Agency Information Collection Activities: Proposed Request and Comment Request, 2114-2118 [2012-580]
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2114
Federal Register / Vol. 77, No. 9 / Friday, January 13, 2012 / Notices
For the Commission, by the Division of
Trading and Markets, pursuant to delegated
authority.9
Kevin M. O’Neill,
Deputy Secretary.
[FR Doc. 2012–527 Filed 1–12–12; 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,
information collections in use without
an OMB number, and a new information
collection.
I
The information collections below are
pending at SSA. SSA will submit them
Number of
respondents
Collection instrument
SSA–2118–U2 .................................................................................................
2. Notice to Show Cause for Failure to
Appear—20 CFR 404.938, 416.1438,
404.957(a)(ii)—0960–NEW. In situations
where claimants who requested a
hearing before an administrative law
judge (ALJ) fail to appear at their
scheduled hearings, the ALJ may
reschedule the hearing if the claimants
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 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. Request for Documents or
Information—20 CFR 404.703—0960–
NEW. SSA asks individuals applying for
Social Security benefits for additional
information when the information they
provided is incomplete or insufficient
for us to determine their eligibility for
benefits. SSA uses Form SSA–2118–U2,
Request for Documents or Information,
to request the additional documents or
information we need to process
individuals’ claims for benefits.
Respondents are claimants for title II
Social Security Old Age, Survivors, and
Disability Insurance (OASDI) benefits.
Type of Request: Existing 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, 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: (410) 966–2830, Email address:
OPLM.RCO@ssa.gov.
Frequency of
response
7,500
Average
burden per
response
(minutes)
1
Estimated total
annual burden
(hours)
5
625
the ALJ makes a claims eligibility
determination based on the claimants’
evidence of record. Respondents are
claimants seeking to show cause for
failure to appear at a scheduled hearing
before an ALJ.
Type of Request: Existing collection in
use without an OMB number.
establish good cause for missing the
hearings. The claimants can provide a
reason for not appearing at their
scheduled hearings using Form HA–
L90. If the ALJ determines the claimants
established good cause for failure to
appear at the hearings, the ALJ will
schedule a supplemental hearing; if not,
Number of
respondents
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
HA–L90 PDF/Paper .........................................................................................
Electronic Records Express ............................................................................
7,000
28,000
1
1
10
10
1,167
4,667
Total ..........................................................................................................
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Collection instrument
35,000
........................
........................
5,834
3. Permanent Residence in the United
States Under Color of Law (PRUCOL)—
20 CFR 416.1615 and 416.1618—0960–
0451. As discussed in 20 CFR 416.1415
and 416.1618 of the Code of Federal
Regulations, PRUCOL aliens must
present evidence of their alien status
when they apply for Supplemental
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Security Income (SSI) payments, and
periodically thereafter as part of the
eligibility re-determination process for
SSI. SSA verifies the validity of the
PRUCOL evidence for grandfathered
nonqualified aliens with the Department
of Homeland Security (DHS). SSA
determines whether the individual is
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Fmt 4703
Sfmt 4703
PRUCOL based on the DHS response.
Without this information, SSA is unable
to determine whether the individual is
eligible for SSI payments. Respondents
are qualified and unqualified aliens who
apply for SSI payments under PRUCOL.
Type of Request: Extension of an
OMB-approved information collection.
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Collection instrument
Number of
respondents
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
Personal or Telephone Interview .....................................................................
1,300
1
5
108
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 13, 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. Homeless with Schizophrenia
Presumptive Disability Pilot
Demonstration—45 CFR 46.101(b)(5)—
0960—NEW. The Federal Strategic Plan
to Prevent and End Homelessness 2010
calls on Federal agencies to work in
partnership with State and local
governments and with the private sector
to end homelessness. A specific
objective of the Strategic Plan is to
increase economic security by
improving access to mainstream
programs and services.
In response to and in support of the
President’s efforts to end homelessness,
SSA has developed the Homeless with
Schizophrenia Presumptive Disability
Pilot Demonstration, which tests both
administrative improvements to the SSI
application process and interventions
that provide financial stability to
individuals who are homeless. The pilot
will test strategies that would remove
the barriers homeless adult applicants
with schizophrenia or schizoaffective
disorder experience when completing
the SSI application process.
SSA uses two key forms to conduct
the demonstration: The Research
Number of
respondents
Collection instrument
Frequency of
response
Subject Information and Consent Form
and the Schizophrenia Presumptive
Disability Recommendation Form. The
consent form provides assurances from
the participants that they understand
the demonstration project and
voluntarily are consenting to participate
in it. The Presumptive Disability
Recommendation Form, filled out by a
medical authority, provides information
on how the applicant meets the
disability criteria necessary to qualify
for SSI benefits. SSA uses the
information in making a presumptive
disability determination. Respondents
are homeless, adult SSI applicants with
schizophrenia or schizoaffective
disorder.
Type of Request: Request for a new
information collection.
Number of
responses
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
Consent Form ......................................................................
PD Recommendation Form .................................................
200
16
1
13
(200)
(208)
120
10
400
35
Totals ............................................................................
216
........................
(408)
........................
435
2. Partnership Questionnaire—20 CFR
404.1080–1082—0960–0025. SSA
considers partnership income in
determining entitlement to Social
Security benefits. SSA uses information
from the SSA–7104 to determine several
aspects of eligibility for benefits,
including the accuracy of reported
partnership earnings, the veracity of a
retirement, and lag earnings. The
respondents are applicants for, and
recipients of, title II Social Security
OASDI benefits.
Type of Request: Revision of an OMBapproved information collection.
Number of
respondents
Frequency of
response
(Number of
responses)
Average
burden per
response
(minutes)
SSA–7104 ........................................................................................................
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Collection instrument
12,350
1
30
6,175
3. Supplement to Claim of Person
Outside the United States—20 CFR
404.463, 20 CFR 422.505(b) and 20 CFR
407.27(c)—0960–0051. Claimants or
beneficiaries (both United States {U.S.}
citizens and aliens entitled to benefits)
living outside the U.S. complete Form
SSA–21 as a supplement to an
application for benefits. SSA collects
the information to determine eligibility
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for U.S. Social Security benefits for
those months an alien beneficiary or
claimant is outside the U.S., and to
determine if tax withholding applies. In
addition, SSA uses the information to
terminate Supplemental Medical
Insurance coverage for recipients who
request it, because they are, or will be,
out of the U.S. The respondents are
individuals entitled to Social Security
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Sfmt 4703
benefits who are, will be, or have been
residing outside the U.S. for three
months or longer.
Note: This is a correction notice. SSA
published the incorrect burden information
for this collection at 76 FR 65315, on 10/20/
11. We are correcting this error here.
Type of Request: Revision of an OMBapproved information collection.
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Number of
responses
Collection instrument
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–21 (non-residents) ..................................................................................
SSA–21 (U.S. citizens and residents) .............................................................
36,874
1,941
1
1
5
15
3,073
485
Totals ........................................................................................................
38,815
........................
........................
3,558
4. Statement of Funds You Provided
to Another and Statement of Funds You
Received—20 CFR 404.1520(b),
404.1571–.1576, 404.1584–.1593 and
416.971–.976—0960–0059. SSA uses the
SSA–821–BK to collect recipient
employment information to determine
whether recipients worked after
becoming disabled and, if so, whether
the work is substantial gainful activity
(SGA). SSA’s field offices use Form
SSA–821–BK to obtain work
information during the initial claims
process, the continuing disability
review process, and for SSI claims
involving work issues. SSA’s processing
centers and the Office of Disability and
International Operations use the form to
document post-adjudicative work issues
with recipients. SSA reviews and
evaluates the data to determine if the
applicant or recipient meets the
disability requirements of the law. The
respondents are applicants and
recipients of Title II Social Security and
SSI disability payments.
Note: This is a correction notice: SSA
published the incorrect burden information
for this collection at 76 FR 68805, on
11/07/11. We provide the correct burden data
below.
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–821–BK ...................................................................................................
300,000
1
30
150,000
5. Application for a Social Security
Number Card, and the Social Security
Number Application Process (SSNAP)—
20 CFR 422.103–422.110—0960–0066.
SSA collects information on the SS–5
(used in the United States) and SS–5–
FS (used outside the United States) to
issue original or replacement Social
Security cards. SSA also enters the
application data into the Social Security
Number Application Process (SSNAP)
when applicants request a new or
replacement card via telephone or in
person.
In addition, hospitals collect the same
information on SSA’s behalf for
newborn children through the
Enumeration-at-Birth process. In this
process, parents of newborns provide
hospital birth registration clerks with
information required to register these
newborns. Hospitals send this
information to State Bureaus of Vital
Statistics (BVS), and they send the
information to SSA’s National Computer
Number of
respondents
Application scenario
Center. SSA then uploads the data to the
SSA mainframe along with all other
enumeration data, and we assign the
newborn a Social Security Number
(SSN) and issue a Social Security card.
The respondents for this collection
are applicants for original and
replacement Social Security cards who
use any of the modalities described
above.
Type of Request: Revision of an OMBapproved information collection.
Frequency of
response
Average burden
per response
(minutes)
Estimated total
annual burden
(hours)
1,487,500
10,500,000
1
8.5
400,000
1
9
1,100,000
1
9.5
600
500
500
1
1
1
Totals ......................................................................................................
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Respondents who do not have to provide parents’ SSNs ............................
Respondents whom we ask to provide parents’ SSNs (when applying for
original SSN cards for children under age 18) ..........................................
Applicants age 12 or older who need to answer additional questions so
SSA can determine whether we previously assigned an SSN ..................
Applicants asking for a replacement SSN card beyond the new allowable
limits (i.e., who must provide additional documentation to accompany
the application) ...........................................................................................
Authorization to SSA to obtain personal information cover letter .................
Authorization to SSA to obtain personal information follow-up cover letter ..
12,001,600
........................
Cost Burden: The state BVSs incur
costs of approximately $9.5 million for
transmitting data to SSA’s mainframe.
However, SSA reimburses the states for
these costs.
6. Application for Search of Census
Records for Proof of Age—20 CFR
404.716–0960–0097. When preferred
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evidence of age is not available or the
available evidence is not convincing,
SSA may ask the U.S. Department of
Commerce, Bureau of the Census, to
search its records to establish a
claimant’s date of birth. SSA collects
information from claimants using Form
SSA–1535–U3 to provide the Census
PO 00000
Frm 00087
Fmt 4703
Sfmt 4703
60
15
15
..........................
60,000
174,167
600
125
125
1,722,517
Bureau with sufficient identification
information to allow an accurate search
of census records. Additionally, the
Census Bureau uses a completed, signed
SSA–1535–U3 to bill SSA for the
search. The respondents are applicants
for Social Security benefits who need to
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establish their date of birth as a factor
of entitlement.
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–1535–U3 .................................................................................................
18,030
1
12
3,606
7. Medical Report on Adult with
Allegation of Human Immunodeficiency
Virus Infection; Medical Report on
Child with Allegation of Human
Immunodeficiency Virus Infection—20
CFR 416.933–20 CFR 416.934—0960–
meets the requirements for presumptive
disability payments. The respondents
are the medical sources of the
applicants for SSI disability payments.
0500. SSA uses Forms SSA–4814–F5
and SSA–4815–F6 to collect
information necessary to determine if an
individual with human
immunodeficiency virus infection who
is applying for SSI disability benefits,
Collection instrument
Number of
responses
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–4814–F5 ..................................................................................................
SSA–4815–F6 ..................................................................................................
46,200
12,900
1
1
10
10
7,700
2,150
Totals ........................................................................................................
59,100
........................
........................
9,850
8. Modified Benefit Formula
Questionnaire—Foreign Pension—
0960–0561. SSA uses Form SSA–308 to
determine exactly how much (if any) of
a foreign pension SSA may use to
reduce the amount of title II Social
Security retirement or disability benefits
under the modified benefit formula. The
respondents are applicants for title II
Social Security retirement or disability
benefits who have foreign pensions.
Type of Request: Revision of an OMBapproved information collection.
Collection instrument
Number of
responses
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–308 ..........................................................................................................
13,452
1
10
2,242
9. Medicare Subsidy Quality Review
Forms—20 CFR 418(b)(5)–0960–0707.
The Medicare Modernization Act of
2003 mandated the creation of the
Medicare Part D prescription drug
coverage program and provides certain
subsidies for eligible Medicare
beneficiaries to help pay for the cost of
prescription drugs. As part of its
stewardship duties of the Medicare Part
D subsidy program, SSA must conduct
periodic quality review checks of the
information Medicare beneficiaries
report on their subsidy applications
(Form SSA–1020). SSA uses the
Medicare Quality Review program to
Number of
respondents
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Collection instrument
SSA–9301 (Medicare Subsidy Quality Review Case Analysis Questionnaire)
SSA–9302 (Notice of Quality Review Acknowledgement Form for those with
Phones) ........................................................................................................
SSA–9303 (Notice of Quality Review Acknowledgement Form for those
without Phones) ...........................................................................................
SSA–9304 (Checklist of Required Information; burden accounted for with
Forms SSA–9302, SSA–9303, SSA–9311, SSA–9314) .............................
SSA–9308 (Request for Information) ..............................................................
SSA–9310 (Request for Documents) ..............................................................
SSA–9311 (Notice of Appointment—Denial-Reviewer Will Call) ....................
SSA–9312 (Notice of Appointment—Denial- Please Call Reviewer) ..............
SSA–9313 (Notice of Quality Review Acknowledgement Form for those with
Phones) ........................................................................................................
SSA–9314 (Notice of Quality Review Acknowledgement Form for those
without Phones) ...........................................................................................
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Frm 00088
Fmt 4703
conduct these checks. The respondents
are applicants for the Medicare Part D
subsidy whom SSA chose to undergo a
quality review.
Type of Request: Revision of an OMBapproved information collection.
Frequency of
response
Average
burden per
response
(minutes
Estimated total
annual burden
(hours)
3,500
1
30
1,750
3,500
1
15
875
350
1
15
88
........................
7,000
3,500
450
50
........................
1
1
1
1
........................
15
5
15
15
........................
1,750
292
113
13
2,500
1
15
625
500
1
15
125
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Number of
respondents
Collection instrument
Frequency of
response
Average
burden per
response
(minutes
Estimated total
annual burden
(hours)
SSA–8510 (Authorization to the Social Security Administration to Obtain
Personal Information) ...................................................................................
3,500
1
5
292
Totals ........................................................................................................
24,850
........................
........................
5,923
10. Application to Collect a Fee for
Payee Service—20 CFR 416.640.640(a),
416.1103(f)—0960–0719. Sections
205(j)(4)(A) and (B) and 1631(a)(2) of the
Social Security Act (Act) allow SSA to
authorize certain organizational
representative payees to collect a fee for
sector businesses or State and local
government offices applying to become
fee-for-service organizational
representative payees.
Type of Request: Revision of an OMBapproved information collection.
providing payee services. Before an
organization may collect this fee, they
complete and submit Form SSA–445.
SSA uses the information to determine
whether to authorize or deny
permission to collect fees for payee
services. The respondents are private
Number of
responses
Collection instrument
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
Private sector business ...................................................................................
State/local government offices ........................................................................
90
10
1
1
10
10
15
2
Totals ........................................................................................................
100
........................
........................
17
Dated: January 10, 2012.
Faye Lipsky,
Reports Clearance Officer, Office of
Regulations and Reports Clearance, Social
Security Administration.
[FR Doc. 2012–580 Filed 1–12–12; 8:45 am]
BILLING CODE 4191–02–P
DEPARTMENT OF STATE
[Public Notice: 7755]
Culturally Significant Objects Imported
for Exhibition Determinations: ‘‘The
Steins Collect: Matisse, Picasso and
the Parisian Avant-Garde’’
ACTION:
Notice, correction.
On April 1, 2011, notice was
published on page 18292 of the Federal
Register (volume 76, number 63) of
determinations made by the Department
of State pertaining to the exhibition
‘‘The Steins Collect: Matisse, Picasso
and the Parisian Avant-Garde.’’ This
notice was corrected by a November 18,
2011, notice published on page 71616 of
the Federal Register (volume 76,
number 223) as to the number of objects
covered at the Metropolitan Museum of
Art. These two referenced notices are
now corrected as to additional objects to
be included in the exhibition. 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
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SUMMARY:
VerDate Mar<15>2010
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Jkt 226001
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 additional objects to be
included in the exhibition ‘‘The Steins
Collect: Matisse, Picasso and the
Parisian Avant-Garde’’ imported from
abroad for temporary exhibition within
the United States, are of cultural
significance. The additional objects are
imported pursuant to loan agreements
with the foreign owners or custodians.
I also determine that the exhibition or
display of the additional exhibit objects
at The Metropolitan Museum of Art,
New York, NY, from on or about
February 22, 2012, until on or about
June 3, 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, including a list of
the additional 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
State, SA–5, L/PD, Fifth Floor (Suite
5H03), Washington, DC 20522–0505.
FOR FURTHER INFORMATION CONTACT:
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Dated: January 9, 2012.
J. Adam Ereli,
Principal Deputy Assistant Secretary, Bureau
of Educational and Cultural Affairs,
Department of State.
[FR Doc. 2012–609 Filed 1–12–12; 8:45 am]
BILLING CODE 4710–05–P
DEPARTMENT OF STATE
[Public Notice: 7754]
In the Matter of the Designation of alQa’ida Kurdish Battalions (AQKB),
Also Known as Kurdistan Brigades,
Also Known as Kurdistan Battalion of
Islamic State in Iraq, Also Known as
Kurdistan Brigade of al-Qaeda in Iraq,
as a Specially Designated Global
Terrorist Pursuant to Section 1(b) of
Executive Order 13224, as Amended
Acting under the authority of and in
accordance with section 1(b) of
Executive Order 13224 of September 23,
2001, as amended by Executive Order
13268 of July 2, 2002, and Executive
Order 13284 of January 23, 2003, I
hereby determine that the entity known
as al-Qa’ida Kurdish Battalions (AQKB),
also known as Kurdistan Brigades, also
known as, Kurdistan Battalion of
Islamic State in Iraq, also known as
Kurdistan Brigade of al-Qaeda in Iraq,
committed, or poses a significant risk of
committing, acts of terrorism that
threaten the security of U.S. nationals or
the national security, foreign policy, or
economy of the United States.
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]]>Agencies
[Federal Register Volume 77, Number 9 (Friday, January 13, 2012)]
[Notices]
[Pages 2114-2118]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-580]
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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 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, information collections in use without an OMB number, and
a new information collection.
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: (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
March 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. Request for Documents or Information--20 CFR 404.703--0960-NEW.
SSA asks individuals applying for Social Security benefits for
additional information when the information they provided is incomplete
or insufficient for us to determine their eligibility for benefits. SSA
uses Form SSA-2118-U2, Request for Documents or Information, to request
the additional documents or information we need to process individuals'
claims for benefits. Respondents are claimants for title II Social
Security Old Age, Survivors, and Disability Insurance (OASDI) benefits.
Type of Request: Existing collection in use without an OMB number.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Collection instrument Number of Frequency of per response total annual
respondents response (minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-2118-U2..................................... 7,500 1 5 625
----------------------------------------------------------------------------------------------------------------
2. Notice to Show Cause for Failure to Appear--20 CFR 404.938,
416.1438, 404.957(a)(ii)--0960-NEW. In situations where claimants who
requested a hearing before an administrative law judge (ALJ) fail to
appear at their scheduled hearings, the ALJ may reschedule the hearing
if the claimants establish good cause for missing the hearings. The
claimants can provide a reason for not appearing at their scheduled
hearings using Form HA-L90. If the ALJ determines the claimants
established good cause for failure to appear at the hearings, the ALJ
will schedule a supplemental hearing; if not, the ALJ makes a claims
eligibility determination based on the claimants' evidence of record.
Respondents are claimants seeking to show cause for failure to appear
at a scheduled hearing before an ALJ.
Type of Request: Existing collection in use without an OMB number.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Collection instrument Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
HA-L90 PDF/Paper............................ 7,000 1 10 1,167
Electronic Records Express.................. 28,000 1 10 4,667
-------------------------------------------------------------------
Total................................... 35,000 ............... ............... 5,834
----------------------------------------------------------------------------------------------------------------
3. Permanent Residence in the United States Under Color of Law
(PRUCOL)--20 CFR 416.1615 and 416.1618--0960-0451. As discussed in 20
CFR 416.1415 and 416.1618 of the Code of Federal Regulations, PRUCOL
aliens must present evidence of their alien status when they apply for
Supplemental Security Income (SSI) payments, and periodically
thereafter as part of the eligibility re-determination process for SSI.
SSA verifies the validity of the PRUCOL evidence for grandfathered
nonqualified aliens with the Department of Homeland Security (DHS). SSA
determines whether the individual is PRUCOL based on the DHS response.
Without this information, SSA is unable to determine whether the
individual is eligible for SSI payments. Respondents are qualified and
unqualified aliens who apply for SSI payments under PRUCOL.
Type of Request: Extension of an OMB-approved information
collection.
[[Page 2115]]
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Collection instrument Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
Personal or Telephone Interview............. 1,300 1 5 108
----------------------------------------------------------------------------------------------------------------
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 13, 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. Homeless with Schizophrenia Presumptive Disability Pilot
Demonstration--45 CFR 46.101(b)(5)--0960--NEW. The Federal Strategic
Plan to Prevent and End Homelessness 2010 calls on Federal agencies to
work in partnership with State and local governments and with the
private sector to end homelessness. A specific objective of the
Strategic Plan is to increase economic security by improving access to
mainstream programs and services.
In response to and in support of the President's efforts to end
homelessness, SSA has developed the Homeless with Schizophrenia
Presumptive Disability Pilot Demonstration, which tests both
administrative improvements to the SSI application process and
interventions that provide financial stability to individuals who are
homeless. The pilot will test strategies that would remove the barriers
homeless adult applicants with schizophrenia or schizoaffective
disorder experience when completing the SSI application process.
SSA uses two key forms to conduct the demonstration: The Research
Subject Information and Consent Form and the Schizophrenia Presumptive
Disability Recommendation Form. The consent form provides assurances
from the participants that they understand the demonstration project
and voluntarily are consenting to participate in it. The Presumptive
Disability Recommendation Form, filled out by a medical authority,
provides information on how the applicant meets the disability criteria
necessary to qualify for SSI benefits. SSA uses the information in
making a presumptive disability determination. Respondents are
homeless, adult SSI applicants with schizophrenia or schizoaffective
disorder.
Type of Request: Request for a new information collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Collection instrument Number of Frequency of Number of per response total annual
respondents response responses (minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
Consent Form.................... 200 1 (200) 120 400
PD Recommendation Form.......... 16 13 (208) 10 35
-------------------------------------------------------------------------------
Totals...................... 216 .............. (408) .............. 435
----------------------------------------------------------------------------------------------------------------
2. Partnership Questionnaire--20 CFR 404.1080-1082--0960-0025. SSA
considers partnership income in determining entitlement to Social
Security benefits. SSA uses information from the SSA-7104 to determine
several aspects of eligibility for benefits, including the accuracy of
reported partnership earnings, the veracity of a retirement, and lag
earnings. The respondents are applicants for, and recipients of, title
II Social Security OASDI benefits.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Estimated
Average burden total
Collection instrument Number of Frequency of (Number of per response annual
respondents response responses) (minutes) burden
(hours)
------------------------------------------------------------------------------------------------------- -----------
SSA-7104........................... 12,350 1 30 6,175
----------------------------------------------------------------------------------------------------------------
3. Supplement to Claim of Person Outside the United States--20 CFR
404.463, 20 CFR 422.505(b) and 20 CFR 407.27(c)--0960-0051. Claimants
or beneficiaries (both United States {U.S.{time} citizens and aliens
entitled to benefits) living outside the U.S. complete Form SSA-21 as a
supplement to an application for benefits. SSA collects the information
to determine eligibility for U.S. Social Security benefits for those
months an alien beneficiary or claimant is outside the U.S., and to
determine if tax withholding applies. In addition, SSA uses the
information to terminate Supplemental Medical Insurance coverage for
recipients who request it, because they are, or will be, out of the
U.S. The respondents are individuals entitled to Social Security
benefits who are, will be, or have been residing outside the U.S. for
three months or longer.
Note: This is a correction notice. SSA published the incorrect
burden information for this collection at 76 FR 65315, on 10/20/11.
We are correcting this error here.
Type of Request: Revision of an OMB-approved information
collection.
[[Page 2116]]
----------------------------------------------------------------------------------------------------------------
Estimated
Number of Frequency of Average burden total annual
Collection instrument responses response per response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-21 (non-residents).......................... 36,874 1 5 3,073
SSA-21 (U.S. citizens and residents)............ 1,941 1 15 485
---------------------------------------------------------------
Totals...................................... 38,815 .............. .............. 3,558
----------------------------------------------------------------------------------------------------------------
4. Statement of Funds You Provided to Another and Statement of
Funds You Received--20 CFR 404.1520(b), 404.1571-.1576, 404.1584-.1593
and 416.971-.976--0960-0059. SSA uses the SSA-821-BK to collect
recipient employment information to determine whether recipients worked
after becoming disabled and, if so, whether the work is substantial
gainful activity (SGA). SSA's field offices use Form SSA-821-BK to
obtain work information during the initial claims process, the
continuing disability review process, and for SSI claims involving work
issues. SSA's processing centers and the Office of Disability and
International Operations use the form to document post-adjudicative
work issues with recipients. SSA reviews and evaluates the data to
determine if the applicant or recipient meets the disability
requirements of the law. The respondents are applicants and recipients
of Title II Social Security and SSI disability payments.
Note: This is a correction notice: SSA published the incorrect
burden information for this collection at 76 FR 68805, on 11/07/11.
We provide the correct burden data below.
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-821-BK.................................. 300,000 1 30 150,000
----------------------------------------------------------------------------------------------------------------
5. Application for a Social Security Number Card, and the Social
Security Number Application Process (SSNAP)--20 CFR 422.103-422.110--
0960-0066. SSA collects information on the SS-5 (used in the United
States) and SS-5-FS (used outside the United States) to issue original
or replacement Social Security cards. SSA also enters the application
data into the Social Security Number Application Process (SSNAP) when
applicants request a new or replacement card via telephone or in
person.
In addition, hospitals collect the same information on SSA's behalf
for newborn children through the Enumeration-at-Birth process. In this
process, parents of newborns provide hospital birth registration clerks
with information required to register these newborns. Hospitals send
this information to State Bureaus of Vital Statistics (BVS), and they
send the information to SSA's National Computer Center. SSA then
uploads the data to the SSA mainframe along with all other enumeration
data, and we assign the newborn a Social Security Number (SSN) and
issue a Social Security card.
The respondents for this collection are applicants for original and
replacement Social Security cards who use any of the modalities
described above.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Estimated
Number of Frequency of Average burden total annual
Application scenario respondents response per response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
Respondents who do not have to provide parents' 10,500,000 1 8.5 1,487,500
SSNs..........................................
Respondents whom we ask to provide parents' 400,000 1 9 60,000
SSNs (when applying for original SSN cards for
children under age 18)........................
Applicants age 12 or older who need to answer 1,100,000 1 9.5 174,167
additional questions so SSA can determine
whether we previously assigned an SSN.........
Applicants asking for a replacement SSN card 600 1 60 600
beyond the new allowable limits (i.e., who
must provide additional documentation to
accompany the application)....................
Authorization to SSA to obtain personal 500 1 15 125
information cover letter......................
Authorization to SSA to obtain personal 500 1 15 125
information follow-up cover letter............
----------------------------------------------------------------
Totals..................................... 12,001,600 .............. ............... 1,722,517
----------------------------------------------------------------------------------------------------------------
Cost Burden: The state BVSs incur costs of approximately $9.5
million for transmitting data to SSA's mainframe. However, SSA
reimburses the states for these costs.
6. Application for Search of Census Records for Proof of Age--20
CFR 404.716-0960-0097. When preferred evidence of age is not available
or the available evidence is not convincing, SSA may ask the U.S.
Department of Commerce, Bureau of the Census, to search its records to
establish a claimant's date of birth. SSA collects information from
claimants using Form SSA-1535-U3 to provide the Census Bureau with
sufficient identification information to allow an accurate search of
census records. Additionally, the Census Bureau uses a completed,
signed SSA-1535-U3 to bill SSA for the search. The respondents are
applicants for Social Security benefits who need to
[[Page 2117]]
establish their date of birth as a factor of entitlement.
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-1535-U3................................. 18,030 1 12 3,606
----------------------------------------------------------------------------------------------------------------
7. Medical Report on Adult with Allegation of Human
Immunodeficiency Virus Infection; Medical Report on Child with
Allegation of Human Immunodeficiency Virus Infection--20 CFR 416.933-20
CFR 416.934--0960-0500. SSA uses Forms SSA-4814-F5 and SSA-4815-F6 to
collect information necessary to determine if an individual with human
immunodeficiency virus infection who is applying for SSI disability
benefits, meets the requirements for presumptive disability payments.
The respondents are the medical sources of the applicants for SSI
disability payments.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Collection instrument Number of Frequency of per response annual burden
responses 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
----------------------------------------------------------------------------------------------------------------
8. Modified Benefit Formula Questionnaire--Foreign Pension--0960-
0561. SSA uses Form SSA-308 to determine exactly how much (if any) of a
foreign pension SSA may use to reduce the amount of title II Social
Security retirement or disability benefits under the modified benefit
formula. The respondents are applicants for title II Social Security
retirement or disability benefits who have foreign pensions.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Collection instrument Number of Frequency of per response annual burden
responses response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-308..................................... 13,452 1 10 2,242
----------------------------------------------------------------------------------------------------------------
9. Medicare Subsidy Quality Review Forms--20 CFR 418(b)(5)-0960-
0707. The Medicare Modernization Act of 2003 mandated the creation of
the Medicare Part D prescription drug coverage program and provides
certain subsidies for eligible Medicare beneficiaries to help pay for
the cost of prescription drugs. As part of its stewardship duties of
the Medicare Part D subsidy program, SSA must conduct periodic quality
review checks of the information Medicare beneficiaries report on their
subsidy applications (Form SSA-1020). SSA uses the Medicare Quality
Review program to conduct these checks. The respondents are applicants
for the Medicare Part D subsidy whom SSA chose to undergo a quality
review.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average Estimated
Number of Frequency of burden per total annual
Collection instrument respondents response response burden
(minutes (hours)
----------------------------------------------------------------------------------------------------------------
SSA-9301 (Medicare Subsidy Quality Review Case 3,500 1 30 1,750
Analysis Questionnaire)........................
SSA-9302 (Notice of Quality Review 3,500 1 15 875
Acknowledgement Form for those with Phones)....
SSA-9303 (Notice of Quality Review 350 1 15 88
Acknowledgement Form for those without Phones).
SSA-9304 (Checklist of Required Information; .............. .............. .............. ..............
burden accounted for with Forms SSA-9302, SSA-
9303, SSA-9311, SSA-9314)......................
SSA-9308 (Request for Information).............. 7,000 1 15 1,750
SSA-9310 (Request for Documents)................ 3,500 1 5 292
SSA-9311 (Notice of Appointment--Denial-Reviewer 450 1 15 113
Will Call).....................................
SSA-9312 (Notice of Appointment--Denial- Please 50 1 15 13
Call Reviewer).................................
SSA-9313 (Notice of Quality Review 2,500 1 15 625
Acknowledgement Form for those with Phones)....
SSA-9314 (Notice of Quality Review 500 1 15 125
Acknowledgement Form for those without Phones).
[[Page 2118]]
SSA-8510 (Authorization to the Social Security 3,500 1 5 292
Administration to Obtain Personal Information).
---------------------------------------------------------------
Totals...................................... 24,850 .............. .............. 5,923
----------------------------------------------------------------------------------------------------------------
10. Application to Collect a Fee for Payee Service--20 CFR
416.640.640(a), 416.1103(f)--0960-0719. Sections 205(j)(4)(A) and (B)
and 1631(a)(2) of the Social Security Act (Act) allow SSA to authorize
certain organizational representative payees to collect a fee for
providing payee services. Before an organization may collect this fee,
they complete and submit Form SSA-445. SSA uses the information to
determine whether to authorize or deny permission to collect fees for
payee services. The respondents are private sector businesses or State
and local government offices applying to become fee-for-service
organizational representative payees.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Estimated
Number of Frequency of Average burden total annual
Collection instrument responses response per response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
Private sector business......................... 90 1 10 15
State/local government offices.................. 10 1 10 2
---------------------------------------------------------------
Totals...................................... 100 .............. .............. 17
----------------------------------------------------------------------------------------------------------------
Dated: January 10, 2012.
Faye Lipsky,
Reports Clearance Officer, Office of Regulations and Reports Clearance,
Social Security Administration.
[FR Doc. 2012-580 Filed 1-12-12; 8:45 am]
BILLING CODE 4191-02-P
