Agency Information Collection Activities: Proposed Request and Comment Request, 55707-55710 [2017-25282]
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Federal Register / Vol. 82, No. 224 / Wednesday, November 22, 2017 / Notices
For the Commission, by the Division of
Trading and Markets, pursuant to delegated
authority.26
Eduardo A. Aleman,
Assistant Secretary.
[FR Doc. 2017–25228 Filed 11–21–17; 8:45 am]
BILLING CODE 8011–01–P
SOCIAL SECURITY ADMINISTRATION
[Docket No: SSA–2017–0064]
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 an
extension of an OMB-approved
information collection, new information
collections, and revisions of OMBapproved 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–
2017–0064].
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 January 22,
2018 Individuals can obtain copies of
the collection instruments by writing to
the above email address.
55707
1. Fee Agreement for Representation
Before the Social Security
Administration—0960–NEW. SSA
requires individuals who represent a
claimant before the Social Security
Administration and want to receive a
fee for their services to obtain SSA’s
authorization of the fee under the Social
Security Act (Act). We currently have
two different, but mutually exclusive,
methods to authorize a fee for a
representative’s services before SSA.
SSA authorizes the fee either via the
agreement process, if the representative
submits the fee agreement before the
first favorable decision, or the fee
petition process, if the representative
submits the request after the favorable
decision. Currently SSA has no
standardized form for the fee agreement
process. Therefore, we created the SSA–
1693 to make it easier for
representatives to obtain the
authorization for a fee agreement. SSA
will use the information we collect on
the SSA–1693 to review the request and
authorize any fee to representatives who
seek to charge and collect from a
claimant. The respondents are the
representatives who help claimants
through the application process.
Type of Request: Request for a new
information collection.
Modality of
completion
Number of
respondents
Frequency of
response
Average burden
per response
(minutes)
Estimated total
annual burden
(hours)
SSA–1693 ........................................................................
600,000
1
12
120,000
2. Statement of Interpreter—0960–
NEW. SSA and the Disability
Determination Services (DDS) will use
Form SSA–4321, Statement of
Interpreter, when a person requiring an
interpreter prefers to provide their own
interpreter during an interview or
conversation between the person
requiring an interpreter and SSA or
DDS. SSA will require the interpreter to
sign Form SSA–4321, and confirm,
among other things, that: (1) They will
not knowingly give false information;
(2) they will act as an interpreter and
witness, and (3) they will accurately
interpret the interview to the best of
their ability. Section 205(a) of the Act,
as amended in 42 U.S.C. 405(a),
authorizes SSA collect this information.
Type of Request: Request for a new
information collection.
Number of
respondents
Frequency of
response
Average burden
per response
(minutes)
Estimated total
annual burden
(hours)
SSA–4321 ........................................................................
asabaliauskas on DSKBBXCHB2PROD with NOTICES
Modality of
completion
5,170,399
1
5
430,867
3. Statement of Living Arrangements,
In-Kind Support, and Maintenance—20
CFR 416.1130–416.1148–0960–0174.
SSA determines Supplemental Security
Income (SSI) payment amounts based
on applicants’ and recipients’ needs. We
measure individuals’ needs, in part, by
the amount of income they receive,
26 17
including in-kind support and
maintenance in the form of food and
shelter other people provide. SSA uses
Form SSA–8006–F4 to determine if inkind 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.
CFR 200.30–3(a)(12).
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55708
Federal Register / Vol. 82, No. 224 / Wednesday, November 22, 2017 / Notices
Modality of
completion
Number of
respondents
Frequency of
response
Average burden
per response
(minutes)
Estimated total
annual burden
(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 DDSs 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
Disabilty Insurance benefits or SSI
payments.
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–4631 ..........................................................................
200,000
1
10
33,333
5. Statement of Funds You Provided
to Another and Statement of Funds You
Received—20 CFR 416.1103(f)—0960–
0481. SSA uses Forms SSA–2854
(Statement of Funds You Provided to
Another) and SSA–2855 (Statement of
Funds You Received) to gather
information to verify if a loan is bona
fide for SSI recipients. The SSA–2854
asks the lender for details on the
transaction, and Form SSA–2855 asks
the borrower the same basic questions
independently. Agency personnel then
compare the two statements; gather
evidence if needed; and make a decision
on the validity of the bona fide status of
the loan.
For SSI purposes, we consider a loan
bona fide if it meets these requirements:
• Must be between a borrower and
lender with the understanding that the
borrower has an obligation to repay the
money;
• Must be in effect at the time the
cash goes to the borrower, that is, the
agreement cannot come after the cash is
paid; and
• Must be enforceable under State
law, often there are additional
requirements from the State.
Number of
respondents
Modality of completion
SSA collects this information at the
time of initial application for SSI, or at
any point when an individual alleges
being party to an informal loan while
receiving SSI. SSA collects information
on the informal loan through both
interviews and mailed forms. The
agency’s field personnel conduct the
interviews and mail the form(s) for
completion, as needed. The respondents
are SSI recipients and applicants, and
individuals who lend money to them.
Type of Request: Revision of an OMBapproved information collection.
Average burden
per response
(minutes)
Frequency
of response
Estimated total
annual burden
(hours)
20,000
20,000
1
1
10
10
3,333
3,333
Totals ........................................................................
asabaliauskas on DSKBBXCHB2PROD with NOTICES
SSA–2854 ........................................................................
SSA–2855 ........................................................................
40,000
................................
................................
6,666
6. Filing Claims Under the Federal
Tort Claims Act—20 CFR 429.101–
429.110—0960–0667. The Federal Tort
Claims Act is the legal mechanism for
compensating people injured by
negligent or wrongful acts that occur
during the performance of Federal
employees’ official duties. In
accordance with the law, SSA accepts
monetary claims filed under the Federal
Tort Claims Act for damages against the
United States; loss of property; personal
injury; or death resulting from an SSA
employee’s wrongful act or omission.
The regulation sections cleared under
this information collection request
require claimants to provide
information SSA can use to investigate
Number of
respondents
Modality of completion
429.102; 429.1031 ...........................................................
429.104(a) ........................................................................
429.104(b) ........................................................................
429.104(c) ........................................................................
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Average burden
per response
(minutes)
Frequency
of response
1
11
43
1
Fmt 4703
and determine whether to make an
award, compromise, or settlement under
the Federal Tort Claims Act. The
respondents are individuals or entities
making a claim under the Federal Tort
Claims Act.
Type of Request: Extension of an
OMB-approved information collection.
Sfmt 4703
1
1
1
1
E:\FR\FM\22NON1.SGM
Estimated total
annual burden
(hours)
1
5
5
5
22NON1
1
1
4
0
Federal Register / Vol. 82, No. 224 / Wednesday, November 22, 2017 / Notices
Number of
respondents
Modality of completion
Average burden
per response
(minutes)
Frequency
of response
55709
Estimated total
annual burden
(hours)
429.106(b) ........................................................................
8
1
10
1
Totals ........................................................................
64
................................
................................
7
1 The 1 hour represents a placeholder burden. We are not reporting a burden for this collection because respondents complete OMB-approved
Form SF–95.
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
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 ........................................................
531,715
346,642
108,194
1
1
1
30
25
30
265,858
144,434
54,097
Totals ........................................................................
986,551
................................
................................
464,389
II. SSA submitted the information
collections below to OMB for clearance.
Your comments regarding these
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
December 22, 2017. Individuals can
obtain copies of the OMB clearance
packages by writing to
OR.Reports.Clearance@ssa.gov.
1. Partnership Questionnaire—20 CFR
404.1080–404.1082(e)—0960–0025. SSA
considers partnership income in
determining entitlement to Social
Security benefits. SSA uses information
from Form SSA–7104 to determine
several aspects of eligibility for benefits,
including the accuracy of reported
partnership earnings; the veracity of a
retirement; and lag earnings where SSA
needs this information to determine the
status of the insured. The respondents
are applicants for, and recipients of,
Title II Social Security benefits who are
reporting partnership earnings,
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–7104 ........................................................................
12,350
1
30
6,175
asabaliauskas on DSKBBXCHB2PROD with NOTICES
2. Supplement to Claim of Person
Outside the United States—20 CFR
422.505(b), 404.460, 404.463, and 42
CFR 407.27(c)—0960–0051. Claimants
or beneficiaries (both United States
(U.S.) citizens and aliens entitled to
benefits) living outside the U.S.
complete Form SSA–21 as a supplement
to an application for benefits. SSA
collects the information to determine
eligibility for U.S. Social Security
benefits for those months an alien
beneficiary or claimant is outside the
U.S., and to determine if tax
withholding applies. In addition, SSA
uses the information to: (1) Allow
beneficiaries or claimants to request a
special payment exception in an SSA
restricted country; (2) terminate
supplemental medical insurance
coverage for recipients who request it,
because they are, or will be, out of the
U.S.; and (3) allow claimants to collect
a lump sum death benefit if the number
Number of
respondents
Modality of completion
Paper SSA–21—U.S. Residents .....................................
Paper SSA–21—Residents of a Tax Treaty Country ......
Paper SSA–21—Nonresident aliens ...............................
Modernized Claims System (MCS) Macros SSA-21—
U.S. Residents .............................................................
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holder died outside the United States
and we do not have information to
determine whether the lump sum death
benefit is payable under the Social
Security Act. The respondents are
Social Security claimants, or
individuals entitled to Social Security
benefits, who are, were, or will be
residing outside the United States for
three months or longer.
Type of Request: Revision of an OMBapproved information collection.
Average burden
per response
(minutes)
Frequency
of response
Estimated total
annual burden
(hours)
510
2,751
1,835
14
9
8
119
413
245
1,325
Fmt 4703
1
1
1
1
11
243
Sfmt 4703
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55710
Federal Register / Vol. 82, No. 224 / Wednesday, November 22, 2017 / Notices
Number of
respondents
Modality of completion
Average burden
per response
(minutes)
Frequency
of response
Estimated total
annual burden
(hours)
MCS Macros SSA 21—Residents of a Tax Treaty
Country .........................................................................
MCS Macros SSA 21—Nonresident aliens .....................
7,153
4,769
1
1
6
5
715
397
Totals ........................................................................
18,343
................................
................................
2,132
Dated: November 17, 2017.
Naomi R. Sipple,
Reports Clearance Officer, Social Security
Administration.
[Public Notice: 10205]
Notice of Public Meeting of the
International Telecommunication
Advisory Committee and Preparations
for Upcoming International
Telecommunications Meetings
[FR Doc. 2017–25282 Filed 11–21–17; 8:45 am]
BILLING CODE 4191–02–P
DEPARTMENT OF STATE
[Public Notice 10209]
U.S. National Commission for UNESCO
Notice of Web Conference Meeting
asabaliauskas on DSKBBXCHB2PROD with NOTICES
The 2017 Annual Meeting of the U.S.
National Commission for the United
Nations Educational, Scientific and
Cultural Organization (UNESCO) will
take place on Tuesday, December 12,
2017, starting at 1:00 p.m. Eastern
Standard Time. This will be a web
conference meeting to discuss recent
UNESCO developments, including the
election of new UNESCO DirectorGeneral Azoulay; overall assessments/
outcomes of the 39th General
Conference; the U.S. decision to
withdraw from UNESCO, effective
December 31, 2018; and plans for the
Commission during this time of
transition. The Commission will accept
brief oral comments during a portion of
this web conference. The public
comment period will be limited to
approximately 30 minutes in total, with
five minutes allowed per speaker. For
more information, or to arrange to
participate in the web conference,
individuals are asked to contact the
Executive Director of the National
Commission by Friday, December 8,
2017, at the following email address:
DCUNESCO@state.gov.
Paul Mungai,
Acting Executive Director, U.S. National
Commission for UNESCO, Department of
State.
[FR Doc. 2017–25274 Filed 11–21–17; 8:45 am]
BILLING CODE 4710–19–P
VerDate Sep<11>2014
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December 11–15, 2017
DEPARTMENT OF STATE
This notice announces a meeting of
the Department of State’s International
Telecommunication Advisory
Committee (ITAC). The ITAC will meet
on December 7, 2017 at 10:00 a.m. EST
at 1120 20th St. NW., 10th Floor,
Washington, DC to report on the
outcome of the World
Telecommunication Development
Conference, review the results of recent
multilateral meetings, updates on
preparations for the International
Telecommunication Union (ITU) 2018
Plenipotentiary Conference (PP–18), and
discuss preparations for upcoming
multilateral meetings at ITU, the
Organization for Economic Cooperation
and Development (OECD), and the Asia
Pacific Economic Cooperation (APEC).
The meeting will focus on the following
topics:
1. Results of Recent Multilateral
Meetings
a. ITU Council Working Groups
b. World Telecommunication
Development Conference
c. ITU–R SG4, SG5, SG6, and SG7
block meetings
d. Inter-American Telecommunication
Commission (CITEL)
• Permanent Consultative Committee
on Radiocommunication (PCC–II)
2. Meeting of the Permanent Executive
Committee (COM/CITEL) 2018 ITU
Plenipotentiary Conference (PP–18)
preparatory process and U.S.
priorities
3. Preparations for upcoming
Multilateral Activities
a. ITU–R meetings
b. ITU–T meetings
c. ITU–D meetings
d. ITU Council Working Groups and
Experts Group on International
Telecommunications Regulations
(ITRs)
e. WSIS Forum
f. APEC Telecommunications
Working Group (APEC TEL 56)—
PO 00000
Frm 00158
Fmt 4703
Sfmt 9990
PP–18 will take place in Dubai, United
Arab Emirates, from October 29 to
November 17, 2018. The Plenipotentiary
Conference, which takes place every
four years, is the highest policy-making
body of the Union. PP–18 will
determine the overall policy direction of
the ITU; adopt the strategic and
financial plans for the next four years;
elect the 48 members of Council, 12
members of the Radio Regulations
Board, and five Elected Officials; and
consider and adopt, if appropriate,
modifications to the ITU Constitution
and Convention.
Attendance at this meeting is open to
the public as seating capacity allows.
The public will have an opportunity to
provide comments at this meeting at the
invitation of the chair. Further details
on this ITAC meeting will be announced
on the Department of State’s email list,
ITAC@lmlist.state.gov. Use of the ITAC
list is limited to meeting
announcements and confirmations,
distribution of agendas and other
relevant meeting documents. The
Department welcomes any U.S. citizen
or legal permanent resident to remain
on or join the ITAC listserv by
registering by email via ITAC@state.gov
and providing his or her name, email
address, telephone contact and the
company, organization, or community
that he or she is representing, if any.
Persons wishing to request reasonable
accommodation during the meeting
should send their requests to ITAC@
state.gov no later than November 30,
2017. Requests made after that time will
be considered, but might not be able to
be fulfilled.
Please send all inquiries to ITAC@
state.gov.
Cecily C. Holiday,
Acting Director, Multilateral Affairs, Cyber
and International Communications, and
Information Policy, Department of State.
[FR Doc. 2017–25235 Filed 11–21–17; 8:45 am]
BILLING CODE 4710–AE–P
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]]>Agencies
[Federal Register Volume 82, Number 224 (Wednesday, November 22, 2017)]
[Notices]
[Pages 55707-55710]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-25282]
=======================================================================
-----------------------------------------------------------------------
SOCIAL SECURITY ADMINISTRATION
[Docket No: SSA-2017-0064]
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 an extension of an OMB-approved information collection, new
information collections, and 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-2017-0064].
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
January 22, 2018 Individuals can obtain copies of the collection
instruments by writing to the above email address.
1. Fee Agreement for Representation Before the Social Security
Administration--0960-NEW. SSA requires individuals who represent a
claimant before the Social Security Administration and want to receive
a fee for their services to obtain SSA's authorization of the fee under
the Social Security Act (Act). We currently have two different, but
mutually exclusive, methods to authorize a fee for a representative's
services before SSA. SSA authorizes the fee either via the agreement
process, if the representative submits the fee agreement before the
first favorable decision, or the fee petition process, if the
representative submits the request after the favorable decision.
Currently SSA has no standardized form for the fee agreement process.
Therefore, we created the SSA-1693 to make it easier for
representatives to obtain the authorization for a fee agreement. SSA
will use the information we collect on the SSA-1693 to review the
request and authorize any fee to representatives who seek to charge and
collect from a claimant. The respondents are the representatives who
help claimants through the application process.
Type of Request: Request for a new information collection.
----------------------------------------------------------------------------------------------------------------
Estimated total
Modality of completion Number of Frequency of Average burden per annual burden
respondents response response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1693.................... 600,000 1 12 120,000
----------------------------------------------------------------------------------------------------------------
2. Statement of Interpreter--0960-NEW. SSA and the Disability
Determination Services (DDS) will use Form SSA-4321, Statement of
Interpreter, when a person requiring an interpreter prefers to provide
their own interpreter during an interview or conversation between the
person requiring an interpreter and SSA or DDS. SSA will require the
interpreter to sign Form SSA-4321, and confirm, among other things,
that: (1) They will not knowingly give false information; (2) they will
act as an interpreter and witness, and (3) they will accurately
interpret the interview to the best of their ability. Section 205(a) of
the Act, as amended in 42 U.S.C. 405(a), authorizes SSA collect this
information.
Type of Request: Request for a new information collection.
----------------------------------------------------------------------------------------------------------------
Estimated total
Modality of completion Number of Frequency of Average burden per annual burden
respondents response response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4321.................... 5,170,399 1 5 430,867
----------------------------------------------------------------------------------------------------------------
3. Statement of Living Arrangements, In-Kind Support, and
Maintenance--20 CFR 416.1130-416.1148-0960-0174. SSA determines
Supplemental Security Income (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 other people provide. 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.
[[Page 55708]]
----------------------------------------------------------------------------------------------------------------
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 DDSs 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 Disabilty Insurance benefits or SSI payments.
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)
----------------------------------------------------------------------------------------------------------------
HA-4631..................... 200,000 1 10 33,333
----------------------------------------------------------------------------------------------------------------
5. Statement of Funds You Provided to Another and Statement of
Funds You Received--20 CFR 416.1103(f)--0960-0481. SSA uses Forms SSA-
2854 (Statement of Funds You Provided to Another) and SSA-2855
(Statement of Funds You Received) to gather information to verify if a
loan is bona fide for SSI recipients. The SSA-2854 asks the lender for
details on the transaction, and Form SSA-2855 asks the borrower the
same basic questions independently. Agency personnel then compare the
two statements; gather evidence if needed; and make a decision on the
validity of the bona fide status of the loan.
For SSI purposes, we consider a loan bona fide if it meets these
requirements:
Must be between a borrower and lender with the
understanding that the borrower has an obligation to repay the money;
Must be in effect at the time the cash goes to the
borrower, that is, the agreement cannot come after the cash is paid;
and
Must be enforceable under State law, often there are
additional requirements from the State.
SSA collects this information at the time of initial application
for SSI, or at any point when an individual alleges being party to an
informal loan while receiving SSI. SSA collects information on the
informal loan through both interviews and mailed forms. The agency's
field personnel conduct the interviews and mail the form(s) for
completion, as needed. The respondents are SSI recipients and
applicants, and individuals who lend money to them.
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-2854........................ 20,000 1 10 3,333
SSA-2855........................ 20,000 1 10 3,333
-------------------------------------------------------------------------------
Totals...................... 40,000 .................. .................. 6,666
----------------------------------------------------------------------------------------------------------------
6. Filing Claims Under the Federal Tort Claims Act--20 CFR 429.101-
429.110--0960-0667. The Federal Tort Claims Act is the legal mechanism
for compensating people injured by negligent or wrongful acts that
occur during the performance of Federal employees' official duties. In
accordance with the law, SSA accepts monetary claims filed under the
Federal Tort Claims Act for damages against the United States; loss of
property; personal injury; or death resulting from an SSA employee's
wrongful act or omission. The regulation sections cleared under this
information collection request require claimants to provide information
SSA can use to investigate and determine whether to make an award,
compromise, or settlement under the Federal Tort Claims Act. The
respondents are individuals or entities making a claim under the
Federal Tort Claims Act.
Type of Request: Extension 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)
----------------------------------------------------------------------------------------------------------------
429.102; 429.103\1\............. 1 1 1 1
429.104(a)...................... 11 1 5 1
429.104(b)...................... 43 1 5 4
429.104(c)...................... 1 1 5 0
[[Page 55709]]
429.106(b)...................... 8 1 10 1
-------------------------------------------------------------------------------
Totals...................... 64 .................. .................. 7
----------------------------------------------------------------------------------------------------------------
\1\ The 1 hour represents a placeholder burden. We are not reporting a burden for this collection because
respondents complete OMB-approved Form SF-95.
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 per Estimated total
Modality of completion Number of Frequency of response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-1020 (paper application 531,715 1 30 265,858
form)..........................
i1020 (online application)...... 346,642 1 25 144,434
Field office interview.......... 108,194 1 30 54,097
-------------------------------------------------------------------------------
Totals...................... 986,551 .................. .................. 464,389
----------------------------------------------------------------------------------------------------------------
II. SSA submitted the information collections below to OMB for
clearance. Your comments regarding these 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 December 22, 2017. Individuals can obtain copies of
the OMB clearance packages by writing to OR.Reports.Clearance@ssa.gov.
1. Partnership Questionnaire--20 CFR 404.1080-404.1082(e)--0960-
0025. SSA considers partnership income in determining entitlement to
Social Security benefits. SSA uses information from Form SSA-7104 to
determine several aspects of eligibility for benefits, including the
accuracy of reported partnership earnings; the veracity of a
retirement; and lag earnings where SSA needs this information to
determine the status of the insured. The respondents are applicants
for, and recipients of, Title II Social Security benefits who are
reporting partnership earnings,
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-7104.................... 12,350 1 30 6,175
----------------------------------------------------------------------------------------------------------------
2. Supplement to Claim of Person Outside the United States--20 CFR
422.505(b), 404.460, 404.463, and 42 CFR 407.27(c)--0960-0051.
Claimants or beneficiaries (both United States (U.S.) citizens and
aliens entitled to benefits) living outside the U.S. complete Form SSA-
21 as a supplement to an application for benefits. SSA collects the
information to determine eligibility for U.S. Social Security benefits
for those months an alien beneficiary or claimant is outside the U.S.,
and to determine if tax withholding applies. In addition, SSA uses the
information to: (1) Allow beneficiaries or claimants to request a
special payment exception in an SSA restricted country; (2) terminate
supplemental medical insurance coverage for recipients who request it,
because they are, or will be, out of the U.S.; and (3) allow claimants
to collect a lump sum death benefit if the number holder died outside
the United States and we do not have information to determine whether
the lump sum death benefit is payable under the Social Security Act.
The respondents are Social Security claimants, or individuals entitled
to Social Security benefits, who are, were, or will be residing outside
the United States for three months or longer.
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)
----------------------------------------------------------------------------------------------------------------
Paper SSA-21--U.S. Residents.... 510 1 14 119
Paper SSA-21--Residents of a Tax 2,751 1 9 413
Treaty Country.................
Paper SSA-21--Nonresident aliens 1,835 1 8 245
Modernized Claims System (MCS) 1,325 1 11 243
Macros SSA[dash]21--U.S.
Residents......................
[[Page 55710]]
MCS Macros SSA 21--Residents of 7,153 1 6 715
a Tax Treaty Country...........
MCS Macros SSA 21--Nonresident 4,769 1 5 397
aliens.........................
-------------------------------------------------------------------------------
Totals...................... 18,343 .................. .................. 2,132
----------------------------------------------------------------------------------------------------------------
Dated: November 17, 2017.
Naomi R. Sipple,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2017-25282 Filed 11-21-17; 8:45 am]
BILLING CODE 4191-02-P
