Agency Information Collection Activities: Proposed Request and Comment Request, 26798-26801 [2014-10662]
Download as PDF
<![CDATA[
26798
Federal Register / Vol. 79, No. 90 / Friday, May 9, 2014 / Notices
ehiers on DSK2VPTVN1PROD with NOTICES
that there is a lack of current and
accurate information concerning the
securities of Technipower Systems, Inc.
because it has not filed any periodic
reports since the period ended
September 30, 2008.
Theater Xtreme Entertainment Group,
Inc. (CIK No. 1089775) is a dissolved
Florida corporation located in Newark,
Delaware with a class of securities
registered with the Commission
pursuant to Exchange Act Section 12(g).
Theater Xtreme Entertainment Group is
delinquent in its periodic filings with
the Commission, having not filed any
periodic reports since it filed a Form
10–Q for the period ended September
30, 2008, which reported a net loss of
over $987,815 for the prior three
months. As of May 1, 2014, the
company’s stock (symbol ‘‘TXEGQ’’)
was quoted on OTC Link, had five
market makers, and was eligible for the
‘‘piggyback’’ exception of Exchange Act
Rule 15c2–11(f)(3). It appears to the
Securities and Exchange Commission
that there is a lack of current and
accurate information concerning the
securities of Theater Xtreme
Entertainment Group, Inc. because it has
not filed any periodic reports since the
period ended September 30, 2008.
WorldGate Communications, Inc. (CIK
No. 1030058) is a forfeited Delaware
corporation located in Trevose,
Pennsylvania with a class of securities
registered with the Commission
pursuant to Exchange Act Section 12(g).
WorldGate Communications, Inc. is
delinquent in its periodic filings with
the Commission, having not filed any
periodic reports since it filed a Form
10–Q for the period ended September
30, 2011, which reported a net loss of
$4,470,000 for the prior nine months. As
of May 1, 2014, the company’s stock
(symbol ‘‘WGATQ’’) was quoted on OTC
Link, had ten market makers, and was
eligible for the ‘‘piggyback’’ exception of
Exchange Act Rule 15c2–11(f)(3). It
appears to the Securities and Exchange
Commission that there is a lack of
current and accurate information
concerning the securities of WorldGate
Communications, Inc. because it has not
filed any periodic reports since the
period ended September 30, 2011.
YTB International, Inc. (a/k/a 1803
International, Inc.) (CIK No. 852766) is
a Delaware corporation located in Wood
River, Illinois with a class of securities
registered with the Commission
pursuant to Exchange Act Section 12(g).
YTB International, Inc. is delinquent in
its periodic filings with the
Commission, having not filed any
periodic reports since it filed a Form
10–Q for the period ended September
30, 2011, which reported a net loss of
$668,000 for the prior three months. As
of May 1, 2014, the company’s stock
(symbol ‘‘YTBLQ’’) was quoted on OTC
Link, had ten market makers, and was
eligible for the ‘‘piggyback’’ exception of
Exchange Act Rule 15c2–11(f)(3). It
appears to the Securities and Exchange
Commission that there is a lack of
current and accurate information
concerning the securities of YTB
International, Inc. because it has not
filed any periodic reports since the
period ended September 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
companies.
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 companies
is suspended for the period from 9:30
a.m. EDT on May 7, 2014, through 11:59
p.m. EDT on May 20, 2014.
By the Commission.
Jill M. Peterson,
Assistant Secretary.
[FR Doc. 2014–10797 Filed 5–7–14; 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
of OMB-approved information
collections.
SSA is soliciting comments on the
accuracy of the agency’s burden
estimate; the need for the information;
its practical utility; ways to enhance its
quality, utility, and clarity; and ways to
minimize burden on respondents,
including the use of automated
collection techniques or other forms of
information technology. Mail, email, or
fax your comments and
recommendations on the information
collection(s) to the OMB Desk Officer
and SSA Reports Clearance Officer at
the following addresses or fax numbers.
(OMB) Office of Management and
Budget, Attn: Desk Officer for SSA,
Fax: 202–395–6974, Email address:
OIRA_Submission@omb.eop.gov.
(SSA) Social Security Administration,
OLCA, Attn: Reports Clearance
Director, 3100 West High Rise, 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 July 8, 2014.
Individuals can obtain copies of the
collection instruments by writing to the
above email address.
1. Statement Regarding Date of Birth
and Citizenship—20CFR 404.716—
0960–0016. Section 205(a) of the Social
Security Act (Act) gives the
Commissioner of SSA the authority to
make rules and regulations, and to
establish procedures for collecting
evidence from individuals applying for
Social Security benefits. When
individuals apply for Social Security
benefits and cannot provide preferred
methods of proving age or citizenship,
SSA uses Form SSA–702 to establish
these facts. Specifically, SSA uses the
SSA–702 to establish age as a factor of
entitlement to Social Security benefits,
or U.S. citizenship as a payment factor.
Respondents are individuals with
knowledge about the date of birth or
citizenship of applicants filing for one
or more Social Security benefits who
need to establish age or citizenship.
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–7157 ........................................................................................................
1,200
1
10
200
VerDate Mar<15>2010
14:53 May 08, 2014
Jkt 232001
PO 00000
Frm 00089
Fmt 4703
Sfmt 4703
E:\FR\FM\09MYN1.SGM
09MYN1
26799
Federal Register / Vol. 79, No. 90 / Friday, May 9, 2014 / Notices
2. Disability Report-Appeal—20 CFR
404.1512, 416.912, 404.916(c),
416.1416(c), 422.140, 404.1713,
416.1513, 404.1740(b)(4),
416.1540(b)(4), and 405 Subpart C—
0960–0144. SSA requires disability
applicants who wish to appeal an
unfavorable disability determination to
complete Form SSA–3441–BK, the
associated Electronic Disability Collect
System (EDCS) interview, or the Internet
application, i3441. This allows
claimants to disclose any changes to
their disability or resources that might
influence SSA’s unfavorable
determination. We may use the
information to: (1) Reconsider and
review an initial disability
determination; (2) review a continuing
disability; and (3) evaluate a request for
a hearing. This information assists the
State Disability Determination Services
(DDS) and administrative law judges
(ALJ) in preparing for the appeals and
hearings, and in issuing a determination
or decision on an individual’s
entitlement (initial or continuing) to
disability benefits. In addition, the
information we collect on the SSA–
3441–BK facilitates SSA’s collection of
Number of
respondents
Modality of completion
medical information to support the
applicant’s request for reconsideration;
request for benefits cessation appeal;
and request for a hearing before an ALJ.
Respondents are individuals who
appeal denial, reduction, or cessation of
Social Security disability income and
Supplemental Security Income (SSI)
payments; who wish to request a
hearing before an ALJ; or their
representatives.
Type of Request: Revision of an OMBapproved information collection.
Average
burden per
response
(minutes)
Frequency
of response
Estimated
total annual
burden
(hours)
SSA–3441–BK .................................................................................................
Electronic Disability Collect System (EDCS) ...................................................
i3441 (Internet) ................................................................................................
2,396
476,771
1,046,938
1
1
1
45
45
28
1,797
357,578
488,571
Totals ........................................................................................................
1,526,105
........................
........................
847,946
3. Request for Hearing by
Administrative Law Judge—20 CFR
404.929, 404.933, 416.1429, 404.1433,
418.1350, and 42 CFR 405.722—0960–
0269. When SSA denies applicants’ or
beneficiaries’ requests for new or
continuing benefits, the Act entitles
those applicants or beneficiaries to
request a hearing to appeal the decision.
To request a hearing, individuals
complete Form HA–501, the associated
Modernized Claims System (MCS) or
Modernized Supplemental Security
Income Claims System (MSSICS)
interview, or the Internet application
(i501). SSA uses the information to
determine if the individual: (1) Filed the
request within the prescribed time; (2)
is the proper party; and (3) took the
steps necessary to obtain the right to a
hearing. SSA also uses the information
to determine: (1) The individual’s
reason(s) for disagreeing with SSA’s
prior determinations in the case; (2) if
the individual has additional evidence
to submit; (3) if the individual wants an
Number of
respondents
Modality of completion
oral hearing or a decision on the record;
and (4) whether the individual has (or
wants to appoint) a representative. The
respondents are Social Security benefit
applicants and recipients who want to
appeal SSA’s denial of their request for
new or continued benefits, and
Medicare Part B recipients who must
pay the Medicare Part B Income-Related
Monthly Adjustment Amount.
Type of Request: Revision of an OMBapproved information collection.
Average
burden per
response
(minutes)
Frequency
of response
Estimated
total annual
burden
(hours)
HA–501; Modernized Claims System (MCS); Modernized Supplemental Security Income Claims System (MSSICS) .....................................................
I501 (Internet iAppeals) ...................................................................................
25,953
643,516
1
1
10
5
4,326
53,626
Totals ........................................................................................................
669,469
........................
........................
57,952
Agreements) between the United States
and foreign countries. SSA collects
information using Form SSA–2490–BK
to determine entitlement to Social
Security benefits from the United States,
or from a country that enters into a
totalization agreement with the United
ehiers on DSK2VPTVN1PROD with NOTICES
4. Application for Benefits under a
U.S. International Social Security
Agreement—20 CFR 404.1925—0960–
0448. Section 233(a) of the Act
authorizes the President of the United
States to broker international Social
Security agreements (Totalization
Number of
respondents
Modality of completion
States. The respondents are individuals
applying for Old Age, Survivors, and
Disability Insurance benefits from the
United States or from a Totalization
Agreement country.
Type of Request: Revision of an OMBapproved information collection.
Average
burden per
response
(minutes)
Frequency
of response
Estimated
total annual
burden
(hours)
SSA–2490–BK (MCS) .....................................................................................
SSA–2490–BK (paper) ....................................................................................
14,175
2,025
1
1
30
30
7,088
1,013
Totals ........................................................................................................
16,200
........................
........................
8,101
VerDate Mar<15>2010
14:53 May 08, 2014
Jkt 232001
PO 00000
Frm 00090
Fmt 4703
Sfmt 4703
E:\FR\FM\09MYN1.SGM
09MYN1
26800
Federal Register / Vol. 79, No. 90 / Friday, May 9, 2014 / Notices
5. Information Collections Conducted
by State Disability Determination
Services on Behalf of SSA—20 CFR,
subpart P, 404.1503a, 404.1512,
404.1513, 404.1514 404.1517, 404.1519;
20 CFR subpart Q, 404.1613, 404.1614,
404.1624; 20 CFR subpart I, 416.903a,
416.912, 416.913, 416.914, 416.917,
416.919 and 20 CFR subpart J, 416.1013,
416.1024, 416.1014—0960–0555. State
DDSs collect the information necessary
to administer the Social Security
Disability Insurance and SSI programs.
They collect medical evidence from
consultative examination (CE) sources,
credential information from CE source
applicants, and medical evidence of
record (MER) from claimants’ medical
sources. The DDSs collect information
from claimants regarding medical
appointments and pain or other
symptoms. The respondents are medical
providers, other sources of MER, and
disability claimants.
Type of Request: Revision of an OMBapproved information collection.
CE Collections
claimants’ medical condition(s) that
DDS’s use to make disability
determinations when the claimant’s
own medical sources cannot or will not
provide the required information, and
proof of credentials from CE providers;
(2) CE appointment letters; and (3) CE
claimant reports sent to claimants’
doctors.
(1) Medical Evidence and Credentials
From CE Providers
There are three CE information
collections: (1) Medical evidence about
Number of
respondents
Modality of completion
Average
burden per
response
(minutes)
Frequency
of response
Total
estimated
annual burden
(hours)
CE Paper Submissions ....................................................................................
CE Electronic Submissions .............................................................................
1,400,000
300,000
1
1
30
15
700,000
75,000
Totals ........................................................................................................
1,700,000
........................
........................
775,000
Frequency
of response
Average
burden per
response
(minutes)
(2) CE Appointment Letters and (3) CE
Claimants’ Report to Medical Providers
Number of
respondents
Modality of completion
Estimated
annual burden
(hours)
(b) CE Appointment Letters .............................................................................
(c) CE Claimants’ Report to Medical Providers ...............................................
880,000
450,000
1
1
5
5
73,333
37,500
Totals ........................................................................................................
1,330,000
........................
........................
110,833
Frequency of
response
Average
burden per
response
(minutes)
MER Collections
The DDS’s collect MER information
from the claimant’s medical sources to
determine a claimant’s physical or
mental status prior to making a
disability determination.
Number of
respondents
Modality of completion
Total
estimated
annual burden
(hours)
Paper Submissions ..........................................................................................
Electronic Submissions ....................................................................................
3,150,000
9,450,000
1
1
20
12
1,050,000
1,890,000
Totals ........................................................................................................
12,600,000
........................
........................
2,940,000
Pain or Other Symptoms—Impairment
Information From Claimants
The DDSs use information about pain
or symptoms to determine how pain or
symptoms affect the claimant’s ability to
do work-related activities prior to
making a disability determination.
ehiers on DSK2VPTVN1PROD with NOTICES
Modality of completion
Number of
respondents
Frequency of
response
Average
burden per
response
(minutes)
Total
estimated
annual burden
(hours)
Pain or Other Symptoms .................................................................................
2,100,000
1
20
700,000
The total estimated annual burden for
all of the categories described in this
VerDate Mar<15>2010
14:53 May 08, 2014
Jkt 232001
information collection is 4,525,833
hours.
PO 00000
Frm 00091
Fmt 4703
Sfmt 4703
6. Request for Reconsideration—20
CFR 404.907–404.921, 416.1407–
E:\FR\FM\09MYN1.SGM
09MYN1
26801
Federal Register / Vol. 79, No. 90 / Friday, May 9, 2014 / Notices
416.1421, 408.1009, and 418.1325—
0960–0622. Individuals use Form SSA–
561–U2, the associated MCS interview,
or the Internet application (i561) to
initiate a request for reconsideration of
a denied claim. SSA uses the
information to document the request
and to determine an individual’s
eligibility or entitlement to Social
Security benefits (Title II), SSI payments
(Title XVI), Special Veterans Benefits
(Title VIII), Medicare (Title XVIII), and
for initial determinations regarding
Medicare Part B income-related
Number of
respondents
Modality of completion
premium subsidy reductions. The
respondents are individuals filing for
reconsideration of a denied claim.
Type of Request: Revision of an OMBapproved information collection.
Average
burden per
response
(minutes)
Frequency of
response
Estimated
total
annual burden
(hours)
SSA–561 and MCS .........................................................................................
I561 (Internet iAppeals) ...................................................................................
550,370
911,330
1
1
8
5
73,383
75,944
Totals ........................................................................................................
1,461,700
........................
........................
149,327
7. Teacher Questionnaire and Request
for Administrative Information—20 CFR
416.1103(f)—0960–0646. When
determining the effects of a child’s
impairment for children applying for
Title II childhood disability benefits,
SSA obtains information about the
child’s functioning from teachers,
parents, and others who observe the
child on a daily basis. SSA obtains
results of formal testing, teacher reports,
therapy progress notes, individualized
education programs, and other records
of a child’s educational aptitude and
Number of
respondents
Modality of completion
achievement using Forms SSA–5665–
BK and SSA–5666. The respondents are
parents, teachers, and other education
personnel.
Type of Request: Revision of an OMBapproved information collection.
Average
burden per
response
(minutes)
Frequency of
response
Estimated
total annual
burden
(hours)
SSA–5665–BK (electronic) ..............................................................................
SSA–5665 (paper form) ...................................................................................
SSA–5666 (electronic) .....................................................................................
SSA–5666 (paper form) ...................................................................................
368,098
2,562
137,590
1,843
1
1
1
1
40
40
30
30
245,399
1,708
68,795
922
Totals ........................................................................................................
510,093
........................
........................
316,824
II. SSA submitted the information
collection below to OMB for clearance.
Your comments regarding the
information collection 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 June
9, 2014. Individuals can obtain copies of
the OMB clearance package by writing
to OR.Reports.Clearance@ssa.gov.
Request for Social Security Earnings
Information—20CFR 404.810 &
401.100—0960–0525. The Act permits
wage earners, or their authorized
representative, to request Social
Security earnings information from SSA
using Form SSA–7050–F4. SSA uses the
information to verify the requestor’s
right to access to the information and to
produce the earnings statement. The
respondents are wage earners and their
authorized representatives.
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–7050–F4 ..................................................................................................
66,800
1
11
12,247
Dated: May 6, 2014.
Faye Lipsky,
Reports Clearance Director, Social Security
Administration.
ehiers on DSK2VPTVN1PROD with NOTICES
[FR Doc. 2014–10662 Filed 5–8–14; 8:45 am]
BILLING CODE 4191–02–P
DEPARTMENT OF STATE
[Public Notice: 8723]
60-Day Notice of Proposed Information
Collection: Certificate of Eligibility for
Exchange Visitor Status (J-Visa)
Notice of request for public
comment.
ACTION:
The Department of State is
seeking Office of Management and
Budget (OMB) approval for the
SUMMARY:
VerDate Mar<15>2010
14:53 May 08, 2014
Jkt 232001
PO 00000
Frm 00092
Fmt 4703
Sfmt 4703
information collection described below.
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 60 days for public
comment preceding submission of the
collection to OMB.
The Department will accept
comments from the public up to July 8,
2014.
DATE(S):
E:\FR\FM\09MYN1.SGM
09MYN1
]]>Agencies
[Federal Register Volume 79, Number 90 (Friday, May 9, 2014)]
[Notices]
[Pages 26798-26801]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-10662]
=======================================================================
-----------------------------------------------------------------------
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 of OMB-approved information collections.
SSA is soliciting comments on the accuracy of the agency's burden
estimate; the need for the information; its practical utility; ways to
enhance its quality, utility, and clarity; and ways to minimize burden
on respondents, including the use of automated collection techniques or
other forms of information technology. Mail, email, or fax your
comments and recommendations on the information collection(s) to the
OMB Desk Officer and SSA Reports Clearance Officer at the following
addresses or fax numbers.
(OMB) Office of Management and Budget, Attn: Desk Officer for SSA, Fax:
202-395-6974, Email address: OIRA_Submission@omb.eop.gov.
(SSA) Social Security Administration, OLCA, Attn: Reports Clearance
Director, 3100 West High Rise, 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 July
8, 2014. Individuals can obtain copies of the collection instruments by
writing to the above email address.
1. Statement Regarding Date of Birth and Citizenship--20CFR
404.716--0960-0016. Section 205(a) of the Social Security Act (Act)
gives the Commissioner of SSA the authority to make rules and
regulations, and to establish procedures for collecting evidence from
individuals applying for Social Security benefits. When individuals
apply for Social Security benefits and cannot provide preferred methods
of proving age or citizenship, SSA uses Form SSA-702 to establish these
facts. Specifically, SSA uses the SSA-702 to establish age as a factor
of entitlement to Social Security benefits, or U.S. citizenship as a
payment factor. Respondents are individuals with knowledge about the
date of birth or citizenship of applicants filing for one or more
Social Security benefits who need to establish age or citizenship.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Modality of completion Number of Frequency of per response total annual
respondents response (minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-7157.................................... 1,200 1 10 200
----------------------------------------------------------------------------------------------------------------
[[Page 26799]]
2. Disability Report-Appeal--20 CFR 404.1512, 416.912, 404.916(c),
416.1416(c), 422.140, 404.1713, 416.1513, 404.1740(b)(4),
416.1540(b)(4), and 405 Subpart C--0960-0144. SSA requires disability
applicants who wish to appeal an unfavorable disability determination
to complete Form SSA-3441-BK, the associated Electronic Disability
Collect System (EDCS) interview, or the Internet application, i3441.
This allows claimants to disclose any changes to their disability or
resources that might influence SSA's unfavorable determination. We may
use the information to: (1) Reconsider and review an initial disability
determination; (2) review a continuing disability; and (3) evaluate a
request for a hearing. This information assists the State Disability
Determination Services (DDS) and administrative law judges (ALJ) in
preparing for the appeals and hearings, and in issuing a determination
or decision on an individual's entitlement (initial or continuing) to
disability benefits. In addition, the information we collect on the
SSA-3441-BK facilitates SSA's collection of medical information to
support the applicant's request for reconsideration; request for
benefits cessation appeal; and request for a hearing before an ALJ.
Respondents are individuals who appeal denial, reduction, or cessation
of Social Security disability income and Supplemental Security Income
(SSI) payments; who wish to request a hearing before an ALJ; or their
representatives.
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-3441-BK..................................... 2,396 1 45 1,797
Electronic Disability Collect System (EDCS)..... 476,771 1 45 357,578
i3441 (Internet)................................ 1,046,938 1 28 488,571
---------------------------------------------------------------
Totals...................................... 1,526,105 .............. .............. 847,946
----------------------------------------------------------------------------------------------------------------
3. Request for Hearing by Administrative Law Judge--20 CFR 404.929,
404.933, 416.1429, 404.1433, 418.1350, and 42 CFR 405.722--0960-0269.
When SSA denies applicants' or beneficiaries' requests for new or
continuing benefits, the Act entitles those applicants or beneficiaries
to request a hearing to appeal the decision. To request a hearing,
individuals complete Form HA-501, the associated Modernized Claims
System (MCS) or Modernized Supplemental Security Income Claims System
(MSSICS) interview, or the Internet application (i501). SSA uses the
information to determine if the individual: (1) Filed the request
within the prescribed time; (2) is the proper party; and (3) took the
steps necessary to obtain the right to a hearing. SSA also uses the
information to determine: (1) The individual's reason(s) for
disagreeing with SSA's prior determinations in the case; (2) if the
individual has additional evidence to submit; (3) if the individual
wants an oral hearing or a decision on the record; and (4) whether the
individual has (or wants to appoint) a representative. The respondents
are Social Security benefit applicants and recipients who want to
appeal SSA's denial of their request for new or continued benefits, and
Medicare Part B recipients who must pay the Medicare Part B Income-
Related Monthly Adjustment Amount.
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)
----------------------------------------------------------------------------------------------------------------
HA-501; Modernized Claims System (MCS); 25,953 1 10 4,326
Modernized Supplemental Security Income Claims
System (MSSICS)................................
I501 (Internet iAppeals)........................ 643,516 1 5 53,626
---------------------------------------------------------------
Totals...................................... 669,469 .............. .............. 57,952
----------------------------------------------------------------------------------------------------------------
4. Application for Benefits under a U.S. International Social
Security Agreement--20 CFR 404.1925--0960-0448. Section 233(a) of the
Act authorizes the President of the United States to broker
international Social Security agreements (Totalization Agreements)
between the United States and foreign countries. SSA collects
information using Form SSA-2490-BK to determine entitlement to Social
Security benefits from the United States, or from a country that enters
into a totalization agreement with the United States. The respondents
are individuals applying for Old Age, Survivors, and Disability
Insurance benefits from the United States or from a Totalization
Agreement country.
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-2490-BK (MCS)............................... 14,175 1 30 7,088
SSA-2490-BK (paper)............................. 2,025 1 30 1,013
---------------------------------------------------------------
Totals...................................... 16,200 .............. .............. 8,101
----------------------------------------------------------------------------------------------------------------
[[Page 26800]]
5. Information Collections Conducted by State Disability
Determination Services on Behalf of SSA--20 CFR, subpart P, 404.1503a,
404.1512, 404.1513, 404.1514 404.1517, 404.1519; 20 CFR subpart Q,
404.1613, 404.1614, 404.1624; 20 CFR subpart I, 416.903a, 416.912,
416.913, 416.914, 416.917, 416.919 and 20 CFR subpart J, 416.1013,
416.1024, 416.1014--0960-0555. State DDSs collect the information
necessary to administer the Social Security Disability Insurance and
SSI programs. They collect medical evidence from consultative
examination (CE) sources, credential information from CE source
applicants, and medical evidence of record (MER) from claimants'
medical sources. The DDSs collect information from claimants regarding
medical appointments and pain or other symptoms. The respondents are
medical providers, other sources of MER, and disability claimants.
Type of Request: Revision of an OMB-approved information
collection.
CE Collections
There are three CE information collections: (1) Medical evidence
about claimants' medical condition(s) that DDS's use to make disability
determinations when the claimant's own medical sources cannot or will
not provide the required information, and proof of credentials from CE
providers; (2) CE appointment letters; and (3) CE claimant reports sent
to claimants' doctors.
(1) Medical Evidence and Credentials From CE Providers
----------------------------------------------------------------------------------------------------------------
Average Total
Number of Frequency of burden per estimated
Modality of completion respondents response response annual burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
CE Paper Submissions............................ 1,400,000 1 30 700,000
CE Electronic Submissions....................... 300,000 1 15 75,000
---------------------------------------------------------------
Totals...................................... 1,700,000 .............. .............. 775,000
----------------------------------------------------------------------------------------------------------------
(2) CE Appointment Letters and (3) CE Claimants' Report to Medical
Providers
----------------------------------------------------------------------------------------------------------------
Average
Number of Frequency of burden per Estimated
Modality of completion respondents response response annual burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
(b) CE Appointment Letters...................... 880,000 1 5 73,333
(c) CE Claimants' Report to Medical Providers... 450,000 1 5 37,500
---------------------------------------------------------------
Totals...................................... 1,330,000 .............. .............. 110,833
----------------------------------------------------------------------------------------------------------------
MER Collections
The DDS's collect MER information from the claimant's medical
sources to determine a claimant's physical or mental status prior to
making a disability determination.
----------------------------------------------------------------------------------------------------------------
Average Total
Number of Frequency of burden per estimated
Modality of completion respondents response response annual burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
Paper Submissions............................... 3,150,000 1 20 1,050,000
Electronic Submissions.......................... 9,450,000 1 12 1,890,000
---------------------------------------------------------------
Totals...................................... 12,600,000 .............. .............. 2,940,000
----------------------------------------------------------------------------------------------------------------
Pain or Other Symptoms--Impairment Information From Claimants
The DDSs use information about pain or symptoms to determine how
pain or symptoms affect the claimant's ability to do work-related
activities prior to making a disability determination.
----------------------------------------------------------------------------------------------------------------
Total
Number of Frequency of Average burden estimated
Modality of completion respondents response per response annual burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
Pain or Other Symptoms...................... 2,100,000 1 20 700,000
----------------------------------------------------------------------------------------------------------------
The total estimated annual burden for all of the categories
described in this information collection is 4,525,833 hours.
6. Request for Reconsideration--20 CFR 404.907-404.921, 416.1407-
[[Page 26801]]
416.1421, 408.1009, and 418.1325--0960-0622. Individuals use Form SSA-
561-U2, the associated MCS interview, or the Internet application
(i561) to initiate a request for reconsideration of a denied claim. SSA
uses the information to document the request and to determine an
individual's eligibility or entitlement to Social Security benefits
(Title II), SSI payments (Title XVI), Special Veterans Benefits (Title
VIII), Medicare (Title XVIII), and for initial determinations regarding
Medicare Part B income-related premium subsidy reductions. The
respondents are individuals filing for reconsideration of a denied
claim.
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-561 and MCS................................. 550,370 1 8 73,383
I561 (Internet iAppeals)........................ 911,330 1 5 75,944
---------------------------------------------------------------
Totals...................................... 1,461,700 .............. .............. 149,327
----------------------------------------------------------------------------------------------------------------
7. Teacher Questionnaire and Request for Administrative
Information--20 CFR 416.1103(f)--0960-0646. When determining the
effects of a child's impairment for children applying for Title II
childhood disability benefits, SSA obtains information about the
child's functioning from teachers, parents, and others who observe the
child on a daily basis. SSA obtains results of formal testing, teacher
reports, therapy progress notes, individualized education programs, and
other records of a child's educational aptitude and achievement using
Forms SSA-5665-BK and SSA-5666. The respondents are parents, teachers,
and other education personnel.
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-5665-BK (electronic)........................ 368,098 1 40 245,399
SSA-5665 (paper form)........................... 2,562 1 40 1,708
SSA-5666 (electronic)........................... 137,590 1 30 68,795
SSA-5666 (paper form)........................... 1,843 1 30 922
---------------------------------------------------------------
Totals...................................... 510,093 .............. .............. 316,824
----------------------------------------------------------------------------------------------------------------
II. SSA submitted the information collection below to OMB for
clearance. Your comments regarding the information collection 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 June 9, 2014. Individuals can obtain copies of the OMB
clearance package by writing to OR.Reports.Clearance@ssa.gov.
Request for Social Security Earnings Information--20CFR 404.810 &
401.100--0960-0525. The Act permits wage earners, or their authorized
representative, to request Social Security earnings information from
SSA using Form SSA-7050-F4. SSA uses the information to verify the
requestor's right to access to the information and to produce the
earnings statement. The respondents are wage earners and their
authorized representatives.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Modality of completion Number of Frequency of per response total annual
respondents response (minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-7050-F4................................. 66,800 1 11 12,247
----------------------------------------------------------------------------------------------------------------
Dated: May 6, 2014.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2014-10662 Filed 5-8-14; 8:45 am]
BILLING CODE 4191-02-P
