Agency Information Collection Activities: Proposed Request, 57650-57653 [2014-22809]

Download as PDF 57650 Federal Register / Vol. 79, No. 186 / Thursday, September 25, 2014 / Notices Comments may be submitted by any of the following methods: Electronic Comments • Use the Commission’s Internet comment form (http://www.sec.gov/ rules/sro.shtml); or • Send an email to rule-comments@ sec.gov. Please include File Number SR– SCCP–2014–01 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. mstockstill on DSK4VPTVN1PROD with NOTICES All submissions should refer to File Number SR–SCCP–2014–01. 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 (http://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 SCCP. 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–SCCP– 2014–01 and should be submitted on or before October 16, 2014. For the Commission, by the Division of Trading and Markets, pursuant to delegated authority.6 Kevin M. O’Neill, Deputy Secretary. [FR Doc. 2014–22783 Filed 9–24–14; 8:45 am] BILLING CODE 8011–01–P 6 17 CFR 200.30–3(a)(12). VerDate Sep<11>2014 17:25 Sep 24, 2014 Jkt 232001 SMALL BUSINESS ADMINISTRATION Reporting and Recordkeeping Requirements Under OMB Review Small Business Administration. 30-Day Notice. AGENCY: ACTION: The Small Business Administration (SBA) is publishing this notice to comply with requirements of the Paperwork Reduction Act (PRA) (44 U.S.C. Chapter 35), which requires agencies to submit proposed reporting and recordkeeping requirements to OMB for review and approval, and to publish a notice in the Federal Register notifying the public that the agency has made such a submission. This notice also allows an additional 30 days for public comments. DATES: Submit comments on or before October 27, 2014. ADDRESSES: Comments should refer to the information collection by name and/ or OMB Control Number and should be sent to: Agency Clearance Officer, Curtis Rich, Small Business Administration, 409 3rd Street SW., 5th Floor, Washington, DC 20416; and SBA Desk Officer, Office of Information and Regulatory Affairs, Office of Management and Budget, New Executive Office Building, Washington, DC 20503. FOR FURTHER INFORMATION CONTACT: Curtis Rich, Agency Clearance Officer, (202) 205–7030 curtis.rich@sba.gov. Copies: A copy of the Form OMB 83– 1, supporting statement, and other documents submitted to OMB for review may be obtained from the Agency Clearance Officer. SUPPLEMENTARY INFORMATION: SBA Form 641 and 888 are used to collect information from the Agency’s resource partners, including: Small Business Development Centers, SCORE, and Women’s Business Centers that provide training and counseling to existing or potential small business owners through SBA funded grants, or cooperative agreements. SBA uses the information to facilitate its management and oversight of these SBA funded grants, assist in evaluating their impact on the small business community, and facilitate performance reporting to Congress and the President. The information is uploaded to SBA through the Entrepreneurial Development Management Information System (EDMIS). SUMMARY: Solicitation of Public Comments Comments may be submitted on (a) whether the collection of information is necessary for the agency to properly perform its functions; (b) whether the PO 00000 Frm 00148 Fmt 4703 Sfmt 4703 burden estimates are accurate; (c) whether there are ways to minimize the burden, including through the use of automated techniques or other forms of information technology; and (d) whether there are ways to enhance the quality, utility, and clarity of the information. Summary of Information Collections (1) Title: Entrepreneurial Development Management Information System (EDMIS) Customer Intake Form & Management Training Report Form. Description of Respondents: SBA resource partners, including Small Business Development Centers (SBDCs), Women’s Business Centers (WBCs), and SCORE, Form Numbers: Form 641 (Counseling Information Form) and Form 888 (Management Training Report). Form Numbers: SBA Form 641, 888. Estimated Annual Respondents: 1,265,000. Estimated Annual Responses: 1,265,000. Estimated Annual Hour Burden: 379,500. Curtis B. Rich, Management Analyst . [FR Doc. 2014–22826 Filed 9–24–14; 8:45 am] BILLING CODE 8025–01–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 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 E:\FR\FM\25SEN1.SGM 25SEN1 Federal Register / Vol. 79, No. 186 / Thursday, September 25, 2014 / Notices 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 November 24, 2014. Individuals can obtain copies of the collection instruments by writing to the above email address. 1. Letter to Employer Requesting Information About Wages Earned By Beneficiary—20 CFR 416.703, 404.801 & 404.820—0960–0034. Social Security disability recipients receive payments based on their inability to engage in substantial gainful activity (SGA) because of a physical or mental condition. If the recipients work, SSA must evaluate and determine if they continue to meet the disability requirements of the law. Therefore, we use Form SSA–L725 to request monthly 57651 earnings information from the recipient’s employer. We then use the earnings data to determine whether the recipient is engaging in SGA, since work after a recipient becomes entitled to benefits can cause a cessation of disability. The respondents are businesses that employ Social Security disability recipients. 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–L725 ................................................................................ 150,000 1 40 100,000 2. Letter to Employer Requesting Wage Information—0960–0138. SSA must establish and verify wage information for Supplemental Security Income (SSI) applicants and recipients when determining SSI eligibility and payment amounts. SSA uses Form SSA– L4201 to collect wage data from employers. SSA uses the information to determine eligibility and proper payment amounts for SSI applicants and recipients. The respondents are employers of SSI applicants and recipients. 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–L4201 .............................................................................. 133,000 1 30 66,500 3. Statement of Living Arrangements, In-Kind Support, and Maintenance—20 CFR 416.1130–416.1148—0960–0174. SSA determines SSI payment amounts based on applicants’ and recipients’ needs. We measure individuals’ needs, in part, by the amount of income they receive, including in-kind support and maintenance in the form of food and shelter provided by other persons. SSA uses Form SSA–8006–F4 to determine if in-kind support and maintenance exists for SSI applicants and recipients. This information also assists SSA in determining the income value of in-kind support and maintenance SSI applicants and recipients receive. The respondents are individuals who apply for SSI payments, or who complete an SSI eligibility redetermination. Type of Request: Revision of an OMBapproved information collection. Number of respondents Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) SSA–8006–F4 .......................................................................... mstockstill on DSK4VPTVN1PROD with NOTICES Modality of completion 173,380 1 7 20,228 4. Claimant’s Recent Medical Treatment—20 CFR 404.1512 and 416.912—0960–0292. When Disability Determinations Services (DDS) deny a claim at the reconsideration level, the claimant has a right to request a hearing before an administrative law judge (ALJ). For the hearing, SSA asks the claimant to complete and return the HA–4631 if the claimant’s file does not reflect a current, complete medical VerDate Sep<11>2014 17:25 Sep 24, 2014 Jkt 232001 history as the claimant proceeds through the appeals process. ALJs must obtain the information to update and complete the record and to verify the accuracy of the information. Through this process, ALJs can ascertain whether the claimant’s situation changed. The ALJs and hearing office staff use the response to make arrangements for consultative examination(s) and the attendance of an expert witness(es), if PO 00000 Frm 00149 Fmt 4703 Sfmt 4703 appropriate. During the hearing, the ALJ offers any completed questionnaires as exhibits and may use them to (1) refresh the claimant’s memory; and (2) shape their questions. The respondents are claimant’s requesting hearings on entitlement to Old Age, Survivors, and Disability Insurance (OASDI) benefits or SSI payments. Type of Request: Revision of an OMBapproved information collection. E:\FR\FM\25SEN1.SGM 25SEN1 57652 Federal Register / Vol. 79, No. 186 / Thursday, September 25, 2014 / Notices Modality of completion Number of respondents Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) HA–4631 .................................................................................. 200,000 1 10 33,333 5. Supplemental Security Income (SSI) Claim Information Notice—20 CFR 416.210—0960–0324. Section 1611(e)(2) of the Social Security Act requires individuals to file for and obtain all payments (annuities, pensions, disability benefits, veteran’s compensation, etc.) for which they are eligible before qualifying for SSI payments. Individuals do not qualify for SSI if they do not first apply for all other benefits. SSA uses the information on Form SSA–L8050–U3 to verify and establish a claimant or recipient’s eligibility under the SSI program. Respondents are SSI applicants or recipients who may be eligible for other payments from public or private programs. Type of Request: Revision of an OMBapproved information collection. Modality of completion Number of responses Frequency of response Average burden per response (minutes) Estimated total annual burden (hours) SSA–L–8050–U3 ..................................................................... 17,044 1 10 2,841 6. You Can Make Your Payment by Credit Card—0960–0462. Using information from Form SSA–4588 and its electronic application, Form SSA– 4589, SSA updates individuals’ Social Security records to reflect payments made on their overpayments. In addition, SSA uses this information to process payments through the appropriate credit card company. SSA provides the SSA–4588 when we inform an individual that we detected an overpayment. Individuals may choose to make a one-time payment or recurring monthly payments by completing and submitting the SSA–4588. SSA uses the SSA–4589 electronic intranet application only when individuals choose to telephone the Program Service Centers to make a one-time payment in Number of respondents Modality of completion lieu of completing Form SSA–4588. An SSA debtor contact representative completes the SSA–4589 electronic intranet application. Respondents are OASDI beneficiaries and SSI recipients who have outstanding overpayments. Type of Request: Revision of an OMBapproved information collection. Average burden per response (minutes) Frequency of response Estimated total annual burden (hours) SSA–4588 paper form ............................................................. SSA–4589 electronic intranet application ................................ 13,200 221,316 1 1 10 5 2,200 18,443 Totals ................................................................................ 234,516 .............................. .............................. 20,643 7. Application for Extra Help with Medicare Prescription Drug Plan Costs—20 CFR 418.3101—0960–0696. The Medicare Modernization Act of 2003 mandated the creation of the Medicare Part D prescription drug coverage program and the provision of subsidies for eligible Medicare beneficiaries. SSA uses Form SSA–1020 or the Internet i1020, the Application for Extra Help with Medicare Prescription Drug Plan Costs, to obtain income and resource information from Medicare beneficiaries and to make a Number of respondents mstockstill on DSK4VPTVN1PROD with NOTICES Modality of completion subsidy decision. The respondents are Medicare beneficiaries applying for the Part D low-income subsidy. Type of Request: Revision of an OMBapproved information collection. Average burden per response (minutes) Frequency of response Estimated total annual burden (hours) SSA–1020 (paper application form) ........................................ i1020 (online application) ......................................................... Field Office Interview ............................................................... 617,070 282,228 155,687 1 1 1 30 25 30 308,535 117,595 77,844 Totals ................................................................................ 1,054,985 .............................. .............................. 503,974 E:\FR\FM\25SEN1.SGM 25SEN1 VerDate Sep<11>2014 17:25 Sep 24, 2014 Jkt 232001 PO 00000 Frm 00150 Fmt 4703 Sfmt 4703 57653 Federal Register / Vol. 79, No. 186 / Thursday, September 25, 2014 / Notices 8. Certification of Low Birth Weight for SSI Eligibility of Funds You Provided to Another and Statement of Funds You Received—20 CFR 416.931, 416.926a(m), and 416.924—0960–0720. Hospitals and claimants use Form SSA– 3380 to provide medical information to local field offices (FO) and DDSs on behalf of infants with low birth weight. FOs use the form as a protective filing statement and the medical information to make presumptive disability findings, which allow expedited payment to eligible claimants. DDSs use the medical information to determine disability and continuing disability. The respondents are hospitals and claimants who have information identifying low birth weight babies and their medical conditions. 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–3380 ................................................................................ 28,125 1 15 7,031 Dated: September 22, 2014. Faye Lipsky, Reports Clearance Director, Social Security Administration. mailing address is U.S. Department of State, SA–5, L/PD, Fifth Floor (Suite 5H03), Washington, DC 20522–0505. Dated: September 19, 2014. Kelly Keiderling, Principal Deputy Assistant Secretary, Bureau of Educational and Cultural Affairs, Department of State. [FR Doc. 2014–22809 Filed 9–24–14; 8:45 am] BILLING CODE 4191–02–P DEPARTMENT OF STATE BILLING CODE 4710–05–P Culturally Significant Objects Imported for Exhibition Determinations: ‘‘Picasso/Dali, Dali/Picasso’’ Notice is hereby given of the following determinations: Pursuant to the authority vested in me by the Act of October 19, 1965 (79 Stat. 985; 22 U.S.C. 2459), Executive Order 12047 of March 27, 1978, the Foreign Affairs Reform and Restructuring Act of 1998 (112 Stat. 2681, et seq.; 22 U.S.C. 6501 note, et seq.), Delegation of Authority No. 234 of October 1, 1999, and Delegation of Authority No. 236–3 of August 28, 2000 (and, as appropriate, Delegation of Authority No. 257 of April 15, 2003), I hereby determine that the objects to be included in the exhibition ‘‘Picasso/ Dali, Dali/Picasso,’’ imported from abroad for temporary exhibition within the United States, are of cultural significance. The objects are imported pursuant to loan agreements with the foreign owners or custodians. I also determine that the exhibition or display of the exhibit objects at the Salvador Dali Museum, St. Petersburg, Florida, from on or about November 8, 2014, until on or about February 16, 2015, and at possible additional exhibitions or venues yet to be determined, is in the national interest. I have ordered that Public Notice of these Determinations be published in the Federal Register. FOR FURTHER INFORMATION CONTACT: For further information, including a list of the imported objects, contact Paul W. Manning, Attorney-Adviser, Office of the Legal Adviser, U.S. Department of State (telephone: 202–632–6469). The SUMMARY: mstockstill on DSK4VPTVN1PROD with NOTICES Barbara J. Hairston, Supervisory Dockets Officer, Docket Operations, Federal Register Liaison. [FR Doc. 2014–22146 Filed 9–24–14; 8:45 am] BILLING CODE 4910–9X–P [FR Doc. 2014–22845 Filed 9–24–14; 8:45 am] [Public Notice 8884] transportation of persons, property, and mail. VerDate Sep<11>2014 17:25 Sep 24, 2014 Jkt 232001 DEPARTMENT OF TRANSPORTATION Office of the Secretary DEPARTMENT OF TRANSPORTATION Office of the Secretary Notice of Applications for Certificates of Public Convenience and Necessity and Foreign Air Carrier Permits Filed Under Subpart B (Formerly Subpart Q) During the Week Ending September 6, 2014 The following Applications for Certificates of Public Convenience and Necessity and Foreign Air Carrier Permits were filed under Subpart B (formerly Subpart Q) of the Department of Transportation’s Procedural Regulations (See 14 CFR 302.201 et. seq.). The due date for Answers, Conforming Applications, or Motions to Modify Scope are set forth below for each application. Following the Answer period DOT may process the application by expedited procedures. Such procedures may consist of the adoption of a show-cause order, a tentative order, or in appropriate cases a final order without further proceedings. Docket Number: DOT–OST–2014– 0152. Date Filed: September 2, 2014. Due Date for Answers, Conforming Applications, or Motion to Modify Scope: September 23, 2014. Description: Application of Caribbean Sun Airlines, Inc. d/b/a World Atlantic Airlines (‘‘World Atlantic’’) requesting a certificate of public convenience and necessity authorizing World Atlantic to engage in interstate charter air PO 00000 Frm 00151 Fmt 4703 Sfmt 4703 Notice of Applications for Certificates of Public Convenience and Necessity and Foreign Air Carrier Permits Filed Under Subpart B (Formerly Subpart Q) During the Week Ending August 9, 2014 The following Applications for Certificates of Public Convenience and Necessity and Foreign Air Carrier Permits were filed under Subpart B (formerly Subpart Q) of the Department of Transportation’s Procedural Regulations (See 14 CFR 302.201 et. seq.). The due date for Answers, Conforming Applications, or Motions to Modify Scope are set forth below for each application. Following the Answer period DOT may process the application by expedited procedures. Such procedures may consist of the adoption of a show-cause order, a tentative order, or in appropriate cases a final order without further proceedings. Docket Number: DOT–OST–2014– 0134. Date Filed: August 5, 2014. Due Date for Answers, Conforming Applications, or Motion to Modify Scope: August 26, 2014. Description: Application of Aeroenlaces Nacionales, S.A. de C.V.(d/ b/a vivaAerobus) requesting an exemption authorizing it to engage in scheduled foreign airtransport of persons, property and mail between Houston, Texas and Cancun, Mexico. In addition, vivaAerobus requests that the Department amend the carrier’s foreign air carrier permit to integrate the E:\FR\FM\25SEN1.SGM 25SEN1

Agencies

[Federal Register Volume 79, Number 186 (Thursday, September 25, 2014)]
[Notices]
[Pages 57650-57653]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-22809]


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

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: OIRASubmission@omb.eop.gov.
    (SSA), Social Security Administration, OLCA, Attn: Reports

[[Page 57651]]

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 
November 24, 2014. Individuals can obtain copies of the collection 
instruments by writing to the above email address.
    1. Letter to Employer Requesting Information About Wages Earned By 
Beneficiary--20 CFR 416.703, 404.801 & 404.820--0960-0034. Social 
Security disability recipients receive payments based on their 
inability to engage in substantial gainful activity (SGA) because of a 
physical or mental condition. If the recipients work, SSA must evaluate 
and determine if they continue to meet the disability requirements of 
the law. Therefore, we use Form SSA-L725 to request monthly earnings 
information from the recipient's employer. We then use the earnings 
data to determine whether the recipient is engaging in SGA, since work 
after a recipient becomes entitled to benefits can cause a cessation of 
disability. The respondents are businesses that employ Social Security 
disability recipients.
    Type of Request: Revision of an OMB-approved information 
collection.

 
----------------------------------------------------------------------------------------------------------------
                                                                                                Estimated total
     Modality of completion            Number of         Frequency of     Average burden per     annual burden
                                      respondents          response       response (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L725........................            150,000                   1                  40             100,000
----------------------------------------------------------------------------------------------------------------

    2. Letter to Employer Requesting Wage Information--0960-0138. SSA 
must establish and verify wage information for Supplemental Security 
Income (SSI) applicants and recipients when determining SSI eligibility 
and payment amounts. SSA uses Form SSA-L4201 to collect wage data from 
employers. SSA uses the information to determine eligibility and proper 
payment amounts for SSI applicants and recipients. The respondents are 
employers of SSI applicants and recipients.
    Type of Request: Revision of an OMB-approved information 
collection.

 
----------------------------------------------------------------------------------------------------------------
                                                                                                Estimated total
     Modality of completion            Number of         Frequency of     Average burden per     annual burden
                                      respondents          response       response (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L4201.......................            133,000                   1                  30              66,500
----------------------------------------------------------------------------------------------------------------

    3. Statement of Living Arrangements, In-Kind Support, and 
Maintenance--20 CFR 416.1130-416.1148--0960-0174. SSA determines SSI 
payment amounts based on applicants' and recipients' needs. We measure 
individuals' needs, in part, by the amount of income they receive, 
including in-kind support and maintenance in the form of food and 
shelter provided by other persons. SSA uses Form SSA-8006-F4 to 
determine if in-kind support and maintenance exists for SSI applicants 
and recipients. This information also assists SSA in determining the 
income value of in-kind support and maintenance SSI applicants and 
recipients receive. The respondents are individuals who apply for SSI 
payments, or who complete an SSI eligibility redetermination.
    Type of Request: Revision of an OMB-approved information 
collection.

 
----------------------------------------------------------------------------------------------------------------
                                                                                                Estimated total
     Modality of completion            Number of         Frequency of     Average burden per     annual burden
                                      respondents          response       response (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-8006-F4.....................            173,380                   1                   7              20,228
----------------------------------------------------------------------------------------------------------------

    4. Claimant's Recent Medical Treatment--20 CFR 404.1512 and 
416.912--0960-0292. When Disability Determinations Services (DDS) deny 
a claim at the reconsideration level, the claimant has a right to 
request a hearing before an administrative law judge (ALJ). For the 
hearing, SSA asks the claimant to complete and return the HA-4631 if 
the claimant's file does not reflect a current, complete medical 
history as the claimant proceeds through the appeals process. ALJs must 
obtain the information to update and complete the record and to verify 
the accuracy of the information. Through this process, ALJs can 
ascertain whether the claimant's situation changed. The ALJs and 
hearing office staff use the response to make arrangements for 
consultative examination(s) and the attendance of an expert 
witness(es), if appropriate. During the hearing, the ALJ offers any 
completed questionnaires as exhibits and may use them to (1) refresh 
the claimant's memory; and (2) shape their questions. The respondents 
are claimant's requesting hearings on entitlement to Old Age, 
Survivors, and Disability Insurance (OASDI) benefits or SSI payments.
    Type of Request: Revision of an OMB-approved information 
collection.

[[Page 57652]]



 
----------------------------------------------------------------------------------------------------------------
                                                                                                Estimated total
     Modality of completion            Number of         Frequency of     Average burden per     annual burden
                                      respondents          response       response (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
HA-4631.........................            200,000                   1                  10              33,333
----------------------------------------------------------------------------------------------------------------

    5. Supplemental Security Income (SSI) Claim Information Notice--20 
CFR 416.210--0960-0324. Section 1611(e)(2) of the Social Security Act 
requires individuals to file for and obtain all payments (annuities, 
pensions, disability benefits, veteran's compensation, etc.) for which 
they are eligible before qualifying for SSI payments. Individuals do 
not qualify for SSI if they do not first apply for all other benefits. 
SSA uses the information on Form SSA-L8050-U3 to verify and establish a 
claimant or recipient's eligibility under the SSI program. Respondents 
are SSI applicants or recipients who may be eligible for other payments 
from public or private programs.
    Type of Request: Revision of an OMB-approved information 
collection.

 
----------------------------------------------------------------------------------------------------------------
                                                                                                Estimated total
     Modality of completion            Number of         Frequency of     Average burden per     annual burden
                                       responses           response       response (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L-8050-U3...................             17,044                   1                  10               2,841
----------------------------------------------------------------------------------------------------------------

    6. You Can Make Your Payment by Credit Card--0960-0462. Using 
information from Form SSA-4588 and its electronic application, Form 
SSA-4589, SSA updates individuals' Social Security records to reflect 
payments made on their overpayments. In addition, SSA uses this 
information to process payments through the appropriate credit card 
company. SSA provides the SSA-4588 when we inform an individual that we 
detected an overpayment. Individuals may choose to make a one-time 
payment or recurring monthly payments by completing and submitting the 
SSA-4588. SSA uses the SSA-4589 electronic intranet application only 
when individuals choose to telephone the Program Service Centers to 
make a one-time payment in lieu of completing Form SSA-4588. An SSA 
debtor contact representative completes the SSA-4589 electronic 
intranet application. Respondents are OASDI beneficiaries and SSI 
recipients who have outstanding overpayments.
    Type of Request: Revision of an OMB-approved information 
collection.

 
----------------------------------------------------------------------------------------------------------------
                                                                              Average burden    Estimated total
       Modality of completion             Number of         Frequency of       per response      annual burden
                                         respondents          response          (minutes)           (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4588 paper form.................             13,200                  1                 10              2,200
SSA-4589 electronic intranet                    221,316                  1                  5             18,443
 application........................
                                     ---------------------------------------------------------------------------
    Totals..........................            234,516  .................  .................             20,643
----------------------------------------------------------------------------------------------------------------

    7. Application for Extra Help with Medicare Prescription Drug Plan 
Costs--20 CFR 418.3101--0960-0696. The Medicare Modernization Act of 
2003 mandated the creation of the Medicare Part D prescription drug 
coverage program and the provision of subsidies for eligible Medicare 
beneficiaries. SSA uses Form SSA-1020 or the Internet i1020, the 
Application for Extra Help with Medicare Prescription Drug Plan Costs, 
to obtain income and resource information from Medicare beneficiaries 
and to make a subsidy decision. The respondents are Medicare 
beneficiaries applying for the Part D low-income subsidy.
    Type of Request: Revision of an OMB-approved information 
collection.

 
----------------------------------------------------------------------------------------------------------------
                                                                              Average burden    Estimated total
       Modality of completion             Number of         Frequency of       per response      annual burden
                                         respondents          response          (minutes)           (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1020 (paper application form)...            617,070                  1                 30            308,535
i1020 (online application)..........            282,228                  1                 25            117,595
Field Office Interview..............            155,687                  1                 30             77,844
                                     ---------------------------------------------------------------------------
    Totals..........................          1,054,985  .................  .................            503,974
----------------------------------------------------------------------------------------------------------------


[[Page 57653]]

    8. Certification of Low Birth Weight for SSI Eligibility of Funds 
You Provided to Another and Statement of Funds You Received--20 CFR 
416.931, 416.926a(m), and 416.924--0960-0720. Hospitals and claimants 
use Form SSA-3380 to provide medical information to local field offices 
(FO) and DDSs on behalf of infants with low birth weight. FOs use the 
form as a protective filing statement and the medical information to 
make presumptive disability findings, which allow expedited payment to 
eligible claimants. DDSs use the medical information to determine 
disability and continuing disability. The respondents are hospitals and 
claimants who have information identifying low birth weight babies and 
their medical conditions.
    Type of Request: Revision of an OMB-approved information 
collection.

 
----------------------------------------------------------------------------------------------------------------
                                                                                                Estimated total
     Modality of completion            Number of         Frequency of     Average burden per     annual burden
                                      respondents          response       response (minutes)        (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3380........................             28,125                   1                  15               7,031
----------------------------------------------------------------------------------------------------------------


    Dated: September 22, 2014.
Faye Lipsky,
Reports Clearance Director, Social Security Administration.
[FR Doc. 2014-22809 Filed 9-24-14; 8:45 am]
BILLING CODE 4191-02-P