Agency Information Collection Activities: Proposed Request and Comment Request, 147-150 [2011-33627]
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147
Federal Register / Vol. 77, No. 1 / Tuesday, January 3, 2012 / Notices
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 such 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–NYSE–
2011–67 and should be submitted on or
before January 24, 2012.
For the Commission, by the Division of
Trading and Markets, pursuant to delegated
authority.20
Elizabeth M. Murphy,
Secretary.
[FR Doc. 2011–33625 Filed 12–30–11; 8:45 am]
BILLING CODE 8011–01–P
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 104–13, the Paperwork
Reduction Act (PRA) of 1995, effective
October 1, 1995. This notice includes
revisions and one extension of OMBapproved 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.
Number of
respondents
Collection method
(SSA), Social Security Administration,
DCRDP, Attn: Reports Clearance
Officer, 1333 Annex Building, 6401
Security Blvd., Baltimore, MD 21235,
Fax: (410) 965–6400, 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 March 5,
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 Parent’s Insurance
Benefits—20 CFR 404.370–404.374, 20
CFR 404.601–404.603—0960–0012.
Section 202(h) of the Social Security Act
establishes the conditions of eligibility a
claimant must meet to receive monthly
benefits as a parent of a deceased
worker. SSA uses information from form
SSA–7–F6 to determine whether the
claimant meets the eligibility and
application criteria. The respondents are
applicants for, and recipients of, Social
Security Old Age, Survivors, and
Disability Insurance benefits.
Type of Request: Revision of an OMBapproved information collection.
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
Modernized Claims System (MCS) .................................................................
MCS/Signature Proxy ......................................................................................
Paper SSA–7–F6 .............................................................................................
153
158
4
1
1
1
15
14
15
38
37
1
Total ..........................................................................................................
315
........................
........................
76
2. Statement of Living Arrangements,
In-Kind Support and Maintenance—20
CFR 416.1130–416.1148—0960–0174. A
recipient’s need is the basis for
determining Supplemental Security
Income (SSI) payment amounts. Need is
measured, in part, by the amount of
income an individual receives. Income
includes in-kind support and
maintenance in the form of food and
shelter provided by other persons. SSA
uses information from form SSA–8006–
F4 to determine if in-kind support and
maintenance exists for SSI applicants
and recipients. This information also
assists SSA in determining the income
value of in-kind support and
maintenance SSI applicants and
recipients receive. The respondents are
individuals who apply for SSI, or who
complete an SSI eligibility
redetermination.
Type of Request: Revision of an OMBapproved information collection.
Number of
respondents
Frequency
of response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–8006–F4 ..................................................................................................
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Collection method
173,380
1
7
20,228
3. Application for Supplemental
Security Income—20 CFR 416.305–
416.335, Subpart C—0960–0444. SSA
collects information on the SSA–8001–
20 17
BK to determine an applicant’s
eligibility for SSI and the SSI payment
amounts. SSA employees also collect
this information during interviews with
members of the public who wish to file
for SSI. SSA uses the information for
two purposes: (1) To formally deny SSI
for non-medical reasons when
CFR 200.30–3(a)(12).
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Federal Register / Vol. 77, No. 1 / Tuesday, January 3, 2012 / Notices
information the applicant provides
results in ineligibility; or (2) to establish
a disability claim, but defer the
complete development of non-medical
issues until SSA approves the disability.
The respondents are applicants for SSI.
Number of
respondents
Collection method
Type of Request: Revision of an OMBapproved information collection.
Frequency of
response
Average
burden
per response
(minutes)
Estimated total
annual burden
(hours)
Modernized SSI Claims System (MSSICS) .....................................................
MSSICS/Signature Proxy ................................................................................
Paper SSA–8001–BK ......................................................................................
1,006,400
326,400
27,200
1
1
1
15
14
18
251,600
76,160
8,160
Total ..........................................................................................................
1,360,000
........................
........................
335,920
4. Statement of Funds You Provided
to Another and Statement of Funds You
Received—20 CFR 416.1103(f)—0960–
0481. SSA uses forms SSA–2854 and
SSA–2855 to gather information to
verify if a loan is bona fide for SSI
recipients. The SSA–2854 asks the
lender for details on the transaction, and
form SSA–2855 asks the borrower the
same basic questions independently.
Agency personnel then compare the two
statements, gather evidence if needed,
and make a decision on the validity of
the bona fide status of the loan.
For SSI purposes, we consider a loan
bona fide if it meets these requirements:
• Must be between a borrower and
lender with the understanding that the
borrower has an obligation to repay the
money;
• Must be in effect at the time the
cash goes to the borrower, that is, the
agreement cannot come after the cash is
paid; and
• Must be enforceable under State
law, often there are additional
requirements from the State.
In addition to these elements: (1)
There must be an understanding
between borrower and lender that the
borrower is obligated to repay the
money; (2) the loan agreement must be
in effect at the time the borrower
receives the cash proceeds; and, (3) the
transaction must be enforceable under
State law. State requirements generally
Number
of respondents
Collection method
demand the presence of other
conditions before the agreement is a
bona fide loan.
SSA collects this information at the
time of initial application for SSI or at
any point when an individual alleges
being party to an informal loan while
receiving SSI. SSA collects information
on the informal loan through both
interviews and mailed forms. The
agency’s field personnel conduct the
interviews and mail the form(s) for
completion, as needed. The respondents
are SSI recipients and applicants, and
individuals who lend money to them.
Type of Request: Revision of an OMBapproved information collection.
Frequency of
response
Average
burden
per response
(minutes)
Estimated total
annual burden
(hours)
SSA–2854 ........................................................................................................
SSA–2855 ........................................................................................................
20,000
20,000
1
1
10
10
3,333
3,333
Total ..........................................................................................................
40,000
........................
........................
6,666
5. Certification of Low Birth Weight
for SSI Eligibility—20 CFR 416.931,
416.926a(m), and 416.924—0960–0720.
Hospitals and claimants use form SSA–
3380 to provide medical information to
local field offices (FO) and State
Disability Determination Services
(DDSs) on behalf of infants with low
birth weight. FOs use the form as a
protective filing statement and the
medical information to make
presumptive disability findings, which
allow expedited payment to eligible
claimants. DDSs use the medical
information to determine disability and
continuing disability. The respondents
are hospitals and claimants who have
information identifying low birth weight
babies and their medical conditions.
Type of Request: Extension of an
OMB-approved information collection.
Number of
respondents
Frequency
of response
Average
burden
per response
(minutes)
Estimated total
annual burden
(hours)
SSA–3380 ........................................................................................................
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Collection method
24,000
1
15
6,000
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 February 2, 2012.
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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. Incoming and Outgoing
Intergovernmental Personnel Act
Assignment Agreement—5 CFR 334—
0960–NEW. The Intergovernmental
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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
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Federal Register / Vol. 77, No. 1 / Tuesday, January 3, 2012 / Notices
(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
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.
assignment, reimbursement
arrangement, and explanation of 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
Number of
respondents
Respondent type
Average
burden
per response
(minutes)
Frequency
of response
Estimated total
annual burden
(hours)
Non-Federal employee ....................................................................................
Non-Federal employer signers ........................................................................
10
20
1
1
30
5
5
2
Total ..........................................................................................................
30
........................
........................
7
broadcasting systems so they can inform
the public about 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.
2. Public Information Campaign—
0960–0544. Periodically, SSA sends
various public information materials,
including public service
announcements, news releases, and
educational tapes, to public
The respondents are broadcast
television sources.
Type of Request: Revision of an OMBapproved information collection.
Collection method
Number of
respondents
Frequency of
response
Number of
responses
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
Reply Cards .........................................................................
1,000
2
2,000
1
33
3. Credit Card Payment Form—0960–
0648. SSA uses the SSA–1414 to
process: (1) Credit card payments from
former employees and vendors with
outstanding debts to the agency; (2)
advance payments for reimbursable
agreements; and (3) credit card
payments for all Freedom of Information
Act (FOIA) requests requiring payment.
The respondents are former employees
and vendors who have outstanding
debts to the agency, entities who have
reimbursable agreements with SSA, and
individuals who request information
through FOIA.
Type of Request: Revision of an OMBapproved information collection.
Collection instrument
Number of
respondents
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–1414 ........................................................................................................
6,000
1
2
200
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4. Medical Source Statement of
Ability To Do Work-Related Activities
(Physical and Mental)—20 CFR
404.1512–404.1513, 404.912–404.913,
404.1517, 416.917–0960 0662. In some
instances, when a claimant appeals a
denied disability claim and the
claimant’s medical sources cannot or
will not give the agency sufficient
evidence to determine whether the
claimant is disabled, SSA may ask the
claimant to have a consultative
examination at the agency’s expense.
The medical providers who perform
these consultative examinations provide
a statement on forms HA–1151 and HA–
1152 about the claimant’s disability and
ability to perform work-related
activities. SSA uses the information to
assess the work-related physical and
Number of
respondents
Collection method
Frequency of
response
mental capabilities of claimants who
appeal SSA’s previous determination on
their issue of disability. The
respondents are medical sources who
provide reports based either on existing
medical evidence or on consultative
examinations.
Type of Request: Revision of an OMBapproved information collection.
Number of
responses
Average
burden
per response
(minutes)
Estimated total
annual burden
(hours)
HA–1151 ..............................................................................
HA–1152 ..............................................................................
5,000
5,000
24
24
120,000
120,000
15
15
30,000
30,000
Total ..............................................................................
10,000
........................
240,000
........................
60,000
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Federal Register / Vol. 77, No. 1 / Tuesday, January 3, 2012 / Notices
Dated: December 28, 2011.
Naomi Sipple,
Management Analyst, Office of Regulations
and Reports Clearance, Social Security
Administration.
[FR Doc. 2011–33627 Filed 12–30–11; 8:45 am]
BILLING CODE 4191–02–P
DEPARTMENT OF TRANSPORTATION
Maritime Administration
Reports, Forms and Recordkeeping
Requirements; Agency Information
Collection Activity Under OMB Review
Maritime Administration, DOT.
Notice and request for
comments.
AGENCY:
ACTION:
In compliance with the
Paperwork Reduction Act of 1995 (44
U.S.C. 3501 et seq.), this notice
announces that the Information
Collection abstracted below has been
forwarded to the Office of Management
and Budget (OMB) for review and
approval. The nature of the information
collection is described as well as its
expected burden. The Federal Register
Notice with a 60-day comment period
soliciting comments on the following
collection of information was published
on September 28, 2011, and comments
were due by November 28, 2011. No
comments were received.
DATES: Comments must be submitted on
or before February 2, 2011.
FOR FURTHER INFORMATION CONTACT:
Patricia Thomas, Maritime
Administration, Office of Sealift
Support, 1200 New Jersey Avenue SE.,
Washington, DC 20590. Telephone:
(202) 366–2646 or email:
patricia.thomas@marad.dot.gov. Copies
of this collection also can be obtained
from that office.
SUPPLEMENTARY INFORMATION: Maritime
Administration (MARAD).
Title: Regulations for Making Excess
or Surplus Federal Property Available to
the U.S. Merchant Marine Academy,
State Maritime Academies and NonProfit Maritime Training Facilities.
OMB Control Number: 2133–0504.
Type of Request: Extension of
currently approved collection.
Affected Public: Maritime training
institutions such as the U.S. Merchant
Marine Academy, State Maritime
Academies and non-profit maritime
institutions.
Forms: None.
Abstract: The Maritime
Administration requires approved
maritime training institutions seeking
excess or surplus government property
to provide a statement of need/
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SUMMARY:
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justification prior to acquiring the
property.
Annual Estimated Burden Hours: 40
hours.
ADDRESSES: Send comments to the
Office of Information and Regulatory
Affairs, Office of Management and
Budget, 725 17th Street NW.,
Washington, DC 20503, Attention
Maritime Administration Desk Officer.
Alternatively, comments may be sent
via email to the Office of Information
and Regulatory Affairs (OIRA), Office of
Management and Budget, at the
following address:
oira.submissions@omb.eop.gov.
Comments Are Invited On: Whether
the proposed collection of information
is necessary for the proper performance
of the functions of the agency, including
whether the information will have
practical utility; the accuracy of the
agency’s estimate of the burden of the
proposed information collection; ways
to enhance the quality, utility and
clarity of the information to be
collected; and ways to minimize the
burden of the collection of information
on respondents, including the use of
automated collection techniques or
other forms of information technology.
A comment to OMB is best assured of
having its full effect if OMB receives it
within 30 days of publication.
Authority: 49 CFR 1.66.
Issued in Washington, DC on December 27,
2011.
Murray A. Bloom,
Acting Secretary, Maritime Administration.
[FR Doc. 2011–33654 Filed 12–30–11; 8:45 am]
BILLING CODE 4910–81–P
DEPARTMENT OF TRANSPORTATION
Maritime Administration
[Docket No. Marad–2011–0165]
Information Collection Available for
Public Comments and
Recommendations
Notice and request for
comments.
ACTION:
In accordance with the
Paperwork Reduction Act of 1995, this
notice announces the Maritime
Administration’s (MARAD’s) intention
to request extension of approval for
three years of a currently approved
information collection.
DATES: Comments should be submitted
on or before March 5, 2012.
FOR FURTHER INFORMATION CONTACT:
Cmdr Michael DeRosa, Maritime
Administration, U.S. Merchant Marine
Academy, 300 Steamboat Road, New
SUMMARY:
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York, NY 11024. Telephone: (516) 726–
5642; or email:
DeRosaM@USMMA.EDU. Copies of this
collection also can be obtained from that
office.
SUPPLEMENTARY INFORMATION:
Title of Collection: U.S. Merchant
Marine Academy Candidate Application
for Admission.
Type of Request: Extension of
currently approved information
collection.
OMB Control Number: 2133–0010.
Form Numbers: KP 2–65.
Expiration Date of Approval: Three
years from date of approval by the
Office of Management and Budget.
Summary of Collection of
Information: The collection consists of
Parts I, II, and III of Form KP 2–65 (U.S.
Merchant Marine Academy Application
for Admission). Part I of the form is
completed by individuals wishing to be
admitted as students to the U.S.
Merchant Marine Academy.
Need and Use of the Information: The
information is necessary to select the
best qualified candidates for the U.S.
Merchant Marine Academy.
Description of Respondents:
Individuals desiring to become students
at the U.S. Merchant Marine Academy.
Annual Responses: 2,500.
Annual Burden: 12,500 hours.
Comments: Comments should refer to
the docket number that appears at the
top of this document. Written comments
may be submitted to the Docket Clerk,
U.S. DOT Dockets, Room W12–140,
1200 New Jersey Avenue SE,
Washington, DC 20590. Comments also
may be submitted by electronic means
via the Internet at https://
www.regulations.gov. Specifically
address whether this information
collection is necessary for proper
performance of the functions of the
agency and will have practical utility,
accuracy of the burden estimates, ways
to minimize this burden, and ways to
enhance the quality, utility, and clarity
of the information to be collected. All
comments received will be available for
examination at the above address
between 10 a.m. and 5 p.m. EDT (or
EST), Monday through Friday, except
Federal Holidays. An electronic version
of this document is available on the
World Wide Web at https://
www,regulations.gov.
Privacy Act: Anyone is able to search
the electronic form of all comments
received into any of our dockets by the
name of the individual submitting the
comment (or signing the comment, if
submitted on behalf of an association,
business, labor union, etc.). You may
review DOT’s complete Privacy Act
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]]>Agencies
[Federal Register Volume 77, Number 1 (Tuesday, January 3, 2012)]
[Notices]
[Pages 147-150]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-33627]
=======================================================================
-----------------------------------------------------------------------
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 104-13, the
Paperwork Reduction Act (PRA) of 1995, effective October 1, 1995. This
notice includes revisions and one extension 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 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, 1333 Annex Building, 6401 Security Blvd., Baltimore, MD 21235,
Fax: (410) 965-6400, 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
March 5, 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 Parent's Insurance Benefits--20 CFR 404.370-
404.374, 20 CFR 404.601-404.603--0960-0012. Section 202(h) of the
Social Security Act establishes the conditions of eligibility a
claimant must meet to receive monthly benefits as a parent of a
deceased worker. SSA uses information from form SSA-7-F6 to determine
whether the claimant meets the eligibility and application criteria.
The respondents are applicants for, and recipients of, Social Security
Old Age, Survivors, and Disability Insurance benefits.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Collection method Number of Frequency of per response total annual
respondents response (minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
Modernized Claims System (MCS).................. 153 1 15 38
MCS/Signature Proxy............................. 158 1 14 37
Paper SSA-7-F6.................................. 4 1 15 1
---------------------------------------------------------------
Total....................................... 315 .............. .............. 76
----------------------------------------------------------------------------------------------------------------
2. Statement of Living Arrangements, In-Kind Support and
Maintenance--20 CFR 416.1130-416.1148--0960-0174. A recipient's need is
the basis for determining Supplemental Security Income (SSI) payment
amounts. Need is measured, in part, by the amount of income an
individual receives. Income includes in-kind support and maintenance in
the form of food and shelter provided by other persons. SSA uses
information from form SSA-8006-F4 to determine if in-kind support and
maintenance exists for SSI applicants and recipients. This information
also assists SSA in determining the income value of in-kind support and
maintenance SSI applicants and recipients receive. The respondents are
individuals who apply for SSI, or who complete an SSI eligibility
redetermination.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Collection method Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-8006-F4................................. 173,380 1 7 20,228
----------------------------------------------------------------------------------------------------------------
3. Application for Supplemental Security Income--20 CFR 416.305-
416.335, Subpart C--0960-0444. SSA collects information on the SSA-
8001-BK to determine an applicant's eligibility for SSI and the SSI
payment amounts. SSA employees also collect this information during
interviews with members of the public who wish to file for SSI. SSA
uses the information for two purposes: (1) To formally deny SSI for
non-medical reasons when
[[Page 148]]
information the applicant provides results in ineligibility; or (2) to
establish a disability claim, but defer the complete development of
non-medical issues until SSA approves the disability. The respondents
are applicants for SSI.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Collection method Number of Frequency of per response total annual
respondents response (minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
Modernized SSI Claims System (MSSICS)........... 1,006,400 1 15 251,600
MSSICS/Signature Proxy.......................... 326,400 1 14 76,160
Paper SSA-8001-BK............................... 27,200 1 18 8,160
---------------------------------------------------------------
Total....................................... 1,360,000 .............. .............. 335,920
----------------------------------------------------------------------------------------------------------------
4. Statement of Funds You Provided to Another and Statement of
Funds You Received--20 CFR 416.1103(f)--0960-0481. SSA uses forms SSA-
2854 and SSA-2855 to gather information to verify if a loan is bona
fide for SSI recipients. The SSA-2854 asks the lender for details on
the transaction, and form SSA-2855 asks the borrower the same basic
questions independently. Agency personnel then compare the two
statements, gather evidence if needed, and make a decision on the
validity of the bona fide status of the loan.
For SSI purposes, we consider a loan bona fide if it meets these
requirements:
Must be between a borrower and lender with the
understanding that the borrower has an obligation to repay the money;
Must be in effect at the time the cash goes to the
borrower, that is, the agreement cannot come after the cash is paid;
and
Must be enforceable under State law, often there are
additional requirements from the State.
In addition to these elements: (1) There must be an understanding
between borrower and lender that the borrower is obligated to repay the
money; (2) the loan agreement must be in effect at the time the
borrower receives the cash proceeds; and, (3) the transaction must be
enforceable under State law. State requirements generally demand the
presence of other conditions before the agreement is a bona fide loan.
SSA collects this information at the time of initial application
for SSI or at any point when an individual alleges being party to an
informal loan while receiving SSI. SSA collects information on the
informal loan through both interviews and mailed forms. The agency's
field personnel conduct the interviews and mail the form(s) for
completion, as needed. The respondents are SSI recipients and
applicants, and individuals who lend money to them.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Collection method Number of Frequency of per response total annual
respondents response (minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-2854........................................ 20,000 1 10 3,333
SSA-2855........................................ 20,000 1 10 3,333
---------------------------------------------------------------
Total....................................... 40,000 .............. .............. 6,666
----------------------------------------------------------------------------------------------------------------
5. Certification of Low Birth Weight for SSI Eligibility--20 CFR
416.931, 416.926a(m), and 416.924--0960-0720. Hospitals and claimants
use form SSA-3380 to provide medical information to local field offices
(FO) and State Disability Determination Services (DDSs) on behalf of
infants with low birth weight. FOs use the form as a protective filing
statement and the medical information to make presumptive disability
findings, which allow expedited payment to eligible claimants. DDSs use
the medical information to determine disability and continuing
disability. The respondents are hospitals and claimants who have
information identifying low birth weight babies and their medical
conditions.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Collection method Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3380.................................... 24,000 1 15 6,000
----------------------------------------------------------------------------------------------------------------
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 February 2, 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. 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
[[Page 149]]
(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 of 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.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Respondent type Number of Frequency of per response total annual
respondents response (minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
Non-Federal employee............................ 10 1 30 5
Non-Federal employer signers.................... 20 1 5 2
---------------------------------------------------------------
Total....................................... 30 .............. .............. 7
----------------------------------------------------------------------------------------------------------------
2. 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 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.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Collection method Number of Frequency of Number of per response annual burden
respondents response responses (minutes) (hours)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Reply Cards........................................................ 1,000 2 2,000 1 33
--------------------------------------------------------------------------------------------------------------------------------------------------------
3. Credit Card Payment Form--0960-0648. SSA uses the SSA-1414 to
process: (1) Credit card payments from former employees and vendors
with outstanding debts to the agency; (2) advance payments for
reimbursable agreements; and (3) credit card payments for all Freedom
of Information Act (FOIA) requests requiring payment. The respondents
are former employees and vendors who have outstanding debts to the
agency, entities who have reimbursable agreements with SSA, and
individuals who request information through FOIA.
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-1414.................................... 6,000 1 2 200
----------------------------------------------------------------------------------------------------------------
4. Medical Source Statement of Ability To Do Work-Related
Activities (Physical and Mental)--20 CFR 404.1512-404.1513, 404.912-
404.913, 404.1517, 416.917-0960 0662. In some instances, when a
claimant appeals a denied disability claim and the claimant's medical
sources cannot or will not give the agency sufficient evidence to
determine whether the claimant is disabled, SSA may ask the claimant to
have a consultative examination at the agency's expense. The medical
providers who perform these consultative examinations provide a
statement on forms HA-1151 and HA-1152 about the claimant's disability
and ability to perform work-related activities. SSA uses the
information to assess the work-related physical and mental capabilities
of claimants who appeal SSA's previous determination on their issue of
disability. The respondents are medical sources who provide reports
based either on existing medical evidence or on consultative
examinations.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Collection method Number of Frequency of Number of per response total annual
respondents response responses (minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
HA-1151......................... 5,000 24 120,000 15 30,000
HA-1152......................... 5,000 24 120,000 15 30,000
----------------------------------------------------------------------------------------------------------------
Total....................... 10,000 .............. 240,000 .............. 60,000
----------------------------------------------------------------------------------------------------------------
[[Page 150]]
Dated: December 28, 2011.
Naomi Sipple,
Management Analyst, Office of Regulations and Reports Clearance, Social
Security Administration.
[FR Doc. 2011-33627 Filed 12-30-11; 8:45 am]
BILLING CODE 4191-02-P
