Agency Information Collection Activities: Proposed Request and Comment Request the Social Security Administration (SSA) Publishes a List of Information Collection Packages Requiring Clearance by the Office of Management and Budget (OMB) in Compliance With Public Law 104-13, the Paperwork Reduction Act of 1995, effective October 1, 1995. This Notice Includes Revisions and Extensions of OMB-Approved Information Collections., 53608-53611 [2015-21967]
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53608
Federal Register / Vol. 80, No. 172 / Friday, September 4, 2015 / Notices
Commission takes such action, the
Commission shall institute proceedings
to determine whether the proposed rule
should be approved or disapproved.
IV. Solicitation of Comments
For the Commission, by the Division of
Trading and Markets, pursuant to delegated
authority.17
Robert W. Errett,
Deputy Secretary.
[FR Doc. 2015–21956 Filed 9–3–15; 8:45 am]
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:
BILLING CODE 8011–01–P
Electronic Comments
Pursuant to the authority granted to
the United States Small Business
Administration under the Small
Business Investment Act of 1958, as
amended, under Section 309 of the Act
and Section 107.1900 of the Small
Business Administration Rules and
Regulations (13 CFR 107.1900) to
function as a small business investment
company under the Small Business
Investment Company License No. 05/
05–0248 issued to Banc of America
Capital Investors SBIC II, LP said license
is hereby declared null and void.
• Use the Commission’s Internet
comment form (https://www.sec.gov/
rules/sro.shtml); or
• Send an email to rulecomments@sec.gov. Please include File
Number SR–Phlx–2015–74 on the
subject line.
Paper Comments
mstockstill on DSK4VPTVN1PROD with NOTICES
• 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–Phlx–2015–74. 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 such
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–Phlx–
2015–74, and should be submitted on or
before September 25, 2015.
VerDate Sep<11>2014
16:57 Sep 03, 2015
Jkt 235001
SMALL BUSINESS ADMINISTRATION
Surrender of License of Small
Business Investment Company
United States Small Business
Administration.
Dated: August 31, 2015.
Javier Saade,
Associate Administrator for Investment and
Innovation.
[FR Doc. 2015–21948 Filed 9–3–15; 8:45 am]
BILLING CODE P
SOCIAL SECURITY ADMINISTRATION
[Docket No: SSA–2015–0052]
Agency Information Collection
Activities: Proposed Request and
Comment Request the Social Security
Administration (SSA) Publishes a List
of Information Collection Packages
Requiring Clearance by the Office of
Management and Budget (OMB) in
Compliance With Public Law 104–13,
the Paperwork Reduction Act of 1995,
effective October 1, 1995. This Notice
Includes Revisions and Extensions 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
17 17
PO 00000
CFR 200.30–3(a)(12).
Frm 00124
Fmt 4703
Sfmt 4703
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.
Or you may submit your comments
online through www.regulations.gov,
referencing Docket ID Number [SSA–
2015–0052].
I. The information collections below
are pending at SSA. SSA will submit
them to OMB within 60 days from the
date of this notice. To be sure we
consider your comments, we must
receive them no later than November 3,
2015. Individuals can obtain copies of
the collection instruments by writing to
the above email address.
1. The Ticket to Work and SelfSufficiency Program—20 CFR 411—
0960–0644. SSA’s Ticket to Work (TTW)
Program transitions Social Security
Disability Insurance (SSDI) and
Supplemental Security Income (SSI)
recipients toward independence by
allowing them to receive Social Security
payments while maintaining
employment under the auspices of the
program. SSA uses service providers,
called Employment Networks (ENs), to
supervise participant progress through
the stages of TTW Program
participation, such as job searches and
interviews, progress reviews, and
changes in ticket status. ENs can be
private for-profit and nonprofit
organizations, as well as state vocational
rehabilitation agencies (VRs). SSA and
the ENs utilize the TTW program
manager to operate the TTW Program
and exchange information about
participants. For example, the ENs use
the program manager to provide updates
on tasks such as selecting a payment
system or requesting payments for
helping the beneficiary achieve certain
work goals. Since the ENs are not PRAexempt, the multiple information
collections within the TTW program
manager require OMB approval, and we
clear them under this information
collection request (ICR). Most of the
categories of information in this ICR are
necessary for SSA to: (1) Comply with
the Ticket to Work legislation; and (2)
provide proper oversight of the program.
SSA collects this information through
several modalities, including forms,
electronic exchanges, and written
documentation. The respondents are the
ENs or state VRs, as well as SSDI
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Federal Register / Vol. 80, No. 172 / Friday, September 4, 2015 / Notices
beneficiaries, and blind or disabled SSI
recipients working under the auspices
of the TTW Program.
Type of Collection: Revision of an
OMB-approved information collection.
Number of
respondents
Modality of completion
a) 20 CFR 411.140(d)(2)—Interactive Voice Recognition
Telephone ............................................................................
a) 20 CFR 411.140(d)(2)—Portal ............................................
a) 20 CFR 411.140(d)(3)—Virtual Job Fair Registration-Employment Networks ...............................................................
a) 20 CFR 411.140(d)(3); 411.325(a); 411.150(b)(3)—SSA–
1365 .....................................................................................
a) 20 CFR 411.140(d)(3); 411.325(a); 411.150(b)(3)—SSA–
1365 Portal ...........................................................................
a) 20 CFR 411.140(d)(3); 411.325(a); 411.150(b)(3)—SSA–
1370 .....................................................................................
a) 20 CFR 411.140(d)(3); 411.325(a); 411.150(b)(3)—SSA–
1370 Portal ...........................................................................
a) 20 CFR 411.166; 411.170(b)—Electronic File Submission
b) 20 CFR 411.145; 411.325 ...................................................
b) 20 CFR 411.145; 411.325—Portal ......................................
b) 20 CFR 411.535(a)(1)(iii)—Data Sharing/Portal .................
c) 20 CFR 411.192(b) & (c) .....................................................
c) 20 CFR 411.200(b)—SSA–1375 .........................................
c) 20 CFR 411.200(b)—Portal .................................................
c) 20 CFR 411.210(b) ..............................................................
c) 20 CFR 411.200(b) Wise Webinar Registration Page ........
c) 20 CFR 411.200(b) Virtual Job Fair Registration ...............
d) 20 CFR 411.365; 411.505; 411.515 ...................................
e) 20 CFR 411.325(d); 411.415 ..............................................
f) 20 CFR 411.575—SSA–1389; SSA–1391; SSA–1393;
SSA–1396; SSA–1398; SSA–1399 .....................................
f) 20 CFR 411.575—Portal ......................................................
f) 20 CFR 411.575—Automatic Payments ..............................
f) 20 CFR 411.560—SSA–1401 ..............................................
g) 20 CFR 411.325(f) ..............................................................
h) 20 CFR 411.435; 411.615; 411.625 ...................................
i) 20 CFR 411.320—SSA–1394 ..............................................
i) 20 CFR 411.320—SSA–1394 Portal ....................................
Average burden
per response
(minutes)
Frequency of
response
Estimated total
annual burden
(hours)
6,428
25,713
2.5
1.25
268
536
500
1
10
83
948
1
15
237
3,792
1
11
695
1,956
1
60
1,956
5,868
40,324
2,494
7,481
8,505
6
112,362
64,824
41
24,000
9,000
6
1*
1
1
1
1
1
1
1
1
1
1
1
1
1
10
5
15
11
5
30
15
5
30
3
10
10
480
978
3,360
624
1,372
709
3
28,091
5,402
21
1,200
1,500
1
8
2,805
42,075
11,220
100
1,371
2
52
158
1
1
1
1
1
1
1
1
40
22
0
20
45
120
10
5
1,870
15,427
0
33
1,028
4
9
13
372,032
Totals ................................................................................
1
1
..............................
..............................
65,428
* (None received in 2012, 2013, 2014)
2. Representative Payment Policies
and Administrative Procedures for
Imposing Penalties for False or
Misleading Statements or Withholding
of Information—0960–0740. This
information collection request
comprises several regulation sections
that provide additional safeguards for
Social Security beneficiaries’ whose
representative payees receive their
payment. SSA requires representative
payees to notify them of any event or
change in circumstances that would
affect receipt of benefits or performance
of payee duties. SSA uses the
information to determine continued
Number of
respondents
mstockstill on DSK4VPTVN1PROD with NOTICES
Modality of completion (regulation citation)
eligibility for benefits, the amount of
benefits due and if the payee is suitable
to continue servicing as payee. The
respondents are representative payees
who receive and use benefits on behalf
of Social Security beneficiaries.
Type of Request: Extension of an
OMB-approved information collection.
Average burden
per response
(minutes)
Frequency of
response
Estimated total
annual burden
(hours)
404.2035(d)—Paper/Mail .........................................................
404.2035(d)—Office interview/Intranet ....................................
404.2035(f)—Paper/Mail ..........................................................
404.2035(f)—Office interview/Intranet .....................................
416.635(d)—Paper/Mail ...........................................................
416.635(d)—Office interview/Intranet ......................................
416.635(f)—Paper/Mail ............................................................
416.635(f)—Office interview/Intranet .......................................
28,600
543,400
286
5,434
15,600
286,400
156
2,964
1
1
1
1
1
1
1
1
5
5
5
5
5
5
5
5
2,383
45,283
24
453
1,300
23,867
13
247
Totals ................................................................................
882,840
..............................
..............................
73,570
Sfmt 4703
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04SEN1
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16:57 Sep 03, 2015
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PO 00000
Frm 00125
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Federal Register / Vol. 80, No. 172 / Friday, September 4, 2015 / Notices
II. 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 5, 2015. Individuals can obtain
copies of the OMB clearance packages
by writing to OR.Reports.Clearance@
ssa.gov.
1. Statement of Employer—20 CFR
404.801–404.803—0960–0030. When
workers report they were paid wages but
cannot provide proof of those earnings,
and the wages do not appear in SSA’s
records of earnings, SSA uses Form
SSA–7011–F4 to document the alleged
wages. Specifically, the agency uses the
form to resolve discrepancies in the
individual’s Social Security earnings
record and to process claims for Social
Security benefits. We only send Form
SSA–7011–F4 to employers if we are
unable able to locate the earnings
information within our own records.
The respondents are employers who can
verify wage allegations made by wage
earners.
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–7011–F4 ..........................................................................
500
1
20
167
2. Substitution of Party Upon Death of
Claimant—20 CFR 404.957(c)(4) and
416.1457(c)(4)—0960–0288. An
administrative law judge (ALJ) may
dismiss a request for a hearing on a
pending claim of a deceased individual
for Social Security benefits or SSI
payments. Individuals who believe the
dismissal may adversely affect them
may complete Form HA–539, which
allows them to request to become a
substitute party for the deceased
claimant. The ALJs and the hearing
office support staff use this information
from the HA–539 to: (1) Maintain a
written record of request; (2) establish
the relationship of the requester to the
deceased claimant; (3) determine the
substituted individual’s wishes
regarding an oral hearing or decision on
the record; and (4) admit the data into
the claimant’s official record as an
exhibit. The respondents are individuals
requesting to be a substitute party for a
deceased claimant.
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)
HA–539 ....................................................................................
4,000
1
5
333
3. Claimant Statement about Loan of
Food or Shelter; Statement about Food
or Shelter Provided to Another—20 CFR
416.1130–416.1148—0960–0529. SSA
bases an SSI claimant or recipient’s
eligibility on need, as measured by the
amount of income an individual
receives. Per our calculations, income
includes other people providing in-kind
support and maintenance in the form of
food and shelter to SSI applicants or
recipients. SSA uses Forms SSA–5062
and SSA–L5063 to obtain statements
about food or shelter provided to SSI
claimants or recipients. SSA uses this
information to determine whether food
or shelters are bona fide loans or income
for SSI purposes. This determination
Number of
respondents
Modality of completion
may affect claimants’ or recipients’
eligibility for SSI as well as the amounts
of their SSI payments. The respondents
are claimants and recipients for SSI
payments, and individuals who provide
loans of food or shelter to them.
Type of Request: Revision of an OMBapproved information collection.
Average burden
per response
(minutes)
Frequency of
response
Estimated total
annual burden
(hours)
34,752
34,752
34,752
34,752
1
1
1
1
10
10
10
10
5,792
5,792
5,792
5,792
Total ..................................................................................
mstockstill on DSK4VPTVN1PROD with NOTICES
SSA–5062 Paper form .............................................................
SSA–L5063 Paper form ...........................................................
SSA–5062 Modernized SSI Claims System (MSSICS) ..........
SSA–L5063 MSSICS ...............................................................
139,008
..............................
..............................
3,168
4. Representative Payee Report of
Benefits and Dedicated Account—20
CFR 416.546, 416.635, 416.640,
416.665—0960–0576. SSA requires
representative payees (RPs) to submit a
written report accounting for the use of
money paid to Social Security or SSI
VerDate Sep<11>2014
16:57 Sep 03, 2015
Jkt 235001
recipients, and to establish and
maintain a dedicated account for these
payments. SSA uses Form SSA–6233 to:
(1) Ensure the RPs use the payments for
the recipient’s current maintenance and
personal needs; and (2) confirm the
expenditures of funds from the
PO 00000
Frm 00126
Fmt 4703
Sfmt 4703
dedicated account remain in
compliance with the law. Respondents
are RPs for SSI and Social Security
recipients.
Type of Request: Revision of an OMBapproved information collection.
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Federal Register / Vol. 80, No. 172 / Friday, September 4, 2015 / Notices
53611
Modality of completion
Number of
respondents
Frequency of
response
Average burden
per response
(minutes)
Estimated total
annual burden
(hours)
SSA–6233 ................................................................................
30,000
1
20
10,000
5. Application for Circuit Court Law—
20 CFR 404.985 & 416.1458—0960–
0581. Persons claiming an acquiescence
ruling (AR) would change SSA’s prior
determination or decision must submit
a written readjudication request with
specific information. SSA reviews the
information in the requests to determine
if the issues stated in the AR pertain to
the claimant’s case, and if the claimant
is entitled to readjudication. If
readjudication is appropriate, SSA
considers the issues the AR covers. Any
new determination or decision is subject
to administrative or judicial review as
specified in the regulations.
Respondents are claimants for Social
Security benefits and SSI payments who
request readjudication. This information
collection request is for the information
claimants must provide to request
readjudication.
Type of Request: Extension of an
OMB-approved information collection.
Modality of completion
Number of
respondents
Frequency of
response
Average burden
per response
(minutes)
Estimated total
annual burden
(hours)
AR-based Readjudication ........................................................
Requests ..................................................................................
10,000
1
17
2,833
6. Certification of Prisoner Identity
Information—20 CFR 422.107—0960–
0688. Inmates of Federal, State, or local
prisons may need a Social Security card
as verification of their Social Security
number for school or work programs, or
as proof of employment eligibility upon
release from incarceration. Before SSA
can issue a replacement Social Security
card, applicants must show SSA proof
of their identity. People who are in
prison for an extended period typically
do not have current identity documents.
Therefore, under formal written
agreement with the correctional
institution, SSA allows prison officials
to verify the identity of certain
incarcerated U.S. citizens who need
replacement Social Security cards.
Information prison officials provide
comes from the official prison files, sent
on correctional facility letterhead. SSA
uses this information to establish the
applicant’s identity in the replacement
Social Security card process. The
respondents are prison officials who
certify the identity of prisoners applying
for replacement Social Security cards.
Type of Request: Extension of an
OMB-approved Information Collection.
Modality of completion
Number of
respondents
Frequency of
response
(Number of
responses)
Average burden
per response
(minutes)
Estimated total
annual burden
(hours)
Verification of Prisoner Identity Statements ..................................................
1,000
200
(200,000)
3
10,000
Dated: September 1, 2015.
Naomi R. Sipple,
Reports Clearance Officer, Social Security
Administration.
[FR Doc. 2015–21967 Filed 9–3–15; 8:45 am]
BILLING CODE 4191–02–P
DEPARTMENT OF STATE
[Public Notice: 9256]
60-Day Notice of Proposed Information
Collection: INTERNational
Connections
Notice of request for public
comment.
mstockstill on DSK4VPTVN1PROD with NOTICES
ACTION:
The U.S. Department of State
is seeking Office of Management and
Budget (OMB) approval for the
information collection described below.
In accordance with the Paperwork
Reduction Act of 1995, we are
requesting comments on this collection
from all interested individuals and
SUMMARY:
VerDate Sep<11>2014
16:57 Sep 03, 2015
Jkt 235001
organizations. The purpose of this
notice is to allow 60 days for public
comment preceding submission of the
collection to OMB.
DATES: The Department will accept
comments from the public up to
November 3, 2015.
You may submit comments by any of
the following methods:
• Web: Persons with access to the
Internet may comment on this notice by
going to www.Regulations.gov. You can
search for the document by entering
‘‘Docket Number: DOS–2015–0044’’ in
the Search field. Then click the
‘‘Comment Now’’ button and complete
the comment form.
• Email: rudowh@state.gov.
• Regular Mail: Send written
comments to: U.S. Department of State,
2401 E St. NW., SA1–518H,
Washington, DC 20520. Attn.: Heather
Rudow.
You must include the DS form
number (if applicable), information
collection title, and the OMB control
number in any correspondence.
PO 00000
Frm 00127
Fmt 4703
Sfmt 4703
FOR FURTHER INFORMATION CONTACT:
Direct requests for additional
information regarding the collection
listed in this notice, including requests
for copies of the proposed collection
instrument and supporting documents,
to Heather Rudow, 2401 E Street NW.,
Washington, DC 20520, who may be
reached on 202–261–8953 or at
rudowh@state.gov.
SUPPLEMENTARY INFORMATION:
• Title of Information Collection:
INTERNational Connections.
• OMB Control Number: 1405–0190.
• Type of Request: Extension of an
Approved Collection.
• Originating Office: Bureau of
Human Resources, Office of
Recruitment, Examination and
Employment (HR/REE).
• Form Number: DS–5103.
• Respondents: Current and former
interns of the U.S. Department of State’s
student programs, including
internships, Pickerings, Rangels,
Pathways, etc., and Department
employees.
E:\FR\FM\04SEN1.SGM
04SEN1
]]>Agencies
[Federal Register Volume 80, Number 172 (Friday, September 4, 2015)]
[Notices]
[Pages 53608-53611]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-21967]
=======================================================================
-----------------------------------------------------------------------
SOCIAL SECURITY ADMINISTRATION
[Docket No: SSA-2015-0052]
Agency Information Collection Activities: Proposed Request and
Comment Request the Social Security Administration (SSA) Publishes a
List of Information Collection Packages Requiring Clearance by the
Office of Management and Budget (OMB) in Compliance With Public Law
104-13, the Paperwork Reduction Act of 1995, effective October 1, 1995.
This Notice Includes Revisions and Extensions 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. Or you may submit your comments online
through www.regulations.gov, referencing Docket ID Number [SSA-2015-
0052].
I. The information collections below are pending at SSA. SSA will
submit them to OMB within 60 days from the date of this notice. To be
sure we consider your comments, we must receive them no later than
November 3, 2015. Individuals can obtain copies of the collection
instruments by writing to the above email address.
1. The Ticket to Work and Self-Sufficiency Program--20 CFR 411--
0960-0644. SSA's Ticket to Work (TTW) Program transitions Social
Security Disability Insurance (SSDI) and Supplemental Security Income
(SSI) recipients toward independence by allowing them to receive Social
Security payments while maintaining employment under the auspices of
the program. SSA uses service providers, called Employment Networks
(ENs), to supervise participant progress through the stages of TTW
Program participation, such as job searches and interviews, progress
reviews, and changes in ticket status. ENs can be private for-profit
and nonprofit organizations, as well as state vocational rehabilitation
agencies (VRs). SSA and the ENs utilize the TTW program manager to
operate the TTW Program and exchange information about participants.
For example, the ENs use the program manager to provide updates on
tasks such as selecting a payment system or requesting payments for
helping the beneficiary achieve certain work goals. Since the ENs are
not PRA-exempt, the multiple information collections within the TTW
program manager require OMB approval, and we clear them under this
information collection request (ICR). Most of the categories of
information in this ICR are necessary for SSA to: (1) Comply with the
Ticket to Work legislation; and (2) provide proper oversight of the
program. SSA collects this information through several modalities,
including forms, electronic exchanges, and written documentation. The
respondents are the ENs or state VRs, as well as SSDI
[[Page 53609]]
beneficiaries, and blind or disabled SSI recipients working under the
auspices of the TTW Program.
Type of Collection: 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)
----------------------------------------------------------------------------------------------------------------
a) 20 CFR 411.140(d)(2)--Interactive 6,428 1 2.5 268
Voice Recognition Telephone........
a) 20 CFR 411.140(d)(2)--Portal..... 25,713 1 1.25 536
a) 20 CFR 411.140(d)(3)--Virtual Job 500 1 10 83
Fair Registration-Employment
Networks...........................
a) 20 CFR 411.140(d)(3); 411.325(a); 948 1 15 237
411.150(b)(3)--SSA-1365............
a) 20 CFR 411.140(d)(3); 411.325(a); 3,792 1 11 695
411.150(b)(3)--SSA-1365 Portal.....
a) 20 CFR 411.140(d)(3); 411.325(a); 1,956 1 60 1,956
411.150(b)(3)--SSA-1370............
a) 20 CFR 411.140(d)(3); 411.325(a); 5,868 1 10 978
411.150(b)(3)--SSA-1370 Portal.....
a) 20 CFR 411.166; 411.170(b)-- 40,324 1 5 3,360
Electronic File Submission.........
b) 20 CFR 411.145; 411.325.......... 2,494 1 15 624
b) 20 CFR 411.145; 411.325--Portal.. 7,481 1 11 1,372
b) 20 CFR 411.535(a)(1)(iii)--Data 8,505 1 5 709
Sharing/Portal.....................
c) 20 CFR 411.192(b) & (c).......... 6 1 30 3
c) 20 CFR 411.200(b)--SSA-1375...... 112,362 1 15 28,091
c) 20 CFR 411.200(b)--Portal........ 64,824 1 5 5,402
c) 20 CFR 411.210(b)................ 41 1 30 21
c) 20 CFR 411.200(b) Wise Webinar 24,000 1 3 1,200
Registration Page..................
c) 20 CFR 411.200(b) Virtual Job 9,000 1 10 1,500
Fair Registration..................
d) 20 CFR 411.365; 411.505; 411.515. 6 1 10 1
e) 20 CFR 411.325(d); 411.415....... 1* 1 480 8
f) 20 CFR 411.575--SSA-1389; SSA- 2,805 1 40 1,870
1391; SSA-1393; SSA-1396; SSA-1398;
SSA-1399...........................
f) 20 CFR 411.575--Portal........... 42,075 1 22 15,427
f) 20 CFR 411.575--Automatic 11,220 1 0 0
Payments...........................
f) 20 CFR 411.560--SSA-1401......... 100 1 20 33
g) 20 CFR 411.325(f)................ 1,371 1 45 1,028
h) 20 CFR 411.435; 411.615; 411.625. 2 1 120 4
i) 20 CFR 411.320--SSA-1394......... 52 1 10 9
i) 20 CFR 411.320--SSA-1394 Portal.. 158 1 5 13
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Totals.......................... 372,032 ................. ................. 65,428
----------------------------------------------------------------------------------------------------------------
* (None received in 2012, 2013, 2014)
2. Representative Payment Policies and Administrative Procedures
for Imposing Penalties for False or Misleading Statements or
Withholding of Information--0960-0740. This information collection
request comprises several regulation sections that provide additional
safeguards for Social Security beneficiaries' whose representative
payees receive their payment. SSA requires representative payees to
notify them of any event or change in circumstances that would affect
receipt of benefits or performance of payee duties. SSA uses the
information to determine continued eligibility for benefits, the amount
of benefits due and if the payee is suitable to continue servicing as
payee. The respondents are representative payees who receive and use
benefits on behalf of Social Security beneficiaries.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion (regulation Number of Frequency of per response annual burden
citation) respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
404.2035(d)--Paper/Mail............. 28,600 1 5 2,383
404.2035(d)--Office interview/ 543,400 1 5 45,283
Intranet...........................
404.2035(f)--Paper/Mail............. 286 1 5 24
404.2035(f)--Office interview/ 5,434 1 5 453
Intranet...........................
416.635(d)--Paper/Mail.............. 15,600 1 5 1,300
416.635(d)--Office interview/ 286,400 1 5 23,867
Intranet...........................
416.635(f)--Paper/Mail.............. 156 1 5 13
416.635(f)--Office interview/ 2,964 1 5 247
Intranet...........................
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Totals.......................... 882,840 ................. ................. 73,570
----------------------------------------------------------------------------------------------------------------
[[Page 53610]]
II. 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 5, 2015. Individuals can obtain copies of the OMB
clearance packages by writing to OR.Reports.Clearance@ssa.gov.
1. Statement of Employer--20 CFR 404.801-404.803--0960-0030. When
workers report they were paid wages but cannot provide proof of those
earnings, and the wages do not appear in SSA's records of earnings, SSA
uses Form SSA-7011-F4 to document the alleged wages. Specifically, the
agency uses the form to resolve discrepancies in the individual's
Social Security earnings record and to process claims for Social
Security benefits. We only send Form SSA-7011-F4 to employers if we are
unable able to locate the earnings information within our own records.
The respondents are employers who can verify wage allegations made by
wage earners.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden per Estimated total
Modality of completion Number of Frequency of response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-7011-F4..................... 500 1 20 167
----------------------------------------------------------------------------------------------------------------
2. Substitution of Party Upon Death of Claimant--20 CFR
404.957(c)(4) and 416.1457(c)(4)--0960-0288. An administrative law
judge (ALJ) may dismiss a request for a hearing on a pending claim of a
deceased individual for Social Security benefits or SSI payments.
Individuals who believe the dismissal may adversely affect them may
complete Form HA-539, which allows them to request to become a
substitute party for the deceased claimant. The ALJs and the hearing
office support staff use this information from the HA-539 to: (1)
Maintain a written record of request; (2) establish the relationship of
the requester to the deceased claimant; (3) determine the substituted
individual's wishes regarding an oral hearing or decision on the
record; and (4) admit the data into the claimant's official record as
an exhibit. The respondents are individuals requesting to be a
substitute party for a deceased claimant.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden per Estimated total
Modality of completion Number of Frequency of response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
HA-539.......................... 4,000 1 5 333
----------------------------------------------------------------------------------------------------------------
3. Claimant Statement about Loan of Food or Shelter; Statement
about Food or Shelter Provided to Another--20 CFR 416.1130-416.1148--
0960-0529. SSA bases an SSI claimant or recipient's eligibility on
need, as measured by the amount of income an individual receives. Per
our calculations, income includes other people providing in-kind
support and maintenance in the form of food and shelter to SSI
applicants or recipients. SSA uses Forms SSA-5062 and SSA-L5063 to
obtain statements about food or shelter provided to SSI claimants or
recipients. SSA uses this information to determine whether food or
shelters are bona fide loans or income for SSI purposes. This
determination may affect claimants' or recipients' eligibility for SSI
as well as the amounts of their SSI payments. The respondents are
claimants and recipients for SSI payments, and individuals who provide
loans of food or shelter to them.
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-5062 Paper form................. 34,752 1 10 5,792
SSA-L5063 Paper form................ 34,752 1 10 5,792
SSA-5062 Modernized SSI Claims 34,752 1 10 5,792
System (MSSICS)....................
SSA-L5063 MSSICS.................... 34,752 1 10 5,792
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Total........................... 139,008 ................. ................. 3,168
----------------------------------------------------------------------------------------------------------------
4. Representative Payee Report of Benefits and Dedicated Account--
20 CFR 416.546, 416.635, 416.640, 416.665--0960-0576. SSA requires
representative payees (RPs) to submit a written report accounting for
the use of money paid to Social Security or SSI recipients, and to
establish and maintain a dedicated account for these payments. SSA uses
Form SSA-6233 to: (1) Ensure the RPs use the payments for the
recipient's current maintenance and personal needs; and (2) confirm the
expenditures of funds from the dedicated account remain in compliance
with the law. Respondents are RPs for SSI and Social Security
recipients.
Type of Request: Revision of an OMB-approved information
collection.
[[Page 53611]]
----------------------------------------------------------------------------------------------------------------
Average burden per Estimated total
Modality of completion Number of Frequency of response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-6233........................ 30,000 1 20 10,000
----------------------------------------------------------------------------------------------------------------
5. Application for Circuit Court Law--20 CFR 404.985 & 416.1458--
0960-0581. Persons claiming an acquiescence ruling (AR) would change
SSA's prior determination or decision must submit a written
readjudication request with specific information. SSA reviews the
information in the requests to determine if the issues stated in the AR
pertain to the claimant's case, and if the claimant is entitled to
readjudication. If readjudication is appropriate, SSA considers the
issues the AR covers. Any new determination or decision is subject to
administrative or judicial review as specified in the regulations.
Respondents are claimants for Social Security benefits and SSI payments
who request readjudication. This information collection request is for
the information claimants must provide to request readjudication.
Type of Request: Extension of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden per Estimated total
Modality of completion Number of Frequency of response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
AR-based Readjudication......... 10,000 1 17 2,833
Requests........................
----------------------------------------------------------------------------------------------------------------
6. Certification of Prisoner Identity Information--20 CFR 422.107--
0960-0688. Inmates of Federal, State, or local prisons may need a
Social Security card as verification of their Social Security number
for school or work programs, or as proof of employment eligibility upon
release from incarceration. Before SSA can issue a replacement Social
Security card, applicants must show SSA proof of their identity. People
who are in prison for an extended period typically do not have current
identity documents. Therefore, under formal written agreement with the
correctional institution, SSA allows prison officials to verify the
identity of certain incarcerated U.S. citizens who need replacement
Social Security cards. Information prison officials provide comes from
the official prison files, sent on correctional facility letterhead.
SSA uses this information to establish the applicant's identity in the
replacement Social Security card process. The respondents are prison
officials who certify the identity of prisoners applying for
replacement Social Security cards.
Type of Request: Extension of an OMB-approved Information
Collection.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Average burden per Estimated total
Modality of completion Number of Frequency of (Number of response annual burden
respondents response responses) (minutes) (hours)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Verification of Prisoner Identity Statements........ 1,000 200 (200,000) 3 10,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
Dated: September 1, 2015.
Naomi R. Sipple,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2015-21967 Filed 9-3-15; 8:45 am]
BILLING CODE 4191-02-PDEPARTMENT OF STATE
