the long-term well-being of
underserved youth should also be
emphasized. Through exchanges
between youth sport coaches, sport
administrators, and/or sport officials,
programs should encourage participants
to share experiences in managing,
organizing, and developing programs for
youth sports activities with the aim of
exposing young people to the ideas of
teamwork and self-discipline that can
lead to success in other aspects of their
lives.
I. Funding Opportunity Description
(2) Sport and Health
Authority: Overall grant making authority
for this program is contained in the Mutual
Educational and Cultural Exchange Act of
1961, Public Law 87–256, as amended, also
known as the Fulbright-Hays Act. The
purpose of the Act is ‘‘to enable the
Government of the United States to increase
mutual understanding between the people of
the United States and the people of other
countries * * *; to strengthen the ties which
unite us with other nations by demonstrating
the educational and cultural interests,
developments, and achievements of the
people of the United States and other nations
* * * and thus to assist in the development
of friendly, sympathetic and peaceful
relations between the United States and the
other countries of the world.’’ The funding
authority for the program above is provided
through legislation.
Purpose: The Office of Citizen
Exchanges welcomes proposals for twoway exchanges (one component in the
United States and the other in the
chosen country) that directly respond to
the thematic areas outlined below.
Projects for themes not listed below will
not be eligible for consideration under
the FY 2012 International Sports
Program Initiative Competition, and will
be deemed technically ineligible and
receive no further consideration in the
review process.
Themes:
(1) Youth Sports Engagement
Exchanges funded under this theme
will focus on effective ways that sport
can play a role in youth development at
the grassroots level, while promoting
technical proficiency among the youth
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Exchanges funded under this theme
will focus on increasing awareness
among young people of the importance
of following a healthy lifestyle. Project
goals should aim to avoid substance
abuse, enhance physical fitness in order
to prevent illness, and raise the overall
quality of life through sports. Emphasis
should be on the responsibility of the
broader community to support healthy
behaviors, and to educate young people
how to prevent and manage noncommunicable or infectious diseases,
such as HIV/AIDS, through sports
programs.
(3) Sport and Disability
Exchanges funded under this theme
are designed to promote and sponsor
sport, recreation, and fitness programs
for persons with disabilities. Project
goals should include improving the
quality of life for persons with
disabilities by providing affordable,
inclusive sports experiences that build
self-esteem and confidence, enhancing
active participation in community life,
and making a significant contribution to
the physical and psychological health of
people with disabilities. Proposals
under this theme aim to demonstrate
that persons with disabilities can be
included in sports opportunities in their
communities, and will develop
opportunities for them to do so. In
addition, projects should aim to raise
the awareness of non-disabled people
about contributions that persons with
disabilities make to society.
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[Federal Register Volume 76, Number 241 (Thursday, December 15, 2011)]
[Notices]
[Pages 78068-78072]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-32145]
=======================================================================
-----------------------------------------------------------------------
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 to 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 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, Email address: OIRA_Submission@omb.eop.gov.
(SSA), Social Security Administration, DCRDP, Attn: Reports Clearance
Officer, 107 Altmeyer Building, 6401 Security Blvd., Baltimore, MD
21235, Fax No.: (410) 966-2830, Email 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
February 13, 2012. 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. Application for Mother's or Father's Insurance Benefits--20 CFR
404.339-404.342, 20 CFR 404.601-404.603--0960-0003. Section 202(g) of
the Social Security Act (Act) provides for the payment of monthly
benefits to the widow or widower of an insured individual if the
surviving spouse is caring for the deceased worker's child (who is
entitled to Social Security benefits). SSA uses the information on Form
SSA-5-F6 to determine an individual's eligibility for mother's or
father's insurance benefits. The respondents are individuals caring for
a child of the deceased worker who is applying for mother's or father's
insurance benefits under the Old Age, Survivors, and Disability
Insurance (OASDI) program.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Collection instrument Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-5-F6 (paper)........................ 1,611 1 15 403
MCS..................................... 26,045 1 15 6,511
MCS/Signature Proxy..................... 26,044 1 15 6,511
-----------------------------------------------------------------------
Total............................... 53,700 ................ ................ 13,425
----------------------------------------------------------------------------------------------------------------
2. Letter to Employer Requesting Information About Wages Earned by
Beneficiary--20 CFR 416.703 & 404.801--0960-0034. SSA uses information
from Form SSA-L725 to verify a beneficiary's wages when SSA has
incomplete or questionable wage data. SSA uses the information to
calculate the correct amount of benefits payable, and to maintain an
accurate record of earnings for the beneficiary. Respondents are
employers who provide information SSA needs to establish specific
monthly earnings.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Collection instrument Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L725............................ 150,000 1 40 100,000
----------------------------------------------------------------------------------------------------------------
[[Page 78069]]
3. Student Reporting Form--20 CFR 404.367 & 20 CFR 404.368--0960-
0088. Sections 20 CFR 404.367 and 20 CFR 404.368 mandate that a student
beneficiary be in full-time attendance at an educational institution to
qualify for student Social Security benefits. SSA requires
beneficiaries to report events that may cause a reduction, termination,
or suspension of their benefits. Using the information from Form SSA-
1383, SSA determines if the change or event reported affects continuing
entitlement to SSA benefits. In addition, SSA uses the information to
determine the correct benefit amounts for student beneficiaries. The
respondents are Social Security student beneficiaries.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Collection instrument Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1383................................ 74,887 1 6 7,489
SSA-1383-FC............................. 113 1 6 11
-----------------------------------------------------------------------
Total............................... 75,000 ................ ................ 7,500
----------------------------------------------------------------------------------------------------------------
4. Letter to Employer Requesting Wage Information--20 CFR 404.726--
0960-0138. SSA must establish and verify wage information for
Supplemental Security Income (SSI) applicants and recipients when
determining SSI eligibility and payment amounts. SSA uses Form SSA-
L4201 to collect this information. SSA uses the information to
determine eligibility and proper payment amounts for SSI applicants and
recipients. The respondents are employers of SSI applicants and
recipients.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Collection instrument Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L4201........................... 133,000 1 30 66,500
----------------------------------------------------------------------------------------------------------------
5. Claimant's Recent Medical Treatment--20 CFR 404.1512 and
416.912--0960-0292. When Disability Determination Services deny a claim
at the reconsideration level, the claimant has a right to request a
hearing before an administrative law judge (ALJ). For the hearing, SSA
asks the claimant to complete and return the HA-4631 if the claimant's
file does not reflect a current, complete medical history as the
claimant proceeds through the appeals process. ALJs must obtain the
information to update and complete the record and to verify the
accuracy of the information. Through this process, ALJs can ascertain
whether the claimant's situation has changed. The ALJs and hearing
office staff use the response to make arrangements for consultative
examination(s) and the attendance of an expert witness(es), if
appropriate. During the hearing, the ALJs offer any completed
questionnaires as exhibits and may use them to refresh the claimant's
memory and to shape their questions. The respondents are claimants
requesting hearings on entitlement to Old Age, Survivors, and
Disability Insurance (OASDI) benefits or SSI payments.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Collection instrument Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
HA-4631............................. 200,000 1 10 33,333
----------------------------------------------------------------------------------------------------------------
6. You Can Make Your Payment by Credit Card--0960-0462. Using
information from Form SSA-4588 and its electronic application, form
SSA-4589, SSA updates individuals' Social Security records to reflect
payments made on their overpayments. In addition, SSA uses this
information to process payments through the appropriate credit card
company. SSA provides the SSA-4588 when we inform an individual that we
detected an overpayment. Individuals may choose to make a one-time
payment or recurring monthly payments by completing and submitting the
SSA-4588.
SSA uses the SSA-4589 electronic intranet application only when
individuals choose to telephone the Program Service Centers to make a
one-time payment in lieu of completing Form SSA-4588. An SSA debtor
contact representative completes the SSA-4589 electronic intranet
application. Respondents are OASDI beneficiaries and SSI recipients who
owe outstanding overpayments to SSA.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Collection instrument Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4588 Paper Form..................... 13,200 1 10 2,200
SSA-4589 Electronic Intranet Application 171,320 1 5 14,277
-----------------------------------------------------------------------
Total............................... 184,520 ................ ................ 16,477
----------------------------------------------------------------------------------------------------------------
[[Page 78070]]
7. Request for Internet Services--Password Authentication--20 CFR
401.45--0960-0632. SSA uses a password infrastructure and process to
verify the identity of individuals who choose to use the Internet to
conduct personal business with SSA electronically. To obtain a password
from SSA's Individual Password Services, we ask an individual for
certain information prescribed by SSA. SSA uses the information to
authenticate individuals prior to issuing a temporary password. Once
SSA authenticates individuals, and these individuals create a permanent
password, they may use SSA's password protected services, e.g., account
status, change of address, direct deposit elections, or changes. The
respondents are individuals electing to do personal business with SSA
electronically.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Collection instrument Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
Internet Requestors..................... 3,092,069 1 10 515,345
----------------------------------------------------------------------------------------------------------------
II. SSA submitted the information collections below to OMB for
clearance. Your comments regarding 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 January 17, 2012. Individuals can obtain copies of
the OMB clearance packages by calling the SSA Reports Clearance Officer
at (410) 965-8783 or by writing to the above email address.
1. Coverage of Employees of State and Local Governments--20 CFR
404, Subpart M--0960-0425. Regulation section 20 CFR 404, Subpart M,
prescribes the rules for states submitting reports of deposits and
recordkeeping to SSA. SSA requires states (and interstate
instrumentalities) to provide wage and deposit contribution information
for pre-1987 periods. Not all states have completely satisfied their
pending wage report and contribution liability with SSA for pre-1987
tax years. SSA needs these regulations 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 (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
404.1204(a) & (b)....................... 52 1 30 26
404.1215................................ 52 1 60 52
404.1216(a) & (b)....................... 52 1 60 52
-----------------------------------------------------------------------
Total............................... 156 ................ ................ 130
----------------------------------------------------------------------------------------------------------------
2. SSI Notice of Interim Assistance Reimbursement (IAR)--0960-0546.
Section 1631(g) of the Act authorizes SSA to reimburse an IAR agency
from an individual's retroactive SSI payment for assistance the IAR
agency gave the individual for meeting basic needs while an SSI claim
was pending or SSI payments were suspended or terminated. The State or
local agency needs an IAR agreement with SSA to participate in the IAR
program. The individual receiving the IAR payment signs an
authorization form with an IAR agency to allow SSA to repay the IAR
agency for funds paid in advance prior to SSA's determination on the
individual's claim. The authorization represents the individual's
intent to file for SSI, if they did not file an application prior to
SSA receiving the authorization. Agencies who wish to enter into an IAR
agreement with SSA need to meet the following requirements:
(a) Reporting Requirements--Each IAR agency agrees to:
(1) Notify SSA of receipt of an authorization for initial claims or
cases they are appealing, and submit a copy of that authorization
either through a manual or electronic process;
(2) Inform SSA of the amount of reimbursement;
(3) Submit a written request for dispute resolution on a
determination;
(4) Notify SSA of interim assistance paid (using the SSA-8125 or
the
SSA-L8125-F6);
(5) Inform SSA of any deceased claimants who participated in the
IAR program and;
(6) Review and sign an agreement with SSA.
(b) Recordkeeping Requirements--The IAR agencies agree to retain
all notices, agreement, authorizations, and accounting forms for the
period defined in the IAR agreement for the purposes of SSA verifying
transactions covered under the agreement.
(c) Third Party Disclosure Requirements--Each participating IAR
agency agrees to send written notices from the IAR agency to the
recipient regarding payment amounts and appeal rights.
(d) Periodic Review of Agency Accounting Process--The IAR agency
makes the IAR accounting records of paid cases available for SSA review
and verification. SSA conducts reviews either onsite or through the
mail of the authorization forms, notices to the claimant, and
accounting forms. Upon completion of the review, SSA provides a written
report of findings to the IAR agency director.
The respondents are State IAR officers.
Type of Request: Revision of an OMB-approved information
collection.
[[Page 78071]]
----------------------------------------------------------------------------------------------------------------
Average Estimated
Number of Frequency of Number of burden per total annual
Type of request respondents response responses response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
Reporting Requirements
----------------------------------------------------------------------------------------------------------------
(a) State notification of 11............. Once per SSI 97,330......... 1 1,622
receipt of authorization Claimant.
(electronic process).
(b) State submission of copy 27............. Once per SSI 68,405......... 3 3,420
of authorization (manual Claimant.
process).
(c) State submission of 38............. Once per SSI 101,352........ 8 13,514
amount of IA paid to Claimant.
recipients (using eIAR).
(d) State request for Average is As needed...... 2.............. 30 1
determination--dispute about 2 States
resolution. per year.
(e) State computation of 38............. Once per SSI 1,524.......... 30 762
reimbursement due form SSA Claimant.
using paper Form
SSA[dash]L8125-F6.
(f) State notification to SSA 20............. As needed when 40............. 15 10
of deceased claimant. SSI claimant
dies while
claim is
pending.
(g) State reviewing/signing 38............. Once during 38............. 12 456
of IAR Agreement. life of the
IAR agreement.
----------------------------------------------------------------------------------------------------------------
Recordkeeping Requirements
----------------------------------------------------------------------------------------------------------------
(h) Maintenance of 38............. One form per 165,735 3 8,287
authorization forms. SSI claimant. (includes both
denied and
approved SSI
claims).
(i) Maintenance of accounting 38............. One set per SSI 101,352........ 3 5,068
forms and notices. claimant.
----------------------------------------------------------------------------------------------------------------
Third Party Disclosure Requirements
----------------------------------------------------------------------------------------------------------------
(j) Written notice from State 38............. Once per SSI 101,352........ 7 11,824
to recipient regarding claimant.
amount of payment.
----------------------------------------------------------------------------------------------------------------
Periodic Review of Agency Accounting Process
----------------------------------------------------------------------------------------------------------------
(k) Retrieve and consolidate 12............. One set of 12............. 3 hours 36
authorization and accounting forms per SSI
forms. claimant for
review by SSA
once every 2
to 3 years.
(l) Participate in periodic 12............. For review by 12............. 16 hours 192
review. SSA once every
2 to 3 years.
(m) Correct administrative 6.............. To correct 6.............. 4 hours 24
and accounting discrepancies. errors
discovered by
SSA in
periodic
review.
----------------------------------------------------------------------------------------------------------------
Total Administrative Burden
----------------------------------------------------------------------------------------------------------------
Total.................... 38............. varies......... 637,160........ varies 45,216
----------------------------------------------------------------------------------------------------------------
3. 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.
Note: This is a correction notice. SSA published this
information collection as an extension on September 23, 2011 at 76
FR 59180. 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.
[[Page 78072]]
----------------------------------------------------------------------------------------------------------------
Average Estimated
Number of Frequency of burden per total annual
Collection instrument respondents response response burden
(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
----------------------------------------------------------------------------------------------------------------
Dated: December 12, 2011.
Faye Lipsky,
Reports Clearance Officer, Center for Reports Clearance, Social
Security Administration.
[FR Doc. 2011-32145 Filed 12-14-11; 8:45 am]
BILLING CODE 4191-02-P
