Agency Information Collection Activities: Proposed Request and Comment Request, 76160-76163 [2012-30949]
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76160
Federal Register / Vol. 77, No. 247 / Wednesday, December 26, 2012 / Notices
reasonable to not charge the Initial
Application Fee so as to avoid doublecharging issuers for the listing of their
shares of common or preferred stock or
common stock equivalents. It is also
equitable and not unfairly
discriminatory to waive the Initial
Application Fee because all such issuers
would be eligible for the waiver of the
Initial Application Fee. It is also
equitable and not unfairly
discriminatory because such issuers
would be under no obligation to transfer
their listing to the Exchange or dually
list on the Exchange and would be
disincentivized to do so if they were
subject to the Initial Application Fee. In
this regard, the waiver would contribute
to providing issuers with the ability to
choose the listing market that best suits
their needs and that is the ideal market
for listing their shares of common or
preferred stock or common stock
equivalents.
Overall, the Exchange believes that
instances of the Initial Application Fee
waiver being granted to issuers that
apply to list on the Exchange will be
relatively rare. Accordingly, the
Exchange does not anticipate that it will
experience any meaningful diminution
in revenue as a result of the proposed
waiver and therefore does not believe
that the proposed waiver would in any
way negatively affect its ability to
continue to adequately fund its
regulatory program or the services that
the Exchange provides to issuers.
B. Self-Regulatory Organization’s
Statement on Burden on Competition
The Exchange does not believe that
the proposed rule change will impose
any burden on competition that is not
necessary or appropriate in furtherance
of the purposes of the Act.
C. Self-Regulatory Organization’s
Statement on Comments on the
Proposed Rule Change Received From
Members, Participants, or Others
No written comments were solicited
or received with respect to the proposed
rule change.
tkelley on DSK3SPTVN1PROD with
III. Date of Effectiveness of the
Proposed Rule Change and Timing for
Commission Action
The foregoing rule change is effective
upon filing pursuant to Section
19(b)(3)(A) 9 of the Act and
subparagraph (f)(2) of Rule 19b–410
thereunder, because it establishes a due,
fee, or other charge imposed by the
NYSE MKT.
9 15
U.S.C. 78s(b)(3)(A).
CFR 240.19b–4(f)(2).
10 17
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At any time within 60 days of the
filing of such proposed rule change, the
Commission summarily may
temporarily suspend such rule change if
it appears to the Commission that such
action is necessary or appropriate in the
public interest, for the protection of
investors, or otherwise in furtherance of
the purposes of the Act.
IV. Solicitation of Comments
Interested persons are invited to
submit written data, views, and
arguments concerning the foregoing,
including whether the proposed rule
change is consistent with the Act.
Comments may be submitted by any of
the following methods:
Electronic Comments
• Use the Commission’s Internet
comment form (https://www.sec.gov/
rules/sro.shtml); or
• Send an email to rulecomments@sec.gov. Please include File
Number SR–NYSEMKT–2012–70 on the
subject line.
Paper Comments
• Send paper comments in triplicate
to Elizabeth M. Murphy, Secretary,
Securities and Exchange Commission,
100 F Street NE., Washington, DC
20549–1090.
All submissions should refer to File
Number SR–NYSEMKT–2012–70. This
file number should be included on the
subject line if email is used. To help the
Commission process and review your
comments more efficiently, please use
only one method. The Commission will
post all comments on the Commission’s
Internet Web site (https://www.sec.gov/
rules/sro.shtml). Copies of the
submission, all subsequent
amendments, all written statements
with respect to the proposed rule
change that are filed with the
Commission, and all written
communications relating to the
proposed rule change between the
Commission and any person, other than
those that may be withheld from the
public in accordance with the
provisions of 5 U.S.C. 552, will be
available for Web site viewing and
printing in the Commission’s Public
Reference Room, 100 F Street NE.,
Washington, DC 20549, on official
business days between the hours of
10:00 a.m. and 3:00 p.m. Copies of such
filing also will be available for
inspection and copying at the principal
office of the Exchange. All comments
received will be posted without change;
the Commission does not edit personal
identifying information from
submissions. You should submit only
information that you wish to make
PO 00000
Frm 00193
Fmt 4703
Sfmt 4703
publicly available. All submissions
should refer to File Number SR–
NYSEMKT–2012–70 and should be
submitted on or before January 16, 2013.
For the Commission, by the Division of
Trading and Markets, pursuant to delegated
authority.11
Kevin M. O’Neill,
Deputy Secretary.
[FR Doc. 2012–30978 Filed 12–21–12; 4:15 pm]
BILLING CODE 8011–01–P
SECURITIES AND EXCHANGE
COMMISSION
[File No. 500–1]
New Generation Biofuels Holdings,
Inc.; Order of Suspension of Trading
December 21, 2012.
It appears to the Securities and
Exchange Commission that there is a
lack of current and accurate information
concerning the securities of New
Generation Biofuels Holdings, Inc.
because it has not filed any periodic
reports since the period ended June 30,
2011.
The Commission is of the opinion that
the public interest and the protection of
investors require a suspension of trading
in the securities of the above-listed
company.
Therefore, it is ordered, pursuant to
Section 12(k) of the Securities Exchange
Act of 1934, that trading in the
securities of the above-listed company is
suspended for the period from 9:30 a.m.
EST, on December 21, 2012 through
11:59 p.m. EST, on January 7, 2013.
By the Commission.
Jill M. Peterson,
Assistant Secretary.
[FR Doc. 2012–31151 Filed 12–21–12; 4:15 pm]
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 of 1995, effective October
1, 1995. This notice includes revisions
to and an extension of OMB-approved
information collections.
SSA is soliciting comments on the
accuracy of the agency’s burden
11 17
E:\FR\FM\26DEN1.SGM
CFR 200.30–3(a)(12).
26DEN1
76161
Federal Register / Vol. 77, No. 247 / Wednesday, December 26, 2012 / Notices
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
for U.S. Social Security benefits directly
with one of the Italian Social Security
agencies must complete Form SSA–
2528. SSA uses the SSA–2528 to
establish age, relationship, citizenship,
marriage, death, military service, or to
evaluate a family bible or other family
record when determining eligibility for
benefits. The Italian Social Security
agencies assist applicants in completing
Form SSA–2528, and then forward the
application to SSA for processing. The
respondents are individuals living in
Italy who wish to file for U.S. Social
Security benefits.
Type of Request: Revision of an OMBapproved information collection.
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 February 22,
2013. Individuals can obtain copies of
the collection instruments by writing to
the above email address.
1. Application for Benefits Under the
Italy-U.S. International Social Security
Agreement—20 CFR 404.1925—0960–
0445. As per the November 1, 1978
agreement between the United States
and Italian Social Security agencies,
residents of Italy filing an application
Modality of completion
Number of
responses
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–2528 ........................................................................................................
300
1
20
100
2. Internet Direct Deposit
Application—31 CFR 210—0960–0634.
SSA requires all applicants and
recipients of Social Security Old Age,
Survivors, and Disability Insurance
(OASDI) benefits, or Supplemental
Security Income (SSI) payments to
receive these benefits and payments via
direct deposit at a financial institution.
SSA receives Direct Deposit/Electronic
Funds Transfer (DD/EFT) enrollment
information from OASDI beneficiaries
and SSI recipients to facilitate DD/EFT
of their funds with their chosen
financial institution. We also use this
information when an enrolled
individual wishes to change their DD/
EFT information. For the convenience of
the respondents, we collect this
information through several modalities,
including an Internet application, inoffice or telephone interviews, and our
automated telephone system. In
addition to using the direct deposit
Number of
respondents
Modality of completion
information to enable DD/EFT of funds
to the recipients’ chosen financial
institution, we also use the information
through our Direct Deposit Fraud
Indicator to ensure the correct recipient
receives the funds. Respondents are
OASDI beneficiaries and SSI recipients
requesting that we enroll them in the
Direct Deposit program or change their
direct deposit banking information.
Type of Request: Extension of an
OMB-approved information collection.
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
Internet DD ......................................................................................................
Non-Electronic
Services
(FO,
800#-ePath,
MSSICS,SPS,MACADE,POS,RP) ...............................................................
Automated 800# Response System ................................................................
Direct Deposit Fraud Indicator .........................................................................
188,129
1
10
31,355
6,455,815
237,065
10,000
1
1
1
12
8
2
1,291,163
31,609
333
Totals ........................................................................................................
6,891,009
........................
........................
1,354,460
tkelley on DSK3SPTVN1PROD with
3. Certification of Contents of
Document(s) or Record(s)—20 CFR
404.715—0960–0689. SSA established
procedures for individuals to provide
the evidence necessary to establish their
rights to Social Security benefits.
Examples of such evidence categories
include age, relationship, citizenship,
marriage, death, and military service.
VerDate Mar<15>2010
06:31 Dec 22, 2012
Jkt 229001
Form SSA–704 allows SSA employees,
State record custodians, and other
custodians of evidentiary documents to
certify and record information from
original documents and records under
their custodial ownership to establish
these types of evidence. SSA uses Form
SSA–704 in situations where
individuals cannot produce the original
PO 00000
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Fmt 4703
Sfmt 4703
evidentiary documentation required to
establish benefits eligibility. The
respondents are State record custodians
and other custodians of evidentiary
documents.
Type of Request: Revision of an OMBapproved information collection.
E:\FR\FM\26DEN1.SGM
26DEN1
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Federal Register / Vol. 77, No. 247 / Wednesday, December 26, 2012 / Notices
Modality of completion
Number of
responses
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–704 ..........................................................................................................
4,800
1
10
800
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
January 23, 2013. Individuals can obtain
copies of the OMB clearance packages
by writing to
OR.Reports.Clearance@ssa.gov.
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 OASDI benefits 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 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. Physician’s/Medical Officer’s
Statement of Patient’s Capability to
Manage Benefits—20 CFR 404.2015 and
416.615—0960–0024. SSA appoints a
representative payee in cases where we
determine beneficiaries are not capable
of managing their own benefits. In those
instances, we require medical evidence
to determine the beneficiaries’
capability of managing or directing their
benefit payments. SSA collects medical
evidence on Form SSA–787 to (1)
determine beneficiaries’ capability or
inability to handle their own benefits,
and (2) assist in determining the
beneficiaries’ need for a representative
payee. The respondents are the
beneficiaries’ physicians, or medical
officers of the institution in which the
beneficiaries reside.
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–787 ..........................................................................................................
120,000
1
10
20,000
3. 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.
Number of
respondents
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–2512 ........................................................................................................
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Modality of completion
5,000
1
10
833
4. 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
VerDate Mar<15>2010
06:31 Dec 22, 2012
Jkt 229001
collects and verifies financial
information from individuals applying
for SSI to determine if the applicant
meets the SSI resource eligibility
requirements. SSA contacts claimants’
PO 00000
Frm 00195
Fmt 4703
Sfmt 4703
financial institutions to verify the
existence, ownership, and value of the
account owned when the claimants
provide incomplete, unavailable, or
seemingly altered records. Financial
E:\FR\FM\26DEN1.SGM
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Federal Register / Vol. 77, No. 247 / Wednesday, December 26, 2012 / Notices
institutions require individuals to sign
Form SSA–461–U2 to authorize them to
disclose records to SSA. The
respondents are SSI applicants,
recipients, and their deemors.
SSA–4641 (paper) ...........................................................................................
e4641 (electronic) ............................................................................................
Totals ........................................................................................................
5. Statement of Household Expenses
and Contributions—20 CFR 416.1130–
416.1148—0960–0456. SSA bases
eligibility for 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
Type of Request: Revision of an OMBapproved information collection.
Frequency of
response
Average
burden per
response
(minutes)
1
1
........................
6
2
........................
Number of
respondents
Modality of completion
44,100
6,955,900
7,000,000
76163
form of food and shelter provided by
others. SSA uses Form SSA–8011–F3 to
determine whether 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
Estimated total
annual burden
(hours)
4,410
231,863
236,273
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
6. 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: December 19, 2012.
Faye Lipsky,
Reports Clearance Director, Social Security
Administration.
[FR Doc. 2012–30949 Filed 12–21–12; 8:45 am]
BILLING CODE 4191–02–P
DEPARTMENT OF STATE
[Public Notice: 8134]
30-Day Notice of Proposed Information
Collection: Application for Consular
Report of Birth Abroad of a Citizen of
the United States of America
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
tkelley on DSK3SPTVN1PROD with
SUMMARY:
VerDate Mar<15>2010
06:31 Dec 22, 2012
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Sfmt 4703
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 January 25, 2013.
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
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]]>Agencies
[Federal Register Volume 77, Number 247 (Wednesday, December 26, 2012)]
[Notices]
[Pages 76160-76163]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-30949]
=======================================================================
-----------------------------------------------------------------------
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 an extension of OMB-approved information
collections.
SSA is soliciting comments on the accuracy of the agency's burden
[[Page 76161]]
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.
I. The information collections below are pending at SSA. SSA will
submit them to OMB within 60 days from the date of this notice. To be
sure we consider your comments, we must receive them no later than
February 22, 2013. Individuals can obtain copies of the collection
instruments by writing to the above email address.
1. Application for Benefits Under the Italy-U.S. International
Social Security Agreement--20 CFR 404.1925--0960-0445. As per the
November 1, 1978 agreement between the United States and Italian Social
Security agencies, residents of Italy filing an application for U.S.
Social Security benefits directly with one of the Italian Social
Security agencies must complete Form SSA-2528. SSA uses the SSA-2528 to
establish age, relationship, citizenship, marriage, death, military
service, or to evaluate a family bible or other family record when
determining eligibility for benefits. The Italian Social Security
agencies assist applicants in completing Form SSA-2528, and then
forward the application to SSA for processing. The respondents are
individuals living in Italy who wish to file for U.S. Social Security
benefits.
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-2528.................................... 300 1 20 100
----------------------------------------------------------------------------------------------------------------
2. Internet Direct Deposit Application--31 CFR 210--0960-0634. SSA
requires all applicants and recipients of Social Security Old Age,
Survivors, and Disability Insurance (OASDI) benefits, or Supplemental
Security Income (SSI) payments to receive these benefits and payments
via direct deposit at a financial institution. SSA receives Direct
Deposit/Electronic Funds Transfer (DD/EFT) enrollment information from
OASDI beneficiaries and SSI recipients to facilitate DD/EFT of their
funds with their chosen financial institution. We also use this
information when an enrolled individual wishes to change their DD/EFT
information. For the convenience of the respondents, we collect this
information through several modalities, including an Internet
application, in-office or telephone interviews, and our automated
telephone system. In addition to using the direct deposit information
to enable DD/EFT of funds to the recipients' chosen financial
institution, we also use the information through our Direct Deposit
Fraud Indicator to ensure the correct recipient receives the funds.
Respondents are OASDI beneficiaries and SSI recipients requesting that
we enroll them in the Direct Deposit program or change their direct
deposit banking information.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average Estimated
Number of Frequency of burden per total annual
Modality of completion respondents response response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
Internet DD..................................... 188,129 1 10 31,355
Non-Electronic Services (FO, 800-ePath, 6,455,815 1 12 1,291,163
MSSICS,SPS,MACADE,POS,RP)......................
Automated 800 Response System.......... 237,065 1 8 31,609
Direct Deposit Fraud Indicator.................. 10,000 1 2 333
---------------------------------------------------------------
Totals...................................... 6,891,009 .............. .............. 1,354,460
----------------------------------------------------------------------------------------------------------------
3. Certification of Contents of Document(s) or Record(s)--20 CFR
404.715--0960-0689. SSA established procedures for individuals to
provide the evidence necessary to establish their rights to Social
Security benefits. Examples of such evidence categories include age,
relationship, citizenship, marriage, death, and military service. Form
SSA-704 allows SSA employees, State record custodians, and other
custodians of evidentiary documents to certify and record information
from original documents and records under their custodial ownership to
establish these types of evidence. SSA uses Form SSA-704 in situations
where individuals cannot produce the original evidentiary documentation
required to establish benefits eligibility. The respondents are State
record custodians and other custodians of evidentiary documents.
Type of Request: Revision of an OMB-approved information
collection.
[[Page 76162]]
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
responses response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-704..................................... 4,800 1 10 800
----------------------------------------------------------------------------------------------------------------
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 January 23, 2013. Individuals can obtain copies of the
OMB clearance packages by writing to OR.Reports.Clearance@ssa.gov.
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 OASDI benefits 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. Physician's/Medical Officer's Statement of Patient's Capability
to Manage Benefits--20 CFR 404.2015 and 416.615--0960-0024. SSA
appoints a representative payee in cases where we determine
beneficiaries are not capable of managing their own benefits. In those
instances, we require medical evidence to determine the beneficiaries'
capability of managing or directing their benefit payments. SSA
collects medical evidence on Form SSA-787 to (1) determine
beneficiaries' capability or inability to handle their own benefits,
and (2) assist in determining the beneficiaries' need for a
representative payee. The respondents are the beneficiaries'
physicians, or medical officers of the institution in which the
beneficiaries reside.
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-787..................................... 120,000 1 10 20,000
----------------------------------------------------------------------------------------------------------------
3. 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
----------------------------------------------------------------------------------------------------------------
4. 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 SSI to determine if the
applicant meets the SSI resource eligibility requirements. SSA contacts
claimants' financial institutions to verify the existence, ownership,
and value of the account owned when the claimants provide incomplete,
unavailable, or seemingly altered records. Financial
[[Page 76163]]
institutions require individuals to sign Form SSA-461-U2 to authorize
them to disclose records to SSA. The respondents are SSI applicants,
recipients, and their deemors.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average Estimated
Number of Frequency of burden per total annual
Modality of completion respondents response 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
----------------------------------------------------------------------------------------------------------------
5. Statement of Household Expenses and Contributions--20 CFR
416.1130-416.1148--0960-0456. SSA bases eligibility for 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
others. SSA uses Form SSA-8011-F3 to determine whether 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 OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-8011-F3................................. 428,100 1 15 107,025
----------------------------------------------------------------------------------------------------------------
6. 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: December 19, 2012.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2012-30949 Filed 12-21-12; 8:45 am]
BILLING CODE 4191-02-P
