Agency Information Collection Activities: Proposed Request and Comment Request, 58903-58906 [2012-23441]

Download as PDF Federal Register / Vol. 77, No. 185 / Monday, September 24, 2012 / Notices (Catalog of Federal Domestic Assistance Numbers 59002 and 59008) This is an amendment of the Presidential declaration of a major disaster for the State of Mississippi (FEMA–4081–DR), dated 09/01/2012. Incident: Hurricane Isaac. Incident Period: 08/26/2012 and continuing. SUMMARY: James E. Rivera, Associate Administrator for Disaster Assistance. [FR Doc. 2012–23398 Filed 9–21–12; 8:45 am] BILLING CODE 8025–01–P Effective Date: 09/07/2012. Physical Loan Application Deadline Date: 10/31/2012. EIDL Loan Application Deadline Date: 05/30/2013. ADDRESSES: Submit completed loan applications to: U.S. Small Business Administration, Processing and Disbursement Center, 14925 Kingsport Road, Fort Worth, TX 76155. FOR FURTHER INFORMATION CONTACT: A. Escobar, Office of Disaster Assistance, U.S. Small Business Administration, 409 3rd Street SW., Suite 6050, Washington, DC 20416. SUPPLEMENTARY INFORMATION: The notice of the Presidential disaster declaration for the State of MISSISSIPPI, dated 09/ 01/2012 is hereby amended to include the following areas as adversely affected by the disaster: Primary Counties: (Physical Damage and Economic Injury Loans): Adams, Amite, Clarke, Forrest, George, Hinds, Lincoln, Marion, Pike, Stone, Walthall, Warren, Wilkinson. Contiguous Counties: (Economic Injury Loans Only): Mississippi: Claiborne, Copiah, Covington, Franklin, Greene, Issaquena, Jasper, Jefferson, Jefferson Davis, Jones, Lauderdale, Lawrence, Madison, Newton, Perry, Rankin, Simpson, Wayne, Yazoo. Alabama: Choctaw. Louisiana: Concordia, East Carroll, East Feliciana, Madison, Saint Helena, Tangipahoa, Tensas, West Feliciana. DATES: SMALL BUSINESS ADMINISTRATION [Disaster Declaration #13271 and #13272] Louisiana Disaster Number LA–00048 U.S. Small Business Administration. ACTION: Amendment 6. AGENCY: This is an amendment of the Presidential declaration of a major disaster for the State of Louisiana (FEMA–4080–DR), dated 08/31/2012. Incident: Hurricane Isaac. Incident Period: 08/26/2012 and continuing through 09/10/2012. DATES: Effective Date: 09/10/2012. Physical Loan Application Deadline Date: 10/30/2012. EIDL Loan Application Deadline Date: 05/29/2013. ADDRESSES: Submit completed loan applications to: U.S. Small Business Administration, Processing and Disbursement Center, 14925 Kingsport Road, Fort Worth, TX 76155. FOR FURTHER INFORMATION CONTACT: A. Escobar, Office of Disaster Assistance, U.S. Small Business Administration, 409 3rd Street SW., Suite 6050, Washington, DC 20416. SUPPLEMENTARY INFORMATION: The notice of the President’s major disaster declaration for the State of Louisiana, dated 08/31/2012 is hereby amended to establish the incident period for this disaster as beginning 08/26/2012 and continuing through 09/10/2012. All other information in the original declaration remains unchanged. SUMMARY: (Catalog of Federal Domestic Assistance Numbers 59002 and 59008) All other information in the original declaration remains unchanged. (Catalog of Federal Domestic Assistance Numbers 59002 and 59008) James E. Rivera, Associate Administrator for Disaster Assistance. [FR Doc. 2012–23405 Filed 9–21–12; 8:45 am] James E. Rivera, Associate Administrator for Disaster Assistance. BILLING CODE 8025–01–P [FR Doc. 2012–23408 Filed 9–21–12; 8:45 am] BILLING CODE 8025–01–P TKELLEY on DSK3SPTVN1PROD with NOTICES SMALL BUSINESS ADMINISTRATION [Disaster Declaration #13273 and #13274] SMALL BUSINESS ADMINISTRATION [Disaster Declaration #13271 and #13272] Mississippi Disaster Number MS– 00059 U.S. Small Business Administration. ACTION: Amendment 1. AGENCY: VerDate Mar<15>2010 18:54 Sep 21, 2012 Jkt 226001 Louisiana Disaster Number LA–00048 U.S. Small Business Administration. ACTION: Amendment 5. AGENCY: PO 00000 Frm 00102 Fmt 4703 Sfmt 4703 58903 This is an amendment of the Presidential declaration of a major disaster for the State of Louisiana (FEMA–4080–DR), dated 08/31/2012. Incident: Hurricane Isaac. Incident Period: 08/26/2012 and continuing. Effective Date: 09/08/2012. Physical Loan Application Deadline Date: 10/30/2012. EIDL Loan Application Deadline Date: 05/29/2013. ADDRESSES: Submit completed loan applications to: U.S. Small Business Administration, Processing and Disbursement Center, 14925 Kingsport Road, Fort Worth, TX 76155. FOR FURTHER INFORMATION CONTACT: A. Escobar, Office of Disaster Assistance, U.S. Small Business Administration, 409 3rd Street SW., Suite 6050, Washington, DC 20416. SUPPLEMENTARY INFORMATION: The notice of the Presidential disaster declaration for the State of Louisiana, dated 08/31/ 2012 is hereby amended to include the following areas as adversely affected by the disaster: Primary Parishes: (Physical Damage and Economic Injury Loans): Saint Mary, Iberville. Contiguous Parishes: (Economic Injury Loans Only): Louisiana: Pointe Coupee, West Baton Rouge. All other information in the original declaration remains unchanged. SUMMARY: (Catalog of Federal Domestic Assistance Numbers 59002 and 59008) James E. Rivera, Associate Administrator for Disaster Assistance. [FR Doc. 2012–23406 Filed 9–21–12; 8:45 am] BILLING CODE 8025–01–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 of 1995, effective October 1, 1995. This notice includes revisions to 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, E:\FR\FM\24SEN1.SGM 24SEN1 58904 Federal Register / Vol. 77, No. 185 / Monday, September 24, 2012 / Notices 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 Director, 107 Altmeyer Building, 6401 Security Blvd., Baltimore, MD 21235, Fax: 410–966–2830, Email address: OR.Reports.Clearance@ssa.gov. I The information collections below are pending at SSA. SSA will submit them to OMB within 60 days from the date of this notice. To be sure we consider your comments, we must receive them no later than November 23, 2012. Individuals can obtain copies of the collection instruments by writing to the above email address. 1. Reporting Changes that Affect Your Social Security Payment—20 CFR 404.301–305, 404.310–311, 404.330– .333, 404.335–.341, 404.350–.352, and 404.468—0960–0073. When Social Security benefits recipients experience a change that could affect their payments, they must report these changes to SSA. Title II beneficiaries in this category use form SSA–1425 to report the relevant information to SSA; the agency then determines if the respondents continue to be entitled to benefits, and if so, the proper amount of these benefits. The respondents are Social Security beneficiaries receiving Title II SSA retirement, disability, or survivor’s auxiliary benefits who need to report an event that could affect their payments. Type of Request: Revision of an OMBapproved information collection. Modality of completion Number of responses Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) SSA–1425 ........................................................................................................ 70,000 1 5 5,833 2. Privacy and Disclosure of Official Records and Information; Availability of Information and Records to the Public— 20 CFR 401.40(b)&(c), 401.55(b), 401.100(a), 402.130, 402.185—0960– 0566. SSA has established methods for the public to: (1) Access their SSA records; (2) allow SSA to disclose records; (3) correct or amend their SSA records; (4) consent to release of their records; (5) request records under the Freedom of Information Act (FOIA); and (6) request SSA waive or reduce fees normally charges for release of FOIA. SSA often collects the necessary information for these requests through a written letter, with the exception of the consent for release of records, for which there is the Form SSA–3288. The respondents are individuals requesting access to, correction of, or disclosure of SSA records. Type of Request: Revision of an OMBapproved information collection. Modality of completion Number of responses Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) Access to Records ........................................................................................... Designating a Representative for Disclosure of Records ............................... Amendment of Records ................................................................................... Consent of Release of Records ...................................................................... FOIA Requests for Records ............................................................................ Waiver/Reduction of Fees ............................................................................... 10,000 3,000 100 3,000,000 15,000 400 1 1 1 1 1 1 11 120 10 3 5 5 1,833 6,000 17 150,000 1,250 33 Totals ........................................................................................................ 3,028,500 ........................ ........................ 159,133 TKELLEY on DSK3SPTVN1PROD with NOTICES 3. Claimant Statement about Loan of Food or Shelter; Statement about Food or Shelter Provided to Another—20 CFR 416.1130–416.1148—0960–0529. SSA uses Forms SSA–5062 and SSA–L5063 in the administration of the Supplemental Security Income (SSI) program. SSA bases an SSI claimant or recipient’s eligibility on need. We measure need by the amount of income an individual receives. Income includes other persons providing in-kind support and maintenance in the form of food and shelter to SSI applicants or recipients. SSA uses Forms SSA–5062 and SSA–L5063 to obtain statements about food or shelter provided to SSI claimants or recipients. SSA uses this information to determine whether food or shelters are bona fide loans or income for SSI purposes. This determination may affect a claimant or recipient’s eligibility for SSI and the amount of SSI payments. The respondents are claimants and recipients for SSI payments, and individuals who provide loans of food or shelter to them. Type of Request: Revision of an OMBapproved information collection. Modality of completion Number of responses Frequency of response Average burden of response (minutes) Estimated total annual burden (hours) SSA–5062 Paper form ..................................................................................... SSA–L5063 Paper form ................................................................................... SSA–5062 Modernized SSI Claims System (MSSICS) .................................. SSA–L5063 MSSICS ....................................................................................... 34,900 34,900 34,900 34,900 1 1 1 1 10 10 10 10 5,817 5,817 5,817 5,817 VerDate Mar<15>2010 18:54 Sep 21, 2012 Jkt 226001 PO 00000 Frm 00103 Fmt 4703 Sfmt 4703 E:\FR\FM\24SEN1.SGM 24SEN1 Federal Register / Vol. 77, No. 185 / Monday, September 24, 2012 / Notices Number of responses Modality of completion Total .......................................................................................................... 4. Site Review Questionnaire for Volume and Fee-for-Service Payees and Beneficiary Interview Form—20 CFR 404.2035, 404.2065, 416.665, 416.701, and 416.708—0960–0633. SSA asks organizational representative payees to complete Form SSA–637, the Site Review Questionnaire for Volume and Fee-for-Service Payees, to provide information on how they carry out their 58905 Frequency of response Average burden of response (minutes) Estimated total annual burden (hours) 139,600 ........................ ........................ 23,268 responsibilities, including how they manage beneficiary funds. SSA then obtains information from the beneficiaries these organizations represent via Form SSA–639, Beneficiary Interview Form, to corroborate the payees’ statements. Due to the sensitivity of the information, SSA employees always complete the forms based on the answers respondents give during the interview. The respondents are individuals, State and local governments, non-profit and forprofit organizations serving as representative payees, and the beneficiaries they serve. Type of Request: Revision of an OMBapproved information collection. Modality of completion Number of responses Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) SSA–637 .......................................................................................................... SSA–639 .......................................................................................................... 1,999 8,293 1 1 120 10 3,998 1,382 Totals ........................................................................................................ 10,292 ........................ ........................ 5,380 5. Certification of Prisoner Identity Information—20 CFR 422.107—0960– 0688. Inmates of Federal, State, or local prisons may need a Social Security card as verification of their Social Security number for school or work programs, or as proof of employment eligibility upon release from incarceration. Before SSA can issue a replacement Social Security card, applicants must show SSA proof of their identity. People who are in prison for an extended period typically do not have current identity documents. Therefore, under formal written agreement with the correctional institution, SSA allows prison officials to verify the identity of certain incarcerated U.S. citizens who need replacement Social Security cards. Information prison officials provide comes from the official prison files, sent on correctional facility letterhead. SSA uses this information to establish the applicant’s identity in the replacement Social Security card process. The respondents are prison officials who certify the identity of prisoners applying for replacement Social Security cards. Type of Request: Extension of an OMB-approved Information Collection. Modality of completion Number of responses Frequency of Response Average burden per response (minutes) Estimated total annual burden (hours) Certification of Prisoner Identity ....................................................................... 1,100 200 3 11,000 TKELLEY on DSK3SPTVN1PROD with NOTICES 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 30 days from the date of this publication. To be sure we consider your comments, we must receive them no later than October 24, 2012. Individuals can obtain copies of the OMB clearance packages by writing to OR.Reports.Clearance@ssa.gov. 1. Statement of Care and Responsibility for Beneficiary—20 CFR VerDate Mar<15>2010 18:54 Sep 21, 2012 Jkt 226001 404.2020, 404.2025, 408.620, 408.625, 416.620, 416.625—0960–0109. SSA uses the information from Form SSA–788 to verify payee applicants’ statements of concern and to identify other potential payees. SSA is concerned with selecting the most qualified representative payee who will use Social Security benefits in the beneficiary’s best interest. SSA considers factors such as the payee applicant’s capacity to perform payee duties, awareness of the beneficiary’s situation and needs, demonstration of past and current concern for the beneficiary’s well-being, etc. If the payee applicant does not have custody PO 00000 Frm 00104 Fmt 4703 Sfmt 4703 of the beneficiary, SSA will obtain information from the custodian for evaluation against information provided by the applicant. Respondents are individuals who have custody of the beneficiary in cases where someone else has filed to be the beneficiary’s representative payee. This is a correction notice: SSA published the incorrect burden information for this collection at 77 FR 47688, on 08/09/12. We are correcting this error here. Type of Request: Revision of an OMBapproved information collection. E:\FR\FM\24SEN1.SGM 24SEN1 58906 Federal Register / Vol. 77, No. 185 / Monday, September 24, 2012 / Notices Modality of completion Number of respondents Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) SSA–788 .......................................................................................................... 130,000 1 10 21,667 2. Function Report Adult—Third Party—20 CFR 404.1512 & 416.912— 0960–0635. Individuals receiving or applying for Social Security Disability Insurance (SSDI) or SSI provide SSA with medical evidence and other proof SSA requires to prove their disability. SSA, and Disability Determination limitations (or lack thereof) of claimants who apply for SSI and SSDI benefits. Services (DDS) on our behalf, collect this information using Form SSA–3380– BK. We use the information to document how claimant’s disabilities affect their ability to function, and to determine eligibility for SSI and SSDI claims. The respondents are third parties familiar with the functional Note: This is a correction notice: SSA published the incorrect burden information for this collection at 77 FR 40401, on 7/09/ 12. We are correcting this error here. Type of Request: Revision of an OMB approved information collection. Modality of completion Number of respondents Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) SSA–338–BK (Individuals) .............................................................................. SSA–338–BK (Private Sector) ......................................................................... 527,000 527,000 1 1 61 61 535,783 535,783 1,054,000 ........................ ........................ 1,071,566 Totals ........................................................................................................ 3. Function Report Adult—20 CFR 404.1512 & 416.912—0960–0681. Individuals receiving or applying for SSDI or SSI must provide medical evidence and other proof SSA requires to prove their disability. SSA, and DDS on our behalf, collect the information using Form SSA–3373. We use the information to document how claimants’ disabilities affect their ability to function, and to determine eligibility for SSI and SSDI claims. The respondents are title II and title XVI applicants (or current recipients undergoing redeterminations) for disability payments. Type of Request: Revision of an OMBapproved information collection. Modality of completion Number of responses Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) SSA–3373 ........................................................................................................ 4,221,656 1 61 4,292,017 Dated: September 19, 2012. Faye Lipsky, Reports Clearance Director, Social Security Administration. [FR Doc. 2012–23441 Filed 9–21–12; 8:45 am] BILLING CODE 4191–02–P DEPARTMENT OF TRANSPORTATION By this notice, the FHWA is advising the public of final agency Notice of Final Federal Agency Actions actions subject to 23 U.S.C. 139(l)(1). A on Proposed Highway in Minnesota claim seeking judicial review of the Federal agency actions of the proposed AGENCY: Federal Highway highway project will be barred unless Administration (FHWA), DOT. the claim is filed within 180 days from ACTION: Notice of statute of limitations the date this notice is published in the on claims for judicial review of actions Federal Register. If the Federal law that by FHWA and other federal agencies. authorizes judicial review of a claim provides a time period of less than 180 SUMMARY: This notice announces actions days for filing such a claim, than that taken by the FHWA and other Federal shorter time period still applies. agencies that are final within the meaning of 23 U.S.C. 139(l)(1). The FOR FURTHER INFORMATION CONTACT: For actions relate to a proposed highway FHWA: Mr. Philip Forst, Environmental project on I–90 over the Mississippi Specialist, Federal Highway Federal Highway Administration TKELLEY on DSK3SPTVN1PROD with NOTICES River. The proposed project includes replacement of the Interstate 90 (I–90) Dresbach Bridge over the Mississippi River with a new bridge that meets structural and geometric standards as well as reconstruction of the I–90/U.S. 61 interchange to improve traffic safety, capacity, and access on and between U.S. 61/14 and I–90. Those actions grant approvals for the project. VerDate Mar<15>2010 18:54 Sep 21, 2012 Jkt 226001 DATES: PO 00000 Frm 00105 Fmt 4703 Sfmt 4703 Administration, 380 Jackson Street, Suite 500, Saint Paul, MN 55101, Telephone (651) 291–6100, email: phil.forst@dot.gov. The Minnesota Division Office’s normal business hours are 8 a.m. to 4 p.m. (Central Time). For the Minnesota Department of Transportation (MnDOT): Mr. Jai Kalsy, PE, Project Manager, District 6, 2900 48th Street NW., Rochester, MN 55901– 5848, Telephone: (507) 286–7500, Email: jai.kalsy@state.mn.us. The MnDOT District 6 normal business hours are 8 a.m. to 4 p.m. (Central Time). Notice is hereby given that the FHWA and other Federal agencies have take final agency actions by issuing approvals for the following highway project in Minnesota: I–90 Bridge over the Mississippi River and I–90/U.S. 14/U.S. 61 approach roadway interchange. The project is located in Dresbach Township, Winona County, Minnesota, and Campbell Township, La Crosse County, SUPPLEMENTARY INFORMATION: E:\FR\FM\24SEN1.SGM 24SEN1

Agencies

Social Security Administration

[Federal Register Volume 77, Number 185 (Monday, September 24, 2012)]
[Notices]
[Pages 58903-58906]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-23441]

=======================================================================
-----------------------------------------------------------------------

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 of 1995, effective October 1, 1995. This notice
includes revisions to 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,

[[Page 58904]]

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
Director, 107 Altmeyer Building, 6401 Security Blvd., Baltimore, MD
21235, Fax: 410-966-2830, Email address: OR.Reports.Clearance@ssa.gov.

The information collections below are pending at SSA. SSA will
submit them to OMB within 60 days from the date of this notice. To be
sure we consider your comments, we must receive them no later than
November 23, 2012. Individuals can obtain copies of the collection
instruments by writing to the above email address.
1. Reporting Changes that Affect Your Social Security Payment--20
CFR 404.301-305, 404.310-311, 404.330-.333, 404.335-.341, 404.350-.352,
and 404.468--0960-0073. When Social Security benefits recipients
experience a change that could affect their payments, they must report
these changes to SSA. Title II beneficiaries in this category use form
SSA-1425 to report the relevant information to SSA; the agency then
determines if the respondents continue to be entitled to benefits, and
if so, the proper amount of these benefits. The respondents are Social
Security beneficiaries receiving Title II SSA retirement, disability,
or survivor's auxiliary benefits who need to report an event that could
affect their payments.
Type of Request: Revision of an OMB-approved information
collection.

2. Privacy and Disclosure of Official Records and Information;
Availability of Information and Records to the Public--20 CFR
401.40(b)&(c), 401.55(b), 401.100(a), 402.130, 402.185--0960-0566. SSA
has established methods for the public to: (1) Access their SSA
records; (2) allow SSA to disclose records; (3) correct or amend their
SSA records; (4) consent to release of their records; (5) request
records under the Freedom of Information Act (FOIA); and (6) request
SSA waive or reduce fees normally charges for release of FOIA. SSA
often collects the necessary information for these requests through a
written letter, with the exception of the consent for release of
records, for which there is the Form SSA-3288. The respondents are
individuals requesting access to, correction of, or disclosure of SSA
records.
Type of Request: Revision of an OMB-approved information
collection.

----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
responses response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
Access to Records........................... 10,000 1 11 1,833
Designating a Representative for Disclosure 3,000 1 120 6,000
of Records.................................
Amendment of Records........................ 100 1 10 17
Consent of Release of Records............... 3,000,000 1 3 150,000
FOIA Requests for Records................... 15,000 1 5 1,250
Waiver/Reduction of Fees.................... 400 1 5 33
-------------------------------------------------------------------
Totals.................................. 3,028,500 ............... ............... 159,133
----------------------------------------------------------------------------------------------------------------

3. Claimant Statement about Loan of Food or Shelter; Statement
about Food or Shelter Provided to Another--20 CFR 416.1130-416.1148--
0960-0529. SSA uses Forms SSA-5062 and SSA-L5063 in the administration
of the Supplemental Security Income (SSI) program. SSA bases an SSI
claimant or recipient's eligibility on need. We measure need by the
amount of income an individual receives. Income includes other persons
providing in-kind support and maintenance in the form of food and
shelter to SSI applicants or recipients. SSA uses Forms SSA-5062 and
SSA-L5063 to obtain statements about food or shelter provided to SSI
claimants or recipients. SSA uses this information to determine whether
food or shelters are bona fide loans or income for SSI purposes. This
determination may affect a claimant or recipient's eligibility for SSI
and the amount of SSI payments. The respondents are claimants and
recipients for SSI payments, and individuals who provide loans of food
or shelter to them.
Type of Request: Revision of an OMB-approved information
collection.

[[Page 58905]]

Total................................... 139,600 ............... ............... 23,268
----------------------------------------------------------------------------------------------------------------

4. Site Review Questionnaire for Volume and Fee-for-Service Payees
and Beneficiary Interview Form--20 CFR 404.2035, 404.2065, 416.665,
416.701, and 416.708--0960-0633. SSA asks organizational representative
payees to complete Form SSA-637, the Site Review Questionnaire for
Volume and Fee-for-Service Payees, to provide information on how they
carry out their responsibilities, including how they manage beneficiary
funds. SSA then obtains information from the beneficiaries these
organizations represent via Form SSA-639, Beneficiary Interview Form,
to corroborate the payees' statements. Due to the sensitivity of the
information, SSA employees always complete the forms based on the
answers respondents give during the interview. The respondents are
individuals, State and local governments, non-profit and for-profit
organizations serving as representative payees, and the beneficiaries
they serve.
Type of Request: Revision of an OMB-approved information
collection.

----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
responses response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-637..................................... 1,999 1 120 3,998
SSA-639..................................... 8,293 1 10 1,382
-------------------------------------------------------------------
Totals.................................. 10,292 ............... ............... 5,380
----------------------------------------------------------------------------------------------------------------

5. Certification of Prisoner Identity Information--20 CFR 422.107--
0960-0688. Inmates of Federal, State, or local prisons may need a
Social Security card as verification of their Social Security number
for school or work programs, or as proof of employment eligibility upon
release from incarceration. Before SSA can issue a replacement Social
Security card, applicants must show SSA proof of their identity. People
who are in prison for an extended period typically do not have current
identity documents. Therefore, under formal written agreement with the
correctional institution, SSA allows prison officials to verify the
identity of certain incarcerated U.S. citizens who need replacement
Social Security cards. Information prison officials provide comes from
the official prison files, sent on correctional facility letterhead.
SSA uses this information to establish the applicant's identity in the
replacement Social Security card process. The respondents are prison
officials who certify the identity of prisoners applying for
replacement Social Security cards.
Type of Request: Extension of an OMB-approved Information
Collection.

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 30 days from the date of this
publication. To be sure we consider your comments, we must receive them
no later than October 24, 2012. Individuals can obtain copies of the
OMB clearance packages by writing to OR.Reports.Clearance@ssa.gov.
1. Statement of Care and Responsibility for Beneficiary--20 CFR
404.2020, 404.2025, 408.620, 408.625, 416.620, 416.625--0960-0109. SSA
uses the information from Form SSA-788 to verify payee applicants'
statements of concern and to identify other potential payees. SSA is
concerned with selecting the most qualified representative payee who
will use Social Security benefits in the beneficiary's best interest.
SSA considers factors such as the payee applicant's capacity to perform
payee duties, awareness of the beneficiary's situation and needs,
demonstration of past and current concern for the beneficiary's well-
being, etc. If the payee applicant does not have custody of the
beneficiary, SSA will obtain information from the custodian for
evaluation against information provided by the applicant. Respondents
are individuals who have custody of the beneficiary in cases where
someone else has filed to be the beneficiary's representative payee.
This is a correction notice: SSA published the incorrect burden
information for this collection at 77 FR 47688, on 08/09/12. We are
correcting this error here.
Type of Request: Revision of an OMB-approved information
collection.

[[Page 58906]]

2. Function Report Adult--Third Party--20 CFR 404.1512 & 416.912--
0960-0635. Individuals receiving or applying for Social Security
Disability Insurance (SSDI) or SSI provide SSA with medical evidence
and other proof SSA requires to prove their disability. SSA, and
Disability Determination Services (DDS) on our behalf, collect this
information using Form SSA-3380-BK. We use the information to document
how claimant's disabilities affect their ability to function, and to
determine eligibility for SSI and SSDI claims. The respondents are
third parties familiar with the functional limitations (or lack
thereof) of claimants who apply for SSI and SSDI benefits.

Note: This is a correction notice: SSA published the incorrect
burden information for this collection at 77 FR 40401, on 7/09/12.
We are correcting this error here.

Type of Request: Revision of an OMB approved information
collection.

----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-338-BK (Individuals).................... 527,000 1 61 535,783
SSA-338-BK (Private Sector)................. 527,000 1 61 535,783
-------------------------------------------------------------------
Totals.................................. 1,054,000 ............... ............... 1,071,566
----------------------------------------------------------------------------------------------------------------

3. Function Report Adult--20 CFR 404.1512 & 416.912--0960-0681.
Individuals receiving or applying for SSDI or SSI must provide medical
evidence and other proof SSA requires to prove their disability. SSA,
and DDS on our behalf, collect the information using Form SSA-3373. We
use the information to document how claimants' disabilities affect
their ability to function, and to determine eligibility for SSI and
SSDI claims. The respondents are title II and title XVI applicants (or
current recipients undergoing redeterminations) for disability
payments.
Type of Request: Revision of an OMB-approved information
collection.

Dated: September 19, 2012.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2012-23441 Filed 9-21-12; 8:45 am]
BILLING CODE 4191-02-P

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