Agency Information Collection Activities: Proposed Request, 38107-38110 [2014-15621]

Download as PDF 38107 Federal Register / Vol. 79, No. 128 / Thursday, July 3, 2014 / Notices notice of its intent to file the proposed rule change, along with a brief description and text of the proposed rule change, at least five business days prior to the date of filing the proposed rule change as required by Rule 19b– 4(f)(6). 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. If the Commission takes such action, the Commission shall institute proceedings to determine whether the proposed rule should be approved or disapproved. 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 rule-comments@ sec.gov. Please include File Number SR– ISE–2014–34 on the subject line. Paper Comments • Send paper comments in triplicate to Secretary, Securities and Exchange Commission, 100 F Street NE., Washington, DC 20549–1090. All submissions should refer to File Number SR–ISE–2014–34. 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 the 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 available publicly. All submissions should refer to File Number SR–ISE– 2014–34 and should be submitted on or before July 24, 2014. For the Commission, by the Division of Trading and Markets, pursuant to delegated authority.12 Kevin M. O’Neill, Deputy Secretary. [FR Doc. 2014–15606 Filed 7–2–14; 8:45 am] BILLING CODE 8011–01–P SOCIAL SECURITY ADMINISTRATION Agency Information Collection Activities: Proposed Request The Social Security Administration (SSA) publishes a list of information collection packages requiring clearance by the Office of Management and Budget (OMB) in compliance with Public Law 104–13, the Paperwork Reduction Act (PRA) 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 Number of responses tkelley on DSK3SPTVN1PROD with NOTICES Modality of completion 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. 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 September 2, 2014. Individuals can obtain copies of the collection instruments by writing to the above email address. 1. Medical Report on Adult with Allegation of Human Immunodeficiency Virus Infection; Medical Report on Child with Allegation of Human Immunodeficiency Virus Infection—20 CFR 416.933–20 CFR 416.934 —0960– 0500. Section 1631(e)(i) of the Social Security Act (Act) authorizes the Commissioner of SSA to gather information necessary to make an immediate determination about an applicant’s claim for Supplemental Security Income (SSI) payments; this procedure is the Presumptive Disability (PD). SSA uses Forms SSA–4814–F5 and SSA–4815–F6 to collect information necessary to determine if an individual with human immunodeficiency virus infection, who is applying for SSI disability payments, meets the requirements for PD. The respondents are the medical sources of the applicants for SSI disability payments. Type of Request: Revision of an OMBapproved information collection. Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) SSA–4814–F5 .................................................................................................. SSA–4815–F6 .................................................................................................. 46,200 12,900 1 1 10 10 7,700 2,150 Totals ........................................................................................................ 59,100 ........................ ........................ 9,850 12 17 CFR 200.30–3(a)(12). VerDate Mar<15>2010 16:53 Jul 02, 2014 Jkt 232001 PO 00000 Frm 00103 Fmt 4703 Sfmt 4703 E:\FR\FM\03JYN1.SGM 03JYN1 38108 Federal Register / Vol. 79, No. 128 / Thursday, July 3, 2014 / Notices 2. SSI Notice of Interim Assistance Reimbursement (IAR)—0960–0546. Section 1631(g) of the Act authorizes SSA to reimburse an IAR agency from an individual’s retroactive SSI payment for assistance the IAR agency gave the individual for meeting basic needs while an SSI claim was pending or when SSI payments were suspended or terminated. The State or local agency needs an IAR agreement with SSA to participate in the IAR program. The individual receiving the IAR payment signs an authorization form with an IAR agency to allow SSA to repay the IAR agency for funds paid in advance prior to SSA’s determination on the individual’s claim. The authorization represents the individual’s intent to file for SSI, if they did not file an application prior to SSA receiving the authorization. Agencies who wish to enter into an IAR agreement with SSA accounting forms for the period defined in the IAR agreement for the purposes of SSA verifying transactions covered under the agreement. (c) Third Party Disclosure Requirements—Each participating IAR agency agrees to send written notices from the IAR agency to the recipient regarding payment amounts and appeal rights. (d) Periodic Review of Agency Accounting Process—The IAR agency makes the IAR accounting records of paid cases available for SSA review and verification. SSA conducts reviews either onsite or through the mail of the authorization forms, notices to the claimant, and accounting forms. Upon completion of the review, SSA provides a written report of findings to the IAR agency director. The respondents are State IAR officers. Type of Request: Revision of an OMBapproved information collection. need to meet the following requirements: (a) Reporting Requirements—Each IAR agency agrees to: (1) Notify SSA of receipt of an authorization for initial claims or cases they are appealing, and submit a copy of that authorization either through a manual or electronic process; (2) inform SSA of the amount of reimbursement; (3) submit a written request for dispute resolution on a determination; (4) notify SSA of interim assistance paid (using the SSA–8125 or the SSA– L8125–F6); (5) inform SSA of any deceased claimants who participate in the IAR program; and, (6) review and sign an agreement with SSA. (b) Recordkeeping Requirements— The IAR agencies agree to retain all notices, agreements, authorizations, and REPORTING REQUIREMENTS Average burden per response (minutes) Estimated total annual burden (hours) Modality of completion Number of respondents Frequency of response Number of responses a) State notification of receipt of authorization (Electronic Process). b) State submission of copy of authorization (Manual Process). c) State submission of amount of IA paid to recipients (using eIAR). d) State request for determination—dispute resolution. e) State computation of reimbursement due form SSA using paper form SSA-L8125–F6. f) State notification to SSA of deceased claimant. 11 States ................ Once per SSI claimant. Once per SSI claimant. Once per SSI claimant. As needed .............. 97,330 ..................... 1 1,622 68,405 ..................... 3 3,420 101,352 ................... 8 13,514 2 .............................. 30 1 Once per SSI claimant. 1,524 ....................... 30 762 40 ............................ 15 10 g) State reviewing/signing of IAR agreement. 38 States ................ 38 ............................ 12 hours 456 h) Maintenance of authorization forms .... 38 States ................ As needed when SSI claimant dies while claim is pending. Once during life of the IAR agreement. One form per SSI claimant. 3 8,287 i) Maintenance of accounting forms and notices. 38 States ................ 165,735 (includes both denied and approved SSI claims). 101,352 ................... 3 5,068 27 States ................ 38 States ................ Average is about 2 states per year. 38 States ................ 20 States ................ One set per SSI claimant. THIRD PARTY DISCLOSURE REQUIREMENTS tkelley on DSK3SPTVN1PROD with NOTICES Modality of completion Number of respondents j) Written notice from State to recipient regarding amount of payment. 38 States ................... VerDate Mar<15>2010 17:41 Jul 02, 2014 Jkt 232001 PO 00000 Frm 00104 Frequency of response Once per SSI claimant. Fmt 4703 Sfmt 4703 Number of responses Average burden per response (minutes) Estimated total annual burden (hours) 101,352 7 11,824 E:\FR\FM\03JYN1.SGM 03JYN1 38109 Federal Register / Vol. 79, No. 128 / Thursday, July 3, 2014 / Notices PERIODIC REVIEW OF AGENCY ACCOUNTING PROCESS Modality of completion Number of respondents Frequency of response k) Retrieve and consolidate authorization and accounting forms. 12 States ................... l) Participate in periodic review ..................... 12 States ................... m) Correct administrative and accounting discrepancies. 6 States ..................... One set of forms per SSI claimant for review by SSA once every 2 to 3 years. For review by SSA once every 2 to 3 years. To correct errors discovered by SSA in periodic review. Average burden per response (minutes) Number of responses Estimated total annual burden (hours) 12 3 36 12 16 192 6 4 24 TOTAL ADMINISTRATIVE BURDEN Number of respondents Total ........................................... Frequency of response Number of responses Average burden per response (minutes) Estimated total annual burden (hours) 38 States .......................................... varies 639,161 varies 45,217 3. Medical Source Statement of Ability To Do Work Related Activities (Physical and Mental)—20 CFR 404.1512–404.1514, 404.912–404.914, 404.1517, 416.917, 404.1519–404.1520, 416.919–416.920, 404.946, 416.946, 404–1546–0960–0662. In some instances when a claimant appeals a denied disability claim, SSA may ask the claimant to have a consultative examination, at the agency’s expense, if the claimant’s medical sources cannot or will not give the agency sufficient evidence to determine whether the claimant is disabled. The medical providers who perform these consultative examinations provide a statement about the claimant’s state of disability. Specifically, these medical source statements determine the workrelated capabilities of these claimants. SSA collects the medical data on the Number of respondents Modality of completion HA–1151 and HA–1152 to assess the work-related physical and mental capabilities of claimants who appeal SSA’s previous determination on their issue of disability. The respondents are medical sources who provide reports based either on existing medical evidence or on consultative examinations. Type of Request: Revision of an OMBapproved information collection. Total estimated annual burden (hours) Average burden per response (minutes) Frequency of response HA–1151 .......................................................................................................... HA–1152 .......................................................................................................... 5,000 5,000 30 30 15 15 37,500 37,500 Totals: ....................................................................................................... 10,000 ........................ ........................ 75,000 tkelley on DSK3SPTVN1PROD with NOTICES 4. Application for Access to SSA Systems—20 CFR 401.45–0960–0791. SSA uses Form SSA–120, Application for Access to SSA Systems, to allow limited access to SSA’s information resources for SSA employees and nonFederal employees (contractors). SSA requires supervisory approval, and local or component Security Officer review prior to granting this access. The respondents are SSA employees and non-Federal Employees (contractors) who require access to SSA systems to perform their jobs. Number of respondents Modality of collection Note: Because SSA employees are Federal workers exempt from the requirements of the PRA, the burden below is only for SSA contractors. Type of Request: Revision of an OMBapproved information collection. Estimated total annual burden (hours) Average burden of response (minutes) Frequency of response SSA–120 (paper version) ................................................................................ SSA–120 (Internet version) ............................................................................. 2,148 1,105 1 1 2 3 73 37 Totals ........................................................................................................ 3,289 ........................ ........................ 110 VerDate Mar<15>2010 17:41 Jul 02, 2014 Jkt 232001 PO 00000 Frm 00105 Fmt 4703 Sfmt 4703 E:\FR\FM\03JYN1.SGM 03JYN1 38110 Federal Register / Vol. 79, No. 128 / Thursday, July 3, 2014 / Notices Dated: June 30, 2014. Faye Lipsky, Reports Clearance Director, Social Security Administration. [FR Doc. 2014–15621 Filed 7–2–14; 8:45 am] BILLING CODE 4191–02–P DEPARTMENT OF TRANSPORTATION Office of the Secretary of Transportation [Docket No. DOT–OST–2014–0113] Notice of Order Soliciting Community Proposals Department of Transportation, Office of the Secretary. ACTION: Notice of Order Soliciting Community Proposals (Order 2014–6– 17). AGENCY: The Department of Transportation is soliciting proposals from communities or consortia of communities interested in receiving grants under the Small Community Air Service Development Program. The full text of the Department’s order, including Appendices, is included in this Notice. As noted in the order, an application for a grant under this program must include a Grant Proposal of no more than 20 pages (one-sided only), a completed Application for Federal Domestic Assistance (SF424), a Summary Information Schedule, and any letters from the applicant community showing support. DATES: Applications must be submitted no later than July 31, 2014. ADDRESSES: Communities must submit applications electronically through https://www.grants.gov. FOR FURTHER INFORMATION CONTACT: Brooke Chapman, Associate Director, Small Community Air Service Development Program, Office of Aviation Analysis, 1200 New Jersey Avenue SE., W86–307, Washington, DC 20590, (202) 366 0577. SUPPLEMENTARY INFORMATION: By this order, the Department of Transportation (the Department or DOT) invites proposals from communities and/or consortia of communities interested in obtaining a federal grant under the Small Community Air Service Development Program (‘‘Small Community Program’’ or ‘‘SCASDP’’) to address air service and airfare issues in their communities. Applications of no more than 20 one-sided pages each (excluding the completed Application for Federal Domestic Assistance (SF424), Summary Information schedule, and any letters from the tkelley on DSK3SPTVN1PROD with NOTICES SUMMARY: VerDate Mar<15>2010 16:53 Jul 02, 2014 Jkt 232001 community or an air carrier showing support for the application), including all required information, must be submitted to www.grants.gov no later than 5 p.m. EDT on July 31, 2014. You are strongly encouraged to submit applications in advance of the deadline. Please be aware that you must complete the registration process before submitting an application, and that this process usually takes two to four weeks to complete. If interested parties experience difficulties at any point during the registration or application process, please call the grants.gov Customer Support Hotline at 1–800– 518–4726, Monday–Friday, from 7 a.m. to 9 p.m. EDT. The Department will not accept late-filed applications. Additional information on applying through grants.gov is in Appendix A, including a notice regarding late submissions related to technical difficulties. This order is organized into the following sections: I. Background II. Selection Criteria and Guidance on Application of Selection Criteria III. Evaluation and Selection Process IV. How to Apply V. Air Service Development Zone VI. Grant Administration VII. Questions and Clarifications Appendix A—Additional Information on Applying Through www.grants.gov Appendix B—Summary Information Appendix C—Application Checklist Appendix D—Confidential Commercial Information I. Background The Small Community Program was established by the Wendell H. Ford Aviation Investment and Reform Act for the 21st Century (Pub. L. 106–181) and reauthorized by the Vision 100— Century of Aviation Reauthorization Act (Pub. L. 108–176) and subsequently the FAA Modernization and Reform Act of 2012 (Pub. L. 112–95) (FAA 2012). The program is designed to provide financial assistance to small communities in order to help them enhance their air service. The Department provides this assistance in the form of monetary grants that are disbursed on a reimbursable basis. Authorization for this program is codified at 49 U.S.C. 41743. The Small Community Program is authorized to receive appropriations under 49 U.S.C. 41743(e)(2), as amended. Appropriations are provided for this program for award selection in FY 2014 pursuant to FAA 2012 and the FY 2014 Appropriations Act (Pub. L. 113–76). The Department has up to $7 million available for FY 2014 grant awards to carry out this program. There PO 00000 Frm 00106 Fmt 4703 Sfmt 4703 is no limit on the amount of individual awards, and the amounts awarded will vary depending upon the features and merits of the selected proposals. In past years, the Department’s individual grant sizes have ranged from $20,000 to nearly $1.6 million. A. Eligible Applicants Eligible applicants are small communities that meet the following statutory criteria under 49 U.S.C. 41743: 1. As of calendar year 1997, the airport serving the community was not larger than a small hub airport,1 and it has insufficient air carrier service or unreasonably high air fares; and 2. The airport serving the community presents characteristics, such as geographic diversity or unique circumstances that demonstrate the need for, and feasibility of, grant assistance from the Small Community Program. No more than four communities or consortia of communities, or a combination thereof, from the same state may be selected to participate in the program in any fiscal year. No more than 40 communities or consortia of communities, or a combination thereof, may be selected to participate in the program in each year for which the funds are appropriated. Consortium applications: Both individual communities and consortia of communities are eligible for SCASDP funds. An application from a consortium of communities must be one that seeks to facilitate the efforts of the communities working together toward one joint grant project, with one joint objective, including the establishment of one entity to ensure that the joint objective is accomplished. Multiple Applications: A community may file only one application for a grant, either individually or as part of a consortium. Communities without existing air service: Communities that do not currently have commercial air service are eligible for SCASDP funds. Essential Air Service communities: Small communities that meet the basic SCASDP criteria and currently receive subsidized air service under the Essential Air Service (‘‘EAS’’) program are eligible to apply for SCASDP funds. However, grant awards to EASsubsidized communities are limited to marketing or promotion projects that support existing or newly subsidized EAS. Grant funds will not be authorized 1 See, https://www.dot.gov/policy/aviation-policy/ small-community-rural-air-service/SCASDP, for the FAA’s 1997 list of Primary and Nonprimary Commercial Service Airports. E:\FR\FM\03JYN1.SGM 03JYN1

Agencies

Social Security Administration

[Federal Register Volume 79, Number 128 (Thursday, July 3, 2014)]
[Notices]
[Pages 38107-38110]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-15621]

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

SOCIAL SECURITY ADMINISTRATION

Agency Information Collection Activities: Proposed Request

The Social Security Administration (SSA) publishes a list of
information collection packages requiring clearance by the Office of
Management and Budget (OMB) in compliance with Public Law 104-13, the
Paperwork Reduction Act (PRA) 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.
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
September 2, 2014. Individuals can obtain copies of the collection
instruments by writing to the above email address.
1. Medical Report on Adult with Allegation of Human
Immunodeficiency Virus Infection; Medical Report on Child with
Allegation of Human Immunodeficiency Virus Infection--20 CFR 416.933-20
CFR 416.934 --0960-0500. Section 1631(e)(i) of the Social Security Act
(Act) authorizes the Commissioner of SSA to gather information
necessary to make an immediate determination about an applicant's claim
for Supplemental Security Income (SSI) payments; this procedure is the
Presumptive Disability (PD). SSA uses Forms SSA-4814-F5 and SSA-4815-F6
to collect information necessary to determine if an individual with
human immunodeficiency virus infection, who is applying for SSI
disability payments, meets the requirements for PD. The respondents are
the medical sources of the applicants for SSI disability payments.
Type of Request: Revision of an OMB-approved information
collection.

----------------------------------------------------------------------------------------------------------------
Average
Number of Frequency of burden per Estimated
Modality of completion responses response response total annual
(minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4814-F5..................................... 46,200 1 10 7,700
SSA-4815-F6..................................... 12,900 1 10 2,150
---------------------------------------------------------------
Totals...................................... 59,100 .............. .............. 9,850
----------------------------------------------------------------------------------------------------------------

[[Page 38108]]

2. SSI Notice of Interim Assistance Reimbursement (IAR)--0960-0546.
Section 1631(g) of the Act authorizes SSA to reimburse an IAR agency
from an individual's retroactive SSI payment for assistance the IAR
agency gave the individual for meeting basic needs while an SSI claim
was pending or when SSI payments were suspended or terminated. The
State or local agency needs an IAR agreement with SSA to participate in
the IAR program. The individual receiving the IAR payment signs an
authorization form with an IAR agency to allow SSA to repay the IAR
agency for funds paid in advance prior to SSA's determination on the
individual's claim. The authorization represents the individual's
intent to file for SSI, if they did not file an application prior to
SSA receiving the authorization. Agencies who wish to enter into an IAR
agreement with SSA need to meet the following requirements:
(a) Reporting Requirements--Each IAR agency agrees to:
(1) Notify SSA of receipt of an authorization for initial claims or
cases they are appealing, and submit a copy of that authorization
either through a manual or electronic process;
(2) inform SSA of the amount of reimbursement;
(3) submit a written request for dispute resolution on a
determination;
(4) notify SSA of interim assistance paid (using the SSA-8125 or
the SSA-L8125-F6);
(5) inform SSA of any deceased claimants who participate in the IAR
program; and,
(6) review and sign an agreement with SSA.
(b) Recordkeeping Requirements--The IAR agencies agree to retain
all notices, agreements, authorizations, and accounting forms for the
period defined in the IAR agreement for the purposes of SSA verifying
transactions covered under the agreement.
(c) Third Party Disclosure Requirements--Each participating IAR
agency agrees to send written notices from the IAR agency to the
recipient regarding payment amounts and appeal rights.
(d) Periodic Review of Agency Accounting Process--The IAR agency
makes the IAR accounting records of paid cases available for SSA review
and verification. SSA conducts reviews either onsite or through the
mail of the authorization forms, notices to the claimant, and
accounting forms. Upon completion of the review, SSA provides a written
report of findings to the IAR agency director. The respondents are
State IAR officers.
Type of Request: Revision of an OMB-approved information
collection.

Reporting Requirements
----------------------------------------------------------------------------------------------------------------
Average
Number of Frequency of Number of burden per Estimated
Modality of completion respondents response responses response total annual
(minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
a) State notification of 11 States...... Once per SSI 97,330......... 1 1,622
receipt of authorization claimant.
(Electronic Process).
b) State submission of copy 27 States...... Once per SSI 68,405......... 3 3,420
of authorization (Manual claimant.
Process).
c) State submission of amount 38 States...... Once per SSI 101,352........ 8 13,514
of IA paid to recipients claimant.
(using eIAR).
d) State request for Average is As needed...... 2.............. 30 1
determination--dispute about 2 states
resolution. per year.
e) State computation of 38 States...... Once per SSI 1,524.......... 30 762
reimbursement due form SSA claimant.
using paper form
SSA[dash]L8125-F6.
f) State notification to SSA 20 States...... As needed when 40............. 15 10
of deceased claimant. SSI claimant
dies while
claim is
pending.
g) State reviewing/signing of 38 States...... Once during 38............. 12 hours 456
IAR agreement. life of the
IAR agreement.
h) Maintenance of 38 States...... One form per 165,735 3 8,287
authorization forms. SSI claimant. (includes both
denied and
approved SSI
claims).
i) Maintenance of accounting 38 States...... One set per SSI 101,352........ 3 5,068
forms and notices. claimant.
----------------------------------------------------------------------------------------------------------------

Third Party Disclosure Requirements
--------------------------------------------------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of respondents Frequency of response Number of per response annual burden
responses (minutes) (hours)
--------------------------------------------------------------------------------------------------------------------------------------------------------
j) Written notice from State to recipient 38 States................... Once per SSI claimant....... 101,352 7 11,824
regarding amount of payment.
--------------------------------------------------------------------------------------------------------------------------------------------------------

[[Page 38109]]

Periodic Review of Agency Accounting Process
----------------------------------------------------------------------------------------------------------------
Average
Number of Frequency of Number of burden per Estimated
Modality of completion respondents response responses response total annual
(minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
k) Retrieve and consolidate 12 States....... One set of 12 3 36
authorization and accounting forms per SSI
forms. claimant for
review by SSA
once every 2
to 3 years.
l) Participate in periodic 12 States....... For review by 12 16 192
review. SSA once every
2 to 3 years.
m) Correct administrative and 6 States........ To correct 6 4 24
accounting discrepancies. errors
discovered by
SSA in
periodic
review.
----------------------------------------------------------------------------------------------------------------

Total Administrative Burden
--------------------------------------------------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Number of respondents Frequency of Number of per response annual burden
response responses (minutes) (hours)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total....................................... 38 States......................... varies 639,161 varies 45,217
--------------------------------------------------------------------------------------------------------------------------------------------------------

3. Medical Source Statement of Ability To Do Work Related
Activities (Physical and Mental)--20 CFR 404.1512-404.1514, 404.912-
404.914, 404.1517, 416.917, 404.1519-404.1520, 416.919-416.920,
404.946, 416.946, 404-1546-0960-0662. In some instances when a claimant
appeals a denied disability claim, SSA may ask the claimant to have a
consultative examination, at the agency's expense, if the claimant's
medical sources cannot or will not give the agency sufficient evidence
to determine whether the claimant is disabled. The medical providers
who perform these consultative examinations provide a statement about
the claimant's state of disability. Specifically, these medical source
statements determine the work-related capabilities of these claimants.
SSA collects the medical data on the HA-1151 and HA-1152 to assess the
work-related physical and mental capabilities of claimants who appeal
SSA's previous determination on their issue of disability. The
respondents are medical sources who provide reports based either on
existing medical evidence or on consultative examinations.
Type of Request: Revision of an OMB-approved information
collection.

----------------------------------------------------------------------------------------------------------------
Average Total
Number of Frequency of burden per estimated
Modality of completion respondents response response annual burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
HA-1151......................................... 5,000 30 15 37,500
HA-1152......................................... 5,000 30 15 37,500
---------------------------------------------------------------
Totals:..................................... 10,000 .............. .............. 75,000
----------------------------------------------------------------------------------------------------------------

4. Application for Access to SSA Systems--20 CFR 401.45-0960-0791.
SSA uses Form SSA-120, Application for Access to SSA Systems, to allow
limited access to SSA's information resources for SSA employees and
non-Federal employees (contractors). SSA requires supervisory approval,
and local or component Security Officer review prior to granting this
access. The respondents are SSA employees and non-Federal Employees
(contractors) who require access to SSA systems to perform their jobs.
Note: Because SSA employees are Federal workers exempt from the
requirements of the PRA, the burden below is only for SSA contractors.
Type of Request: Revision of an OMB-approved information
collection.

----------------------------------------------------------------------------------------------------------------
Average Estimated
Number of Frequency of burden of total annual
Modality of collection respondents response response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-120 (paper version)......................... 2,148 1 2 73
SSA-120 (Internet version)...................... 1,105 1 3 37
---------------------------------------------------------------
Totals...................................... 3,289 .............. .............. 110
----------------------------------------------------------------------------------------------------------------

[[Page 38110]]

Dated: June 30, 2014.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2014-15621 Filed 7-2-14; 8:45 am]
BILLING CODE 4191-02-P

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