Agency Information Collection Activities: Comment Request, 56428-56430 [2014-22341]

Download as PDF 56428 Federal Register / Vol. 79, No. 182 / Friday, September 19, 2014 / Notices Submit completed loan applications to: U.S. Small Business Administration, Processing And Disbursement Center, 14925 Kingsport Road, Fort Worth, TX 76155. FOR FURTHER INFORMATION CONTACT: A. Escobar, Office of Disaster Assistance, U.S. Small Business Administration, 409 3rd Street SW., Suite 6050, Washington, DC 20416. SUPPLEMENTARY INFORMATION: Notice is hereby given that as a result of the President’s major disaster declaration on 09/10/2014, Private Non-Profit organizations that provide essential services of governmental nature may file disaster loan applications at the address listed above or other locally announced locations. The following areas have been determined to be adversely affected by the disaster: Primary Counties: Guam The Interest Rates are: ADDRESSES: Percent For Physical Damage: Non-Profit Organizations With Credit Available Elsewhere ... Non-Profit Organizations Without Credit Available Elsewhere ..................................... For Economic Injury: Non-Profit Organizations Without Credit Available Elsewhere ..................................... 2.625 2.625 2.625 The number assigned to this disaster for physical damage is 141148 and for economic injury is 141158. (Catalog of Federal Domestic Assistance Numbers 59002 and 59008). Joseph P. Loddo, Acting Associate Administrator, for Disaster Assistance. [FR Doc. 2014–22330 Filed 9–18–14; 8:45 am] BILLING CODE 8025–01–P SOCIAL SECURITY ADMINISTRATION Agency Information Collection Activities: 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 (PRA), 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 SSA submitted the information collections below to OMB for clearance. Your comments regarding the information collections would be most useful if OMB and SSA receive them 30 days from the date of this publication. To be sure we consider your comments, we must receive them no later than October 20, 2014. Individuals can obtain copies of the OMB clearance packages by writing to OR.Reports.Clearance@ ssa.gov. 1. Marital Relationship Questionnaire—20 CFR 416.1826— 0960–0460. SSA uses Form SSA–4178, Marital Relationship Questionnaire, to determine if unrelated individuals of the opposite sex who live together are misrepresenting themselves as husband and wife. SSA needs this information to determine whether we are making correct payments to couples and individuals applying for or currently receiving Supplemental Security Income (SSI) payments. The respondents are applicants for and recipients of SSI payments. Type of Request: Revision of an OMBapproved information collection. Number of respondents Frequency of response Average burden per response (minutes) Total estimated annual burden (hours) SSA–4178 ........................................................................................................ tkelley on DSK3SPTVN1PROD with NOTICES Modality of completion 5,100 1 5 425 2. SSI Notice of Interim Assistance Reimbursement (IAR)—0960–0546. Section 1631(g) of the Social Security 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 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 VerDate Sep<11>2014 17:15 Sep 18, 2014 Jkt 232001 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; PO 00000 Frm 00094 Fmt 4703 Sfmt 4703 (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, agreement, 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 E:\FR\FM\19SEN1.SGM 19SEN1 56429 Federal Register / Vol. 79, No. 182 / Friday, September 19, 2014 / Notices 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 Number of respondents (States) Modality of completion Frequency of response 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. Total estimated annual burden (hours) Average burden per response (minutes) Number of responses Reporting Requirements (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 from SSA using paper Form SSA–L8125– F6. (f) State notification to SSA of deceased claimant. 11 Once per SSI Claimant ........ 97,330 1 1,622 27 Once per SSI Claimant ........ 68,405 3 3,420 38 Once per SSI Claimant ........ 101,352 8 13,514 (1) As needed ............................ 2 30 1 38 Once per SSI Claimant ........ 1,524 30 762 20 40 15 10 (g) State reviewing/signing of IAR Agreement. 38 As needed when SSI claimant dies while claim is pending. Once during life of the IAR agreement. 38 212 456 3165,735 101,352 3 3 8,287 5,068 101,352 7 11,824 12 3 36 12 16 192 6 4 24 639,161 Varies 45,217 Recordkeeping Requirements (h) Maintenance of authorization forms ........ (i) Maintenance of accounting forms and notices. 38 38 One form per SSI claimant ... One set per SSI claimant ..... Third Party Disclosure Requirements (j) Written notice from State to recipient regarding amount of payment. 38 One per SSI claimant ........... Periodic Review of Agency Accounting Process (k) Retrieve and consolidate authorization and accounting forms. 12 (l) Participate in periodic review ................... 12 (m) Correct administrative and accounting discrepancies. 6 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. Total Administrative Burden Totals ..................................................... 1Average 38 Varies .................................... of about 2 States per year. 2Hours. tkelley on DSK3SPTVN1PROD with NOTICES 3Includes both denied and approved SSI claims. 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 VerDate Sep<11>2014 17:15 Sep 18, 2014 Jkt 232001 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 PO 00000 Frm 00095 Fmt 4703 Sfmt 4703 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. E:\FR\FM\19SEN1.SGM 19SEN1 56430 Federal Register / Vol. 79, No. 182 / Friday, September 19, 2014 / Notices Number of respondents Modality of completion Frequency of response Total estimated annual burden (hours) Average burden per response Number of responses HA–1151 .............................................................................. HA–1152 .............................................................................. 5,000 5,000 30 30 150,000 150,000 15 15 37,500 37,500 Totals ............................................................................ 10,000 ........................ 300,000 ........................ 75,000 4. Electronic Records Express—20 CFR 404.1512 and 416.912—0960–0753. Electronic Records Express (ERE) is a Web-based SSA program that allows medical and educational providers to electronically submit disability claimant data to SSA. Both medical providers and other third parties with connections to disability applicants or recipients (e.g., teachers and school administrators for child disability applicants) use this system once they complete the registration process. SSA employees and State agency employees request the medical and educational records collected through the ERE Web site. The agency uses the information collected through ERE to make a determination on an Application for Benefits. We also use the ERE Web site to order and receive consultative examinations when we are unable to collect enough medical records to determine disability findings. The respondents are medical providers who evaluate or treat disability claimants or recipients, and other third parties with connections to disability applicants or recipients (ex: Teachers and school administrators for child disability applicants), who voluntarily choose to use ERE for submitting information. Type of Request: Revision of an OMBapproved information collection. Modality of completion Number of respondents Frequency of response Average burden per response (minutes) Total estimated annual burden (hours) ERE .................................................................................................................. 4,508,968 1 10 751,495 5. 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 completion 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. Total estimated annual burden (hours) Average burden per 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 Dated: September 16, 2014. Faye Lipsky, Reports Clearance Director, Social Security Administration. [FR Doc. 2014–22341 Filed 9–18–14; 8:45 am] tkelley on DSK3SPTVN1PROD with NOTICES BILLING CODE 4191–02–P DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Office of Commercial Space Transportation; Notice of Availability and Request for Comment on the Draft Environmental Assessment (EA) for the Kodiak Launch Complex Launch Pad 3, Kodiak Island, Alaska Federal Aviation Administration (FAA), Department of Transportation (DOT). AGENCY: Notice of availability, notice of public comment period, notice of public meeting and request for comment. ACTIONS: VerDate Sep<11>2014 17:15 Sep 18, 2014 Jkt 232001 PO 00000 Frm 00096 Fmt 4703 Sfmt 4703 In accordance with the National Environmental Policy Act of 1969, as amended (NEPA; 42 United States Code 4321 et seq.), Council on Environmental Quality NEPA implementing regulations (40 Code of Federal Regulations parts 1500 to 1508), and FAA Order 1050.1E, Change 1, Environmental Impacts: Policies and Procedures, the FAA is announcing the availability of and requesting comments on the Draft Environmental Assessment for the Kodiak Launch Complex Launch Pad 3 (Draft EA). FOR FURTHER INFORMATION CONTACT: Stacey M. Zee, Federal Aviation Administration, c/o ICF International, 9300 Lee Highway, Fairfax, VA 22031; SUMMARY: E:\FR\FM\19SEN1.SGM 19SEN1

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[Federal Register Volume 79, Number 182 (Friday, September 19, 2014)]
[Notices]
[Pages 56428-56430]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-22341]


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SOCIAL SECURITY ADMINISTRATION


Agency Information Collection Activities: 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 (PRA), 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: OIRASubmission@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

    SSA submitted the information collections below to OMB for 
clearance. Your comments regarding the information collections would be 
most useful if OMB and SSA receive them 30 days from the date of this 
publication. To be sure we consider your comments, we must receive them 
no later than October 20, 2014. Individuals can obtain copies of the 
OMB clearance packages by writing to OR.Reports.Clearance@ssa.gov.
    1. Marital Relationship Questionnaire--20 CFR 416.1826--0960-0460. 
SSA uses Form SSA-4178, Marital Relationship Questionnaire, to 
determine if unrelated individuals of the opposite sex who live 
together are misrepresenting themselves as husband and wife. SSA needs 
this information to determine whether we are making correct payments to 
couples and individuals applying for or currently receiving 
Supplemental Security Income (SSI) payments. The respondents are 
applicants for and recipients of SSI payments.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden  Total estimated
           Modality of completion                Number of       Frequency of     per response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4178....................................           5,100                1                5              425
----------------------------------------------------------------------------------------------------------------

    2. SSI Notice of Interim Assistance Reimbursement (IAR)--0960-0546. 
Section 1631(g) of the Social Security 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 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, agreement, 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

[[Page 56429]]

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.

----------------------------------------------------------------------------------------------------------------
                                                                                                       Total
                                   Number of      Frequency of       Number of    Average burden     estimated
    Modality of completion        respondents       response         responses     per response    annual burden
                                   (States)                                          (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
                                             Reporting Requirements
----------------------------------------------------------------------------------------------------------------
(a) State notification of                   11  Once per SSI              97,330               1           1,622
 receipt of authorization                        Claimant.
 (Electronic Process).
(b) State submission of copy                27  Once per SSI              68,405               3           3,420
 of authorization (Manual                        Claimant.
 Process).
(c) State submission of amount              38  Once per SSI             101,352               8          13,514
 of IA paid to recipients                        Claimant.
 (using eIAR).
(d) State request for                    (\1\)  As needed.......               2              30               1
 determination--dispute
 resolution.
(e) State computation of                    38  Once per SSI               1,524              30             762
 reimbursement due from SSA                      Claimant.
 using paper Form SSA-L8125-F6.
(f) State notification to SSA               20  As needed when                40              15              10
 of deceased claimant.                           SSI claimant
                                                 dies while
                                                 claim is
                                                 pending.
(g) State reviewing/signing of              38  Once during life              38           \2\12             456
 IAR Agreement.                                  of the IAR
                                                 agreement.
----------------------------------------------------------------------------------------------------------------
                                           Recordkeeping Requirements
----------------------------------------------------------------------------------------------------------------
(h) Maintenance of                          38  One form per SSI      \3\165,735               3           8,287
 authorization forms.                            claimant.
(i) Maintenance of accounting               38  One set per SSI          101,352               3           5,068
 forms and notices.                              claimant.
----------------------------------------------------------------------------------------------------------------
                                       Third Party Disclosure Requirements
----------------------------------------------------------------------------------------------------------------
(j) Written notice from State               38  One per SSI              101,352               7          11,824
 to recipient regarding amount                   claimant.
 of payment.
----------------------------------------------------------------------------------------------------------------
                                  Periodic Review of Agency Accounting Process
----------------------------------------------------------------------------------------------------------------
(k) Retrieve and consolidate                12  One set of forms              12               3              36
 authorization and accounting                    per SSI
 forms.                                          claimant for
                                                 review by SSA
                                                 once every 2 to
                                                 3 years.
(l) Participate in periodic                 12  For review by                 12              16             192
 review.                                         SSA once every
                                                 2 to 3 years.
(m) Correct administrative and               6  To correct                     6               4              24
 accounting discrepancies.                       errors
                                                 discovered by
                                                 SSA in periodic
                                                 review.
----------------------------------------------------------------------------------------------------------------
                                           Total Administrative Burden
----------------------------------------------------------------------------------------------------------------
    Totals....................              38  Varies..........         639,161          Varies          45,217
----------------------------------------------------------------------------------------------------------------
 \1\Average of about 2 States per year.
 \2\Hours.
 \3\Includes both denied and approved SSI claims.

    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.

[[Page 56430]]



----------------------------------------------------------------------------------------------------------------
                                                                                                       Total
                                     Number of     Frequency of      Number of    Average burden     estimated
     Modality of completion         respondents      response        responses     per response    annual burden
                                                                                                      (hours)
----------------------------------------------------------------------------------------------------------------
HA-1151.........................           5,000              30         150,000              15          37,500
HA-1152.........................           5,000              30         150,000              15          37,500
                                 -------------------------------------------------------------------------------
    Totals......................          10,000  ..............         300,000  ..............          75,000
----------------------------------------------------------------------------------------------------------------

    4. Electronic Records Express--20 CFR 404.1512 and 416.912--0960-
0753. Electronic Records Express (ERE) is a Web-based SSA program that 
allows medical and educational providers to electronically submit 
disability claimant data to SSA. Both medical providers and other third 
parties with connections to disability applicants or recipients (e.g., 
teachers and school administrators for child disability applicants) use 
this system once they complete the registration process. SSA employees 
and State agency employees request the medical and educational records 
collected through the ERE Web site. The agency uses the information 
collected through ERE to make a determination on an Application for 
Benefits. We also use the ERE Web site to order and receive 
consultative examinations when we are unable to collect enough medical 
records to determine disability findings. The respondents are medical 
providers who evaluate or treat disability claimants or recipients, and 
other third parties with connections to disability applicants or 
recipients (ex: Teachers and school administrators for child disability 
applicants), who voluntarily choose to use ERE for submitting 
information.
    Type of Request: Revision of an OMB-approved information 
collection.

----------------------------------------------------------------------------------------------------------------
                                                                                 Average burden  Total estimated
           Modality of completion                Number of       Frequency of     per response    annual burden
                                                respondents        response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
ERE.........................................       4,508,968                1               10          751,495
----------------------------------------------------------------------------------------------------------------

    5. 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.

----------------------------------------------------------------------------------------------------------------
                                                                                                       Total
                                                     Number of     Frequency of   Average burden     estimated
             Modality of completion                 respondents      response      per response    annual 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
----------------------------------------------------------------------------------------------------------------


    Dated: September 16, 2014.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2014-22341 Filed 9-18-14; 8:45 am]
BILLING CODE 4191-02-P