Agency Information Collection Activities: Proposed Request, 12159-12161 [2017-03850]
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Federal Register / Vol. 82, No. 38 / Tuesday, February 28, 2017 / Notices
Incident Period: 01/05/2017 through
01/14/2017.
Effective Date: 02/17/2017.
Physical Loan Application Deadline
Date: 04/18/2017.
Economic Injury (EIDL) Loan
Application Deadline Date: 11/17/2017.
SMALL BUSINESS ADMINISTRATION
Submit completed loan
applications to: U.S. Small Business
Administration, Processing and
Disbursement Center, 14925 Kingsport
Road, Fort Worth, TX 76155.
SUMMARY:
ADDRESSES:
A.
Escobar, Office of Disaster Assistance,
U.S. Small Business Administration,
409 3rd Street SW., Suite 6050,
Washington, DC 20416.
FOR FURTHER INFORMATION CONTACT:
Notice is
hereby given that as a result of the
President’s major disaster declaration on
02/17/2017, 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:
SUPPLEMENTARY INFORMATION:
Primary Counties/Areas:
Carson City, Douglas, Lyon, Storey,
Washoe
And the PYRAMID Lake Paiute Tribe,
the Reno-Sparks Indian Colony, and
the Washoe Tribe of Nevada and
California
The Interest Rates are:
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 .....................................
2.500
mstockstill on DSK3G9T082PROD with NOTICES
U.S. Small Business
Administration.
ACTION: Amendment 2.
AGENCY:
This is an amendment of the
Presidential declaration of a major
disaster for Public Assistance Only for
the State of Georgia (FEMA–4297–DR),
dated 2/07/2017.
Incident: Severe Storms, Tornadoes,
Straight-line Winds, and Flooding.
Incident Period: 1/21/2017 through
1/22/2017.
Effective Date: 2/15/2017.
Physical Loan Application Deadline
Date: 4/10/2017.
Economic Injury (EIDL) Loan
Application Deadline Date: 11/07/2017.
ADDRESSES: 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: The notice
of the President’s major disaster
declaration for Private Non-Profit
organizations in the State of Georgia,
dated 02/07/2017, is hereby amended to
include the following areas as adversely
affected by the disaster.
Primary Counties: Colquitt.
All other information in the original
declaration remains unchanged.
(Catalog of Federal Domestic Assistance
Number 59008)
James E. Rivera,
Associate Administrator for Disaster
Assistance.
BILLING CODE 8025–01–P
2.500
SOCIAL SECURITY ADMINISTRATION
2.500
(Catalog of Federal Domestic Assistance
Number 59008)
James E. Rivera,
Associate Administrator for Disaster
Assistance.
[FR Doc. 2017–03837 Filed 2–27–17; 8:45 am]
BILLING CODE 8025–01–P
18:46 Feb 27, 2017
Georgia Disaster Number GA–00092
[FR Doc. 2017–03834 Filed 2–27–17; 8:45 am]
The number assigned to this disaster
for physical damage is 150536 and for
economic injury is 150546.
VerDate Sep<11>2014
[Disaster Declaration #15043 and #15044]
Jkt 241001
[Docket No: SSA–2017–0008]
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 of 1995, effective October
1, 1995. This notice includes revisions
of OMB-approved information
collections.
PO 00000
Frm 00081
Fmt 4703
Sfmt 4703
12159
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–
2017–0008].
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 May 1, 2017. Individuals can
obtain copies of the collection
instruments by writing to the above
email address.
1. Statement Regarding Marriage—20
CFR 404.726—0960–0017. According to
Section 216(h)(1)(A) of the Social
Security Act (Act), SSA must apply state
law when determining an individual’s
marital status. Some state laws
recognize marriages without a ceremony
(i.e., common-law marriages). In such
cases, SSA provides the same spouse or
widow(er) benefits to the common-law
spouses as it does to ceremonially
married spouses. To determine
common-law spouses, SSA must elicit
information from blood relatives or
other persons who are knowledgeable
about the alleged common-law
relationship. SSA uses Form SSA–753,
Statement Regarding Marriage, to collect
information from third parties to verify
the applicant’s statements about intent,
cohabitation, and holding out to the
public as married, which are the basic
tenets of a common-law marriage. SSA
uses the information to determine if a
valid marital relationship exists, and if
the common-law spouse is entitled to
Social Security spouse or widow(er)
benefits. The respondents are third
parties who can confirm or deny the
alleged common-law marriage.
Type of Request: Revision of an OMBapproved information collection.
E:\FR\FM\28FEN1.SGM
28FEN1
12160
Federal Register / Vol. 82, No. 38 / Tuesday, February 28, 2017 / Notices
Modality of completion
Number of
respondents
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–753 ..........................................................................................................
40,000
1
9
6,000
2. Statement of Income and
Resources—20 CFR 416.207, 146.301–
416.310, 416.704, and 416.708–0960–
0124. SSA collects information about
income and resources for Supplemental
Security Income (SSI) claims and
redeterminations on the SSA–8010–BK.
SSA uses the information to make initial
or continuing eligibility determinations
for SSI claimants or recipients who are
subject to deeming. The respondents are
people whose income and resources
SSA may deem (consider to be
available) to SSI applicants or
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–8010–BK .................................................................................................
341,000
1
26
147,767
3. Claimant’s Work Background—20
CFR 404.1512(a); 404.1520(a)(4);
404.1565(b); 416.912(a); 416.920(a)(4);
416.965(b)—0960–0300. Sections 205(a)
and 1631(e) of the Act provide the
Commissioner of Social Security with
the authority to establish procedures for
determining if a claimant is entitled to
disability benefits. An administrative
law judge (ALJ) may ask individuals to
provide background information on
Form HA–4633 about work they
performed in the past 15 years. When a
claimant requests a hearing before an
ALJ to establish an entitlement to
disability benefits, the ALJ may request
that the claimant provide a work history
to assist the ALJ in fully inquiring into
statutory issues related to the disability.
The ALJ uses the information collected
from the claimants on Form HA–4633
to: (1) Identify the claimant’s relevant
work history; (2) decide if SSA requires
expert vocational testimony and, if so,
have a vocational expert available to
testify during the hearing; and (3)
Number of
respondents
Modality of completion
provide a reference for the ALJ to
discuss the claimant’s work history. The
ALJ makes the completed HA–4633 part
of the documentary evidence of record.
The respondents are claimants for
disability benefits under Title II or Title
XVI who requested a hearing before an
ALJ after SSA denied their application
for disability payments.
Type of Request: Revision of an OMBapproved information collection.
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
20,000
180,000
1
1
15
15
5,000
45,000
Total ..........................................................................................................
mstockstill on DSK3G9T082PROD with NOTICES
HA–4633 PDF/paper version ...........................................................................
Electronic Records Express ............................................................................
200,000
........................
........................
50,000
4. Letter to Landlord Requesting
Rental Information—20 CFR
416.1130(b)—0960–0454. SSA uses
Form SSA–L5061 to obtain rental
subsidy information, which enables
SSA to determine and verify an income
value for such subsidies. SSA uses this
income value as part of determining
eligibility for SSI and the correct
amount of SSI payable to the claimant.
SSA bases an individual’s eligibility for
SSI payments, in part, on the amount of
countable income the individual
receives. Income includes in-kind
support and maintenance in the form of
room or rent, such as a subsidized rental
VerDate Sep<11>2014
18:46 Feb 27, 2017
Jkt 241001
arrangement. SSA requires claimants to
assist in obtaining this information to
prevent a delay or overpayment with
their SSI payments. We collect this
information only if the SSI applicant or
recipient is the parent or child of the
landlord (respondent). For most
respondents, we collect this information
once per year or less, via telephone, or
face-to-face personal interview. The
claims representative records the
information in our Modernized SSI
Claims System (MSSICS), and we
require verbal attestation in lieu of a wet
signature. However, if the claims
representative is unable to contact the
PO 00000
Frm 00082
Fmt 4703
Sfmt 4703
respondent via the telephone or face-toface, we print and mail a paper form to
the respondent for completion. The
respondent completes, signs, and
returns the form to the claims
representative. Upon receipt, the claims
representative documents the
information in MSSICS or, for nonMSSICS cases, faxes the form into the
appropriate electronic folder and shreds
the paper form. The respondents are
landlords related to the SSI beneficiaries
as a parent or child.
Type of Request: Revision of an OMBapproved information collection.
E:\FR\FM\28FEN1.SGM
28FEN1
12161
Federal Register / Vol. 82, No. 38 / Tuesday, February 28, 2017 / Notices
Modality of completion
Number of
respondents
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–L5061 ......................................................................................................
72,000
1
10
12,000
5. Request for Evidence From Doctor
and Request for Evidence From
Hospital—20 CFR 404 Subpart P and 20
CFR 416 Subpart I—0960–0722.
Sections 223(d)(5) and 1614(a)(3)(H)(i)
of the Act require claimants to furnish
medical evidence of their disability
when filing a disability claim. SSA uses
Forms HA–66 and HA–67 to request
evidence from medical sources, which
claimants identify as having information
relative to their impairments, or ability
to do work-related activities. In addition
to accepting manual paper responses,
SSA sends a barcode with the HA–66
and HA–67, allowing respondents to fax
the information directly into the
electronic claims folder rather than
Number of
respondents
Modality of completion
submitting it manually. SSA uses the
information to determine eligibility for
benefits, and to pay medical sources for
furnishing the information. The
respondents are medical sources,
doctors, and hospitals that evaluate the
claimants.
Type of Request: Revision of an OMBapproved information collection.
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
HA–66—Paper Version ...................................................................................
HA–66—Electronic Version .............................................................................
HA–67—Paper Version ...................................................................................
HA–67—Electronic Version .............................................................................
3,060
8,940
3,060
8,940
22
22
22
22
15
15
15
15
16,830
49,170
16,830
49,170
Totals ........................................................................................................
24,000
........................
........................
132,000
Dated: February 23, 2017.
Naomi R. Sipple,
Reports Clearance Officer, Social Security
Administration.
[FR Doc. 2017–03850 Filed 2–27–17; 8:45 am]
BILLING CODE 4191–02–P
DEPARTMENT OF STATE
[Public Notice: 9899]
Notice of Determinations; Culturally
Significant Objects Imported for
´ ´
Exhibition Determinations: ‘‘Frederic
Bazille and the Birth of Impressionism’’
Exhibition
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), E.O. 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, Delegation of Authority
No. 236–3 of August 28, 2000 (and, as
appropriate, Delegation of Authority No.
257–1 of December 11, 2015), I hereby
determine that the objects to be
´ ´
included in the exhibition ‘‘Frederic
Bazille and the Birth of Impressionism,’’
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
mstockstill on DSK3G9T082PROD with NOTICES
SUMMARY:
VerDate Sep<11>2014
18:46 Feb 27, 2017
Jkt 241001
display of the exhibit objects at the
National Gallery of Art, Washington,
District of Columbia, from on or about
April 9, 2017, until on or about July 9,
2017, 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 the Office
of Public Diplomacy and Public Affairs
in the Office of the Legal Adviser, U.S.
Department of State (telephone: 202–
632–6471; email: section2459@
state.gov). The mailing address is U.S.
Department of State, L/PD, SA–5, Suite
5H03, Washington, DC 20522–0505.
Alyson Grunder,
Deputy Assistant Secretary for Policy, Bureau
of Educational and Cultural Affairs,
Department of State.
[FR Doc. 2017–03863 Filed 2–27–17; 8:45 am]
BILLING CODE 4710–05–P
DEPARTMENT OF STATE
[Public Notice 9898]
Notice is hereby given of the
following determinations: Pursuant to
SUMMARY:
Frm 00083
Fmt 4703
For
further information, including a list of
the imported objects, contact the Office
of Public Diplomacy and Public Affairs
in the Office of the Legal Adviser, U.S.
Department of State (telephone: 202–
632–6471; email: section2459@
state.gov). The mailing address is U.S.
FOR FURTHER INFORMATION CONTACT:
Notice of Determinations; Culturally
Significant Objects Imported for
Exhibition Determinations: ‘‘Matisse in
the Studio’’ Exhibition
PO 00000
the authority vested in me by the Act of
October 19, 1965 (79 Stat. 985; 22 U.S.C.
2459), E.O. 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, Delegation of Authority
No. 236–3 of August 28, 2000 (and, as
appropriate, Delegation of Authority No.
257–1 of December 11, 2015), I hereby
determine that the objects to be
included in the exhibition ‘‘Matisse in
the Studio,’’ 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 Museum of Fine Arts,
Boston, Boston, Massachusetts, from on
or about April 9, 2017, until on or about
July 9, 2017, 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.
Sfmt 4703
E:\FR\FM\28FEN1.SGM
28FEN1
]]>Agencies
[Federal Register Volume 82, Number 38 (Tuesday, February 28, 2017)]
[Notices]
[Pages 12159-12161]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-03850]
=======================================================================
-----------------------------------------------------------------------
SOCIAL SECURITY ADMINISTRATION
[Docket No: SSA-2017-0008]
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 of 1995, effective October 1, 1995. This notice
includes revisions of OMB-approved information collections.
SSA is soliciting comments on the accuracy of the agency's burden
estimate; the need for the information; its practical utility; ways to
enhance its quality, utility, and clarity; and ways to minimize burden
on respondents, including the use of automated collection techniques or
other forms of information technology. Mail, email, or fax your
comments and recommendations on the information collection(s) to the
OMB Desk Officer and SSA Reports Clearance Officer at the following
addresses or fax numbers. (OMB), Office of Management and Budget, Attn:
Desk Officer for SSA, Fax: 202-395-6974, Email address:
OIRA_Submission@omb.eop.gov, (SSA), Social Security Administration,
OLCA, Attn: Reports Clearance Director, 3100 West High Rise, 6401
Security Blvd., Baltimore, MD 21235, Fax: 410-966-2830, Email address:
OR.Reports.Clearance@ssa.gov. Or you may submit your comments online
through www.regulations.gov, referencing Docket ID Number [SSA-2017-
0008].
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 May
1, 2017. Individuals can obtain copies of the collection instruments by
writing to the above email address.
1. Statement Regarding Marriage--20 CFR 404.726--0960-0017.
According to Section 216(h)(1)(A) of the Social Security Act (Act), SSA
must apply state law when determining an individual's marital status.
Some state laws recognize marriages without a ceremony (i.e., common-
law marriages). In such cases, SSA provides the same spouse or
widow(er) benefits to the common-law spouses as it does to ceremonially
married spouses. To determine common-law spouses, SSA must elicit
information from blood relatives or other persons who are knowledgeable
about the alleged common-law relationship. SSA uses Form SSA-753,
Statement Regarding Marriage, to collect information from third parties
to verify the applicant's statements about intent, cohabitation, and
holding out to the public as married, which are the basic tenets of a
common-law marriage. SSA uses the information to determine if a valid
marital relationship exists, and if the common-law spouse is entitled
to Social Security spouse or widow(er) benefits. The respondents are
third parties who can confirm or deny the alleged common-law marriage.
Type of Request: Revision of an OMB-approved information
collection.
[[Page 12160]]
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-753..................................... 40,000 1 9 6,000
----------------------------------------------------------------------------------------------------------------
2. Statement of Income and Resources--20 CFR 416.207, 146.301-
416.310, 416.704, and 416.708-0960-0124. SSA collects information about
income and resources for Supplemental Security Income (SSI) claims and
redeterminations on the SSA-8010-BK. SSA uses the information to make
initial or continuing eligibility determinations for SSI claimants or
recipients who are subject to deeming. The respondents are people whose
income and resources SSA may deem (consider to be available) to SSI
applicants or recipients.
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-8010-BK................................. 341,000 1 26 147,767
----------------------------------------------------------------------------------------------------------------
3. Claimant's Work Background--20 CFR 404.1512(a); 404.1520(a)(4);
404.1565(b); 416.912(a); 416.920(a)(4); 416.965(b)--0960-0300. Sections
205(a) and 1631(e) of the Act provide the Commissioner of Social
Security with the authority to establish procedures for determining if
a claimant is entitled to disability benefits. An administrative law
judge (ALJ) may ask individuals to provide background information on
Form HA-4633 about work they performed in the past 15 years. When a
claimant requests a hearing before an ALJ to establish an entitlement
to disability benefits, the ALJ may request that the claimant provide a
work history to assist the ALJ in fully inquiring into statutory issues
related to the disability. The ALJ uses the information collected from
the claimants on Form HA-4633 to: (1) Identify the claimant's relevant
work history; (2) decide if SSA requires expert vocational testimony
and, if so, have a vocational expert available to testify during the
hearing; and (3) provide a reference for the ALJ to discuss the
claimant's work history. The ALJ makes the completed HA-4633 part of
the documentary evidence of record. The respondents are claimants for
disability benefits under Title II or Title XVI who requested a hearing
before an ALJ after SSA denied their application for disability
payments.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average
Number of Frequency of burden per Estimated
Modality of completion respondents response response total annual
(minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
HA-4633 PDF/paper version....................... 20,000 1 15 5,000
Electronic Records Express...................... 180,000 1 15 45,000
---------------------------------------------------------------
Total....................................... 200,000 .............. .............. 50,000
----------------------------------------------------------------------------------------------------------------
4. Letter to Landlord Requesting Rental Information--20 CFR
416.1130(b)--0960-0454. SSA uses Form SSA-L5061 to obtain rental
subsidy information, which enables SSA to determine and verify an
income value for such subsidies. SSA uses this income value as part of
determining eligibility for SSI and the correct amount of SSI payable
to the claimant. SSA bases an individual's eligibility for SSI
payments, in part, on the amount of countable income the individual
receives. Income includes in-kind support and maintenance in the form
of room or rent, such as a subsidized rental arrangement. SSA requires
claimants to assist in obtaining this information to prevent a delay or
overpayment with their SSI payments. We collect this information only
if the SSI applicant or recipient is the parent or child of the
landlord (respondent). For most respondents, we collect this
information once per year or less, via telephone, or face-to-face
personal interview. The claims representative records the information
in our Modernized SSI Claims System (MSSICS), and we require verbal
attestation in lieu of a wet signature. However, if the claims
representative is unable to contact the respondent via the telephone or
face-to-face, we print and mail a paper form to the respondent for
completion. The respondent completes, signs, and returns the form to
the claims representative. Upon receipt, the claims representative
documents the information in MSSICS or, for non-MSSICS cases, faxes the
form into the appropriate electronic folder and shreds the paper form.
The respondents are landlords related to the SSI beneficiaries as a
parent or child.
Type of Request: Revision of an OMB-approved information
collection.
[[Page 12161]]
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L5061................................... 72,000 1 10 12,000
----------------------------------------------------------------------------------------------------------------
5. Request for Evidence From Doctor and Request for Evidence From
Hospital--20 CFR 404 Subpart P and 20 CFR 416 Subpart I--0960-0722.
Sections 223(d)(5) and 1614(a)(3)(H)(i) of the Act require claimants to
furnish medical evidence of their disability when filing a disability
claim. SSA uses Forms HA-66 and HA-67 to request evidence from medical
sources, which claimants identify as having information relative to
their impairments, or ability to do work-related activities. In
addition to accepting manual paper responses, SSA sends a barcode with
the HA-66 and HA-67, allowing respondents to fax the information
directly into the electronic claims folder rather than submitting it
manually. SSA uses the information to determine eligibility for
benefits, and to pay medical sources for furnishing the information.
The respondents are medical sources, doctors, and hospitals that
evaluate the claimants.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average
Number of Frequency of burden per Estimated
Modality of completion respondents response response total annual
(minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
HA-66--Paper Version............................ 3,060 22 15 16,830
HA-66--Electronic Version....................... 8,940 22 15 49,170
HA-67--Paper Version............................ 3,060 22 15 16,830
HA-67--Electronic Version....................... 8,940 22 15 49,170
---------------------------------------------------------------
Totals...................................... 24,000 .............. .............. 132,000
----------------------------------------------------------------------------------------------------------------
Dated: February 23, 2017.
Naomi R. Sipple,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2017-03850 Filed 2-27-17; 8:45 am]
BILLING CODE 4191-02-P
