Agency Information Collection Activities: Proposed Request and Comment Request, 26798-26801 [2014-10662]

Download as PDF 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