Agency Information Collection Activities: Proposed Request, 62593-62595 [2012-25277]
Download as PDF
<![CDATA[
Federal Register / Vol. 77, No. 199 / Monday, October 15, 2012 / Notices
beneficiary’s physicians, or medical
officers of the institution in which the
beneficiary resides.
62593
Type of Request: Revision of an OMBapproved information collection.
Modality of completion
Number of
respondents
Frequency of
response
Average
burden
per response
(minutes)
Estimated total
annual burden
(hours)
SSA–7156 ........................................................................................................
120,000
1
10
20,000
2. Farm Self-Employment
Questionnaire—20 CFR 404.1082(c) &
404.1095—0960–0061. SSA requires
proof of the existence of a trade or
business before determining if an
individual or partnership may have net
earnings from self-employment. When a
claimant indicates self-employment as a
farmer, SSA obtains the information we
need to determine the existence of an
agricultural trade or business and
subsequent covered earnings for Social
Security entitlement purposes using
Form SSA–7165, Farm SelfEmployment Questionnaire. As part of
the application process, we conduct a
personal interview, either face-to-face or
via telephone, and document the
interview using Form SSA–7165. The
respondents are applicants for Social
Security benefits, whose entitlement
depends on worker’s having covered
earnings from self-employment as a
farmer.
Type of Request: Revision of an OMBapproved information collection.
Modality of completion
Number of
respondents
Frequency of
response
Average
burden
per response
(minutes)
Estimated total
annual burden
(hours)
SSA–7156 ........................................................................................................
47,500
1
10
7,917
3. Statement of Household Expenses
and Contributions—20 CFR 416.1130–
416.1148—0960–0456. SSA bases
eligibility for Supplemental Security
Income (SSI) on the needs of the
recipient. In part, we assess need by
determining the amount of income a
recipient receives. This income includes
in-kind support and maintenance in the
form of food and shelter provided by
other persons. SSA uses Form SSA–
8011–F3 to determine if the claimant or
recipient receives in-kind support and
maintenance. This is necessary to
determine (1) the claimant or recipient’s
eligibility for SSI and (2) the SSI
payment amount. SSA only uses this
form in cases where SSA needs the
householder’s (head of household)
corroboration of in-kind support and
maintenance. Respondents are
householders of homes in which an SSI
applicant or recipient resides.
Type of Request: Revision of an OMBapproved information collection.
Modality of completion
Number of
respondents
Frequency of
response
Average
burden
per response
(minutes)
Estimated total
annual burden
(hours)
SSA–8011–F3 ..................................................................................................
428,100
1
15
107,025
Dated: October 10, 2012.
Faye Lipsky,
Reports Clearance Director, Social Security
Administration.
[FR Doc. 2012–25276 Filed 10–12–12; 8:45 am]
BILLING CODE 4191–02–P
SOCIAL SECURITY ADMINISTRATION
erowe on DSK2VPTVN1PROD with
Agency Information Collection
Activities: Proposed 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 OMB-approved information
collections.
VerDate Mar<15>2010
20:13 Oct 12, 2012
Jkt 229001
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.
PO 00000
Frm 00104
Fmt 4703
Sfmt 4703
(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 December 14, 2012.
Individuals can obtain copies of the
collection instruments by writing to the
above email address.
1. Certificate of Support—20 CFR
404.370, 404.750, 404.408a—0960–
0001. A parent of a deceased, fully
insured worker may be entitled to Social
Security Old-Age, Survivors, and
Disability Insurance (OASDI) benefits
E:\FR\FM\15OCN1.SGM
15OCN1
62594
Federal Register / Vol. 77, No. 199 / Monday, October 15, 2012 / Notices
based on the earnings record of the
deceased worker under certain
conditions. One of the conditions is the
parent must have received at least onehalf support from the deceased worker.
The one-half support requirement also
applies to a spousal applicant in
determining whether OASDI benefits
are subject to Government Pension
Offset (GPO). SSA uses the information
from Form SSA–760–F4 to determine if
the parent of a deceased worker or a
spouse applicant meets the one-half
support requirement. Respondents are
(1) parents of deceased workers and (2)
spouses who may meet the GPO
exception.
Type of Request: Revision of an OMBapproved information collection.
Modality of completion
Number of
respondents
Frequency of
response
Average
burden
per response
(minutes)
Estimated total
annual burden
(hours)
SSA–760–F4 ....................................................................................................
18,000
1
15
4,500
2. Pre-1957 Military Service Federal
Benefit Questionnaire—20 CFR
404.1301–404.1371—0960–0120. SSA
may grant gratuitous military wage
credits for active military or naval
service (under certain conditions)
during the period September 16, 1940
through December 31, 1956, if no other
Federal agency (other than the Veterans
Administration) credited the service for
benefit eligibility or computation
purposes. We use Form SSA–2512 to
collect specific information about other
Federal, military, or civilian benefits the
wage earner may receive when the
applicant indicates both pre-1957
military service and the receipt of a
Federal benefit. SSA uses the data in the
claims adjudication process to grant
gratuitous military wage credits when
applicable, and to solicit sufficient
information to determine eligibility.
Respondents are applicants for Social
Security benefits on a record where the
wage earner claims pre-1957 military
service.
Type of Request: Revision of an OMBapproved information collection.
Modality of completion
Number of
respondents
Frequency of
response
Average
burden
per response
(minutes)
Estimated total
annual burden
(hours)
SSA–2512 ........................................................................................................
5,000
1
10
833
3. Authorization for the Social
Security Administration to Obtain
Account Records from a Financial
Institution and Request for Records—20
CFR 416.200, 416.203—0960–0293. SSA
collects and verifies financial
information from individuals applying
for Supplemental Security Income (SSI)
to determine if the applicant meets the
SSI resource eligibility requirements. If
the SSI claimants provide records that
are incomplete, unavailable, or
seemingly altered, SSA contacts their
financial institution to verify the
existence, ownership, and value of
accounts owned. Financial institutions
Number of
respondents
Modality of completion
require individuals to sign Form SSA–
4641–U2 to authorize them to disclose
records to SSA. The respondents are
financial institutions of SSI applicants,
recipients, and their deemors.
Type of Request: Revision of an OMBapproved information collection.
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–4641 (paper) ...........................................................................................
e4641 (electronic) ............................................................................................
44,100
6,955,900
1
1
6
2
4,410
231,863
Totals ........................................................................................................
7,000,000
........................
........................
236,273
4. Response to Notice of Revised
Determination—20 CFR 404.913–
404.914, 404.992(b), 416.1413–416.1414
and 416.1492(d)—0960–0347. When
SSA determines that (1) claimants for
initial disability benefits do not actually
have a disability or (2) current disability
recipients’ records show their disability
ceased, SSA notifies the disability
claimants or recipients of this decision.
In response to this notice, the affected
claimants and disability recipients have
the following recourse: (1) They may
request a disability hearing to contest
SSA’s decision and (2) they may submit
additional information or evidence for
SSA to consider. Disability claimants,
recipients, and their representatives use
Form SSA–765 to accomplish these two
actions. The respondents are disability
claimants, current disability recipients,
or their representatives.
Type of Request: Revision of an OMBapproved information collection.
erowe on DSK2VPTVN1PROD with
Modality of completion
Number of
respondents
Frequency of
response
Average
burden
per response
(minutes)
Estimated total
annual burden
(hours)
SSA–765 ..........................................................................................................
1,925
1
30
963
VerDate Mar<15>2010
20:13 Oct 12, 2012
Jkt 229001
PO 00000
Frm 00105
Fmt 4703
Sfmt 4703
E:\FR\FM\15OCN1.SGM
15OCN1
62595
Federal Register / Vol. 77, No. 199 / Monday, October 15, 2012 / Notices
5. Notification of a Social Security
Number (SSN) To An Employer for
Wage Reporting—20 CFR 422.103(a)—
0960–0778. Individuals applying for
employment must provide an SSN or
indicate they have applied for one.
However, when an individual applies
for an initial SSN, there is a delay
between the assignment of the number
and the delivery of the SSN card. At an
individual’s request, SSA uses Form
SSA–132 to send the individual’s SSN
to an employer. Mailing this
information to the employer (1) ensures
the employer has the correct SSN for the
individual; (2) allows SSA to receive
correct earnings information for wage
reporting purposes; and (3) reduces the
delay in the initial SSN assignment and
delivery of the SSN information directly
to the employer. It also enables SSA to
verify the employer as a safeguard for
the applicant’s personally identifiable
information. The majority of individuals
who take advantage of this option are in
the United States with exchange visitor
and student visas; however, we allow
any applicant for an SSN to use the
SSA–132. The respondents are
individuals applying for an initial SSN
who ask SSA to mail confirmation of
their application or the SSN to their
employers.
Type of Request: Revision of an OMBapproved information collection.
Modality of completion
Number of
respondents
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–132 ..........................................................................................................
249,000
1
2
8,300
Dated: October 10, 2012.
Faye Lipsky,
Reports Clearance Director, Social Security
Administration.
[FR Doc. 2012–25277 Filed 10–12–12; 8:45 am]
BILLING CODE 4191–02–P
[Public Notice: 8060]
30-Day Notice of Proposed Information
Collection: Passport Demand
Forecasting Study
Notice of request for public
comment and submission to OMB of
proposed collection of information.
ACTION:
The Department of State has
submitted the information collection
described below to the Office of
Management and Budget (OMB) for
approval. In accordance with the
Paperwork Reduction Act of 1995 we
are requesting comments on this
collection from all interested
individuals and organizations. The
purpose of this Notice is to allow 30
days for public comment.
DATES: Submit comments directly to the
Office of Management and Budget
(OMB) up to November 14, 2012.
ADDRESSES: Direct comments to the
Department of State Desk Officer in the
Office of Information and Regulatory
Affairs at the Office of Management and
Budget (OMB). You may submit
comments by the following methods:
• Email:
oira_submission@omb.eop.gov. You
must include the DS form number,
information collection title, and the
OMB control number in the subject line
of your message.
• Fax: 202–395–5806. Attention: Desk
Officer for Department of State.
erowe on DSK2VPTVN1PROD with
SUMMARY:
15:21 Oct 12, 2012
Direct requests for additional
information regarding the collection
listed in this notice, including requests
for copies of the proposed collection
instrument and supporting documents,
to the Office of Passport Services at
PassportStudy@state.gov.
SUPPLEMENTARY INFORMATION:
DEPARTMENT OF STATE
VerDate Mar<15>2010
FOR FURTHER INFORMATION CONTACT:
Jkt 229001
• Title of Information Collection:
Passport Demand Forecasting Study.
• OMB Control Number: 1405–0177.
• Type of Request: Reinstatement of a
previous collection.
• Originating Office: Bureau of
Consular Affairs/Passport Services (CA/
PPT).
• Form Number: SV2012–0006.
• Respondents: A national
representative sample of U.S. citizens,
U.S. nationals, and any other categories
of individuals that are entitled to a U.S.
passport product.
• Estimated Number of Respondents:
4,000 survey respondents per month.
• Estimated Number of Responses:
48,000 survey responses per year.
• Average Time Per Response:
approx. 10 minutes per survey.
• Total Estimated Burden Time: 8,000
hours.
• Frequency: Monthly.
• Obligation to Respond: Voluntary.
We are soliciting public comments to
permit the Department to:
• Evaluate whether the proposed
information collection is necessary for
the proper functions of the Department.
• Evaluate the accuracy of our
estimate of the time and cost burden for
this proposed collection, including the
validity of the methodology and
assumptions used.
• Enhance the quality, utility, and
clarity of the information to be
collected.
• Minimize the reporting burden on
those who are to respond, including the
PO 00000
Frm 00106
Fmt 4703
Sfmt 4703
use of automated collection techniques
or other forms of information
technology.
Please note that comments submitted
in response to this Notice are public
record. Before including any detailed
personal information, you should be
aware that your comments as submitted,
including your personal information,
will be available for public review.
Abstract of proposed collection:
The Intelligence Reform and
Terrorism Prevention Act of 2004
(IRTPA) calls for the Secretary of
Homeland Security, along with the
Secretary of State, to develop and
implement a plan that requires
sufficient documentation of identity and
citizenship to be shown when entering
the United States. The requirement that
requires sufficient documentation of
identity and citizenship to be shown
when entering the United States along
with other socio-demographic variables
has left the future demand for U.S.
passport products as undefined. The
ambiguity of passport demand has
resulted in Passport Services (CA/PPT)
having an urgent need to obtain regular
statistical data on issues that focuses on
and are related to passport applications
and travel. In support of these efforts,
CA/PPT will conduct monthly forecasts
of passport demand. The data gathered
from the Passport Demand Forecasting
Study will be used to monitor, assess,
and forecast passport demand on a
continuous basis.
Methodology:
CA/PPT is conducting a Passport
Demand Forecast Study that includes
monthly surveys that will gather data
from a national representative sample of
U.S. citizens, U.S. nationals, and any
other categories of individuals that are
entitled to a U.S. passport product.
Methodologies can include mail, web/
internet, telephone, and mixed-mode
E:\FR\FM\15OCN1.SGM
15OCN1
]]>Agencies
[Federal Register Volume 77, Number 199 (Monday, October 15, 2012)]
[Notices]
[Pages 62593-62595]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-25277]
-----------------------------------------------------------------------
SOCIAL SECURITY ADMINISTRATION
Agency Information Collection Activities: Proposed 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 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
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
December 14, 2012. Individuals can obtain copies of the collection
instruments by writing to the above email address.
1. Certificate of Support--20 CFR 404.370, 404.750, 404.408a--0960-
0001. A parent of a deceased, fully insured worker may be entitled to
Social Security Old-Age, Survivors, and Disability Insurance (OASDI)
benefits
[[Page 62594]]
based on the earnings record of the deceased worker under certain
conditions. One of the conditions is the parent must have received at
least one-half support from the deceased worker. The one-half support
requirement also applies to a spousal applicant in determining whether
OASDI benefits are subject to Government Pension Offset (GPO). SSA uses
the information from Form SSA-760-F4 to determine if the parent of a
deceased worker or a spouse applicant meets the one-half support
requirement. Respondents are (1) parents of deceased workers and (2)
spouses who may meet the GPO exception.
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-760-F4.................................. 18,000 1 15 4,500
----------------------------------------------------------------------------------------------------------------
2. Pre-1957 Military Service Federal Benefit Questionnaire--20 CFR
404.1301-404.1371--0960-0120. SSA may grant gratuitous military wage
credits for active military or naval service (under certain conditions)
during the period September 16, 1940 through December 31, 1956, if no
other Federal agency (other than the Veterans Administration) credited
the service for benefit eligibility or computation purposes. We use
Form SSA-2512 to collect specific information about other Federal,
military, or civilian benefits the wage earner may receive when the
applicant indicates both pre-1957 military service and the receipt of a
Federal benefit. SSA uses the data in the claims adjudication process
to grant gratuitous military wage credits when applicable, and to
solicit sufficient information to determine eligibility. Respondents
are applicants for Social Security benefits on a record where the wage
earner claims pre-1957 military service.
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-2512.................................... 5,000 1 10 833
----------------------------------------------------------------------------------------------------------------
3. Authorization for the Social Security Administration to Obtain
Account Records from a Financial Institution and Request for Records--
20 CFR 416.200, 416.203--0960-0293. SSA collects and verifies financial
information from individuals applying for Supplemental Security Income
(SSI) to determine if the applicant meets the SSI resource eligibility
requirements. If the SSI claimants provide records that are incomplete,
unavailable, or seemingly altered, SSA contacts their financial
institution to verify the existence, ownership, and value of accounts
owned. Financial institutions require individuals to sign Form SSA-
4641-U2 to authorize them to disclose records to SSA. The respondents
are financial institutions of SSI applicants, recipients, and their
deemors.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Estimated
Number of Frequency of Average burden total annual
Modality of completion respondents response per response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4641 (paper)................................ 44,100 1 6 4,410
e4641 (electronic).............................. 6,955,900 1 2 231,863
---------------------------------------------------------------
Totals...................................... 7,000,000 .............. .............. 236,273
----------------------------------------------------------------------------------------------------------------
4. Response to Notice of Revised Determination--20 CFR 404.913-
404.914, 404.992(b), 416.1413-416.1414 and 416.1492(d)--0960-0347. When
SSA determines that (1) claimants for initial disability benefits do
not actually have a disability or (2) current disability recipients'
records show their disability ceased, SSA notifies the disability
claimants or recipients of this decision. In response to this notice,
the affected claimants and disability recipients have the following
recourse: (1) They may request a disability hearing to contest SSA's
decision and (2) they may submit additional information or evidence for
SSA to consider. Disability claimants, recipients, and their
representatives use Form SSA-765 to accomplish these two actions. The
respondents are disability claimants, current disability recipients, or
their representatives.
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-765..................................... 1,925 1 30 963
----------------------------------------------------------------------------------------------------------------
[[Page 62595]]
5. Notification of a Social Security Number (SSN) To An Employer
for Wage Reporting--20 CFR 422.103(a)--0960-0778. Individuals applying
for employment must provide an SSN or indicate they have applied for
one. However, when an individual applies for an initial SSN, there is a
delay between the assignment of the number and the delivery of the SSN
card. At an individual's request, SSA uses Form SSA-132 to send the
individual's SSN to an employer. Mailing this information to the
employer (1) ensures the employer has the correct SSN for the
individual; (2) allows SSA to receive correct earnings information for
wage reporting purposes; and (3) reduces the delay in the initial SSN
assignment and delivery of the SSN information directly to the
employer. It also enables SSA to verify the employer as a safeguard for
the applicant's personally identifiable information. The majority of
individuals who take advantage of this option are in the United States
with exchange visitor and student visas; however, we allow any
applicant for an SSN to use the SSA-132. The respondents are
individuals applying for an initial SSN who ask SSA to mail
confirmation of their application or the SSN to their employers.
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-132..................................... 249,000 1 2 8,300
----------------------------------------------------------------------------------------------------------------
Dated: October 10, 2012.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2012-25277 Filed 10-12-12; 8:45 am]
BILLING CODE 4191-02-P
