Agency Information Collection Activities: Proposed Request and Comment Request, 34469-34472 [2019-15249]
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Federal Register / Vol. 84, No. 138 / Thursday, July 18, 2019 / Notices
409 3rd Street SW, Suite 6050,
Washington, DC 20416, (202) 205–6734.
SUPPLEMENTARY INFORMATION: Notice is
hereby given that as a result of the
Administrator’s disaster declaration,
applications for disaster loans may be
filed at the address listed above or other
locally announced locations.
The following areas have been
determined to be adversely affected by
the disaster:
Primary Counties: Andrew, Atchison,
Buchanan, Holt.
Percent Contiguous Counties:
Missouri: Clinton, DeKalb, Gentry,
Nodaway, Platte.
Iowa: Fremont, Page.
2.750
Kansas: Atchison, Doniphan.
Nebraska: Nemaha, Otoe, Richardson.
2.750
The Interest Rates are:
07/09/2019, Private Non-Profit
organizations that provide essential
services of a governmental nature may
file disaster loan applications at the
address listed above or other locally
announced locations.
The following areas have been
determined to be adversely affected by
the disaster:
Primary Counties: Curry, Douglas,
Grant, Linn, Umatilla, Wheeler.
The Interest Rates are:
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 .....
2.750
The number assigned to this disaster
for physical damage is 160336 and for
economic injury is 160340.
(Catalog of Federal Domestic Assistance
Number 59008)
James Rivera,
Associate Administrator for Disaster
Assistance.
[FR Doc. 2019–15276 Filed 7–17–19; 8:45 am]
BILLING CODE 8026–03–P
SMALL BUSINESS ADMINISTRATION
[Disaster Declaration # 16037 and # 16038;
Missouri Disaster Number MO–00096]
Administrative Declaration of a
Disaster for the State of Missouri
U.S. Small Business
Administration.
ACTION: Notice.
AGENCY:
This is a notice of an
Administrative declaration of a disaster
for the State of Missouri dated 07/12/
2019.
Incident: Severe Storms, Straight-line
Winds and Flooding.
Incident Period: 03/11/2019 through
04/16/2019.
DATES: Issued on 07/12/2019.
Physical Loan Application Deadline
Date: 09/10/2019.
Economic Injury (EIDL) Loan
Application Deadline Date: 04/13/2020.
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,
khammond on DSKBBV9HB2PROD with NOTICES
SUMMARY:
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For Physical Damage:
Homeowners with Credit Available Elsewhere ....................
Homeowners without Credit
Available Elsewhere ............
Businesses with Credit Available Elsewhere ....................
Businesses without Credit
Available Elsewhere ............
Non-Profit Organizations with
Credit Available Elsewhere
Non-Profit Organizations without Credit Available Elsewhere ...................................
For Economic Injury:
Businesses & Small Agricultural Cooperatives without
Credit Available Elsewhere
Non-Profit Organizations without Credit Available Elsewhere ...................................
This is an amendment of the
Presidential declaration of a major
disaster for the State of Iowa (FEMA–
4421–DR), dated 03/23/2019.
Incident: Severe Storms and Flooding.
Incident Period: 03/12/2019 through
06/15/2019.
DATES: Issued on 07/09/2019.
Physical Loan Application Deadline
Date: 07/16/2019.
Economic Injury (EIDL) Loan
Application Deadline Date: 12/23/2019.
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, (202) 205–6734.
Percent
SUPPLEMENTARY INFORMATION: The notice
of the President’s major disaster
declaration for the State of IOWA, dated
4.125
03/23/2019, is hereby amended to
2.063 include the following areas as adversely
affected by the disaster:
8.000 Primary Counties (Physical Damage and
Economic Injury Loans): Muscatine.
4.000
All counties contiguous to the above
named county have previously been
2.750
declared.
All other information in the original
2.750 declaration remains unchanged.
4.000
James Rivera,
Associate Administrator for Disaster
Assistance.
2.750
[FR Doc. 2019–15275 Filed 7–17–19; 8:45 am]
(Catalog of Federal Domestic Assistance
Number 59008)
Christopher Pilkerton,
Acting Administrator.
[FR Doc. 2019–15279 Filed 7–17–19; 8:45 am]
BILLING CODE 8026–03–P
SMALL BUSINESS ADMINISTRATION
[Disaster Declaration #15898 and #15899;
Iowa Disaster Number IA–00086]
Presidential Declaration Amendment of
a Major Disaster for the State of Iowa
U.S. Small Business
Administration.
ACTION: Amendment 8.
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SUMMARY:
(Catalog of Federal Domestic Assistance
Number 59008)
The number assigned to this disaster
for physical damage is 16037 6 and for
economic injury is 16038 0.
The States which received an EIDL
Declaration # are Missouri, Iowa,
Kansas, Nebraska.
AGENCY:
34469
BILLING CODE 8026–03–P
SOCIAL SECURITY ADMINISTRATION
[Docket No: SSA–2019–0030]
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 one
extension, 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,
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Federal Register / Vol. 84, No. 138 / Thursday, July 18, 2019 / Notices
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–
2019–0030].
I. The information collection below is
pending at SSA. SSA will submit it 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 September 16, 2019.
Individuals can obtain copies of the
collection instruments by writing to the
above email address.
Work Incentives Planning and
Assistance Program—0960–0629. As
part of SSA’s strategy to assist Social
Security Disability Insurance (SSDI)
beneficiaries and Supplemental Security
Income (SSI) recipients who wish to
return to work and achieve selfsufficiency, SSA established the Work
Incentives Planning and Assistance
(WIPA) program. This community
based, work incentive, planning and
assistance project collects identifying
claimant information via project sites
and community work incentives
Number of
respondents
Modality of completion
Small Site (Under 150 beneficiaries served) (SSA–4565; SSA–4566; SSA–
4567) ............................................................................................................
Medium Site (150–599 beneficiaries served) (SSA–4565; SSA–4566; SSA–
4567) ............................................................................................................
Large Site (600 or more beneficiaries served) (SSA–4565; SSA–4566;
SSA–4567) ...................................................................................................
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
4,800
1
20
1,600
7,500
1
20
2,500
17,700
1
20
5,900
Total Sites .................................................................................................
SSDI & SSI Beneficiaries ................................................................................
Help Line ..........................................................................................................
30,000
30,000
30,000
........................
1
1
........................
25
5
10,000
12,500
2,500
Total ..........................................................................................................
90,000
........................
........................
25,000
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
August 19, 2019. Individuals can obtain
copies of the OMB clearance packages
by writing to OR.Reports.Clearance@
ssa.gov.
khammond on DSKBBV9HB2PROD with NOTICES
coordinators (CWIC). SSA uses this
information to ensure proper
management of the project, with
particular emphasis on administration,
budgeting, and training. In addition,
project sites and CWIC’s collect data
from SSDI beneficiaries and SSI
recipients on background employment,
training, benefits, and work incentives.
SSA is interested in identifying SSDI
beneficiary and SSI recipient outcomes
under the WIPA program, to determine
the extent to which beneficiaries with
disabilities and SSI recipients achieve
their employment, financial, and
healthcare goals. SSA will also use the
data in its analysis and future planning
for SSDI and SSI programs. Respondents
are SSDI beneficiaries, SSI recipients,
community project sites, and
employment advisors.
Type of Request: Revision of an OMBapproved information collection.
1. Real Property Current Market Value
Estimate—0960–0471. SSA considers an
individual’s resources when evaluating
eligibility for Supplemental Security
Income (SSI) payments. The value of an
individual’s resources, including nonhome real property, is one of the
eligibility requirements for SSI
payments. SSA obtains current market
value estimates of the claimant’s real
property through Form SSA–L2794. We
allow respondents to use readily
available records to complete the form,
or we can accept their best estimates.
We use this form as part of initial
applications and in post-entitlement
situations. The respondents are small
business operators in real estate; state
and local government employees tasked
with assessing real property values; and
other individuals knowledgeable about
local real estate values.
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)
SSA–L2794 ......................................................................................................
300
1
20
100
2. Child Care Dropout
Questionnaire—20 CFR 404.211(e)(4)
—0960–0474. If individuals applying for
Title II disability benefits care for their
own or their spouse’s children under
age 3, and have no steady earnings
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during the time they care for those
children, they may exclude that period
of care from the disability computation
period. We call this the child-care
dropout exclusion. SSA uses the
information from Form SSA–4162 to
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determine if an individual qualifies for
this exclusion. Respondents are
applicants for Title II disability benefits.
Type of Request: Revision of an OMBapproved information collection.
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Modality of completion
Number of
respondents
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–4162 ........................................................................................................
2,000
1
5
167
3. Medical Report on Adult with
Allegation of Human Immunodeficiency
Virus Infection; Medical Report on Child
with Allegation of Human
Immunodeficiency Virus Infection—20
CFR 416.933—20 CFR 416.934—0960–
0500. Section 1631(e)(i) of the Social
Security Act authorizes the
Commissioner of SSA to gather
information to make a determination
about an applicant’s claim for SSI
payments; this procedure is the
Presumptive Disability (PD). SSA uses
Forms SSA–4814–F5 and SSA–4815–F6
to collect information necessary to
determine if an individual with human
Number of
respondents
Modality of completion
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–4814–F5 ..................................................................................................
SSA–4815–F6 ..................................................................................................
9,600
80
1
1
8
10
1,280
13
Totals ........................................................................................................
9,680
........................
........................
1,293
4. Beneficiary Recontact Report—20
CFR 404.703 & 404.705—0960–0502.
SSA investigates recipients of disability
payments to determine their continuing
eligibility for payments. Research
indicates recipients may fail to report
circumstances that affect their
eligibility. Two such cases are: (1) When
parents receiving disability benefits for
their child marry; and (2) the removal of
an entitled child from parents’ care.
SSA uses Form SSA–1588–SM to ask
mothers or fathers about both their
marital status and children under their
care, to detect overpayments and avoid
continuing payment to those are no
longer entitled. Respondents are
recipients of mothers’ or fathers’ Social
Security benefits.
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–1588–SM ................................................................................................
76,944
1
5
6,412
5. Certification of Contents of
Document(s) or Record(s)—20 CFR
404.715—0960–0689. SSA established
procedures for individuals to provide
the evidence necessary to establish their
rights to Social Security benefits.
Examples of such evidence categories
include age, relationship, citizenship,
marriage, death, and military service.
khammond on DSKBBV9HB2PROD with NOTICES
immunodeficiency virus infection, who
is applying for SSI disability benefits,
meets the requirements for PD. The
respondents are the medical sources of
the applicants for SSI disability
payments.
Type of Request: Revision of an OMBapproved information collection.
Form SSA–704 allows SSA employees;
State record custodians; and other
custodians of evidentiary documents to
certify and record information from
original documents and records under
their custodial ownership to establish
these types of evidence. SSA uses Form
SSA–704 in situations where
individuals cannot produce the original
evidentiary documentation required to
establish benefits eligibility. The
respondents are State record custodians
and other custodians of evidentiary
documents.
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–704 ..........................................................................................................
293
1
10
49
6. Registration for Appointed
Representative Services and Direct
Payment—0960–0732. SSA uses Form
SSA–1699 to register appointed
representatives of claimants before SSA
who:
• Want to register for direct payment
of fees;
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17:56 Jul 17, 2019
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• Registered for direct payment of
fees prior to 10/31/09, but need to
update their information;
• Registered as appointed
representatives on or after 10/31/09, but
need to update their information; or
• Received a notice from SSA
instructing them to complete this form.
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Frm 00140
Fmt 4703
Sfmt 4703
By registering these individuals, SSA:
(1) Authenticates and authorizes them
to do business with us; (2) allows them
to access our records for the claimants
they represent; (3) facilitates direct
payment of authorized fees to appointed
representatives; and, (4) collects the
information we need to meet Internal
Revenue Service (IRS) requirements to
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issue specific IRS forms if we pay an
appointed representative in excess of a
specific amount ($600). The
respondents are appointed
representatives who want to use Form
SSA–1699 for any of the purposes cited
in this Notice.
Modality of completion
Number of
respondents
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–1699 ........................................................................................................
17,700
1
20
5,900
7. Certificate of Incapacity—5 CFR
890.302(d)—0960–0739. Rules
governing the Federal Employee Health
Benefits (FEHB) plan require a
physician to verify the disability of
Federal employees’ children ages 26 and
over for these children to retain health
benefits under their employed parents’
plans. The physician must verify the
adult child’s disability: (1) Pre-dates the
child’s 26th birthday; (2) is very serious;
and (3) will continue for at least one
year. Physicians use Form SSA–604, the
Certificate of Incapacity, to document
and certify this information, and the
Social Security Administration uses the
information provided to determine the
eligibility for these children, ages 26
and over, for coverage under a parent’s
FEHB plan. The respondents are
physicians of SSA employees’ children
ages 26 or over who are seeking to retain
health benefits under their parent’s
FEHB coverage.
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–604 ..........................................................................................................
50
1
45
38
Dated: July 12, 2019.
Naomi Sipple,
Reports Clearance Officer, Social Security
Administration.
(Authority: 41 CFR part 102–3.65)
[FR Doc. 2019–15249 Filed 7–17–19; 8:45 am]
[FR Doc. 2019–15285 Filed 7–17–19; 8:45 am]
On June 28, 2019, Savage Davenport
Railroad Company (SDR) filed with the
Board a petition under 49 U.S.C. 10502
for an exemption from the prior
approval requirements of 49 U.S.C.
10903, to enable SDR to discontinue its
operations over a rail line (the Line)
owned by the City of Davenport, Iowa
(the City), in Scott County, Iowa. The
Line is approximately 2.8 miles long,
extending from a switch near milepost
191.2 on the main line of a Canadian
Pacific Railway subsidiary, west and
south to the Davenport Transload
Facility owned by the City. The Line
traverses U.S. Postal Service Zip Code
52748.
According to SDR, the Line was
constructed, and is owned, by the City 1
and is subject to a lease between the
City and SDR, requiring SDR to provide
common carrier rail service over the
Line, serving industrial shippers.2 SDR
explains that it began operations on the
Line in March of 2018, serving one rail
customer and the Transload Facility.
SDR states that the Transload Facility
currently has zero activity. (Pet. 3 n.3.)
SDR states that it has advised the City
of its desire to discontinue service, and
the City has raised no objection
provided a suitable replacement is
identified. (Id. at 3.) SDR states that,
based on the information in SDR’s
possession, the Line does not contain
federally granted rights-of-way. Any
documentation in SDR’s possession will
be made available promptly to those
requesting it.
As a condition to this exemption, any
employee adversely affected by the
discontinuance of service shall be
protected under Oregon Short Line
Railroad—Abandonment Portion
Goshen Branch Between Firth &
Ammon, in Bingham & Bonneville
Counties, Idaho, 360 I.C.C. 91 (1979).
Because this is a discontinuance
proceeding and not an abandonment
proceeding, trail use/rail banking and
public use conditions are not
appropriate. Because there will be an
environmental review during any
subsequent abandonment proceeding,
this discontinuance does not require an
1 See City of Davenport—Construction &
Operation Exemption—in Scott Cty., Iowa, FD
35237 (STB served Apr. 6, 2011).
2 See Savage Davenport R.R.—Lease & Operation
Exemption—City of Davenport, FD 36142 (STB
served Sept. 1, 2017).
Christopher M. Herrick,
Executive Director, International Security
Advisory Board, Department of State.
BILLING CODE 4191–02–P
BILLING CODE 4710–27–P
SURFACE TRANSPORTATION BOARD
DEPARTMENT OF STATE
[Docket No. AB 1277X]
[Public Notice: 10823]
Savage Davenport Railroad
Company—Discontinuance of Service
Exemption—in Scott County, Iowa
Renewal of International Security
Advisory Board
khammond on DSKBBV9HB2PROD with NOTICES
Type of Request: Revision of an OMBapproved information collection.
The Department of State announces
the renewal of the Charter of the
International Security Advisory Board
(ISAB).
The purpose of the ISAB is to provide
the Department with a continuing
source of independent insight, advice,
and innovation on all aspects of arms
control, disarmament, nonproliferation,
cybersecurity, the national security
aspects of emerging technologies, and
international security, and related
aspects of public diplomacy. The ISAB
will remain in existence for two years
after the filing date of the Charter unless
terminated.
For more information, please contact
Christopher M. Herrick, Executive
Director of the International Security
Advisory Board, Department of State,
Washington, DC 20520, telephone: (202)
647–9683.
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]]>Agencies
[Federal Register Volume 84, Number 138 (Thursday, July 18, 2019)]
[Notices]
[Pages 34469-34472]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-15249]
=======================================================================
-----------------------------------------------------------------------
SOCIAL SECURITY ADMINISTRATION
[Docket No: SSA-2019-0030]
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 one extension, 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,
[[Page 34470]]
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: [email protected].
(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: [email protected].
Or you may submit your comments online through www.regulations.gov,
referencing Docket ID Number [SSA-2019-0030].
I. The information collection below is pending at SSA. SSA will
submit it 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
September 16, 2019. Individuals can obtain copies of the collection
instruments by writing to the above email address.
Work Incentives Planning and Assistance Program--0960-0629. As part
of SSA's strategy to assist Social Security Disability Insurance (SSDI)
beneficiaries and Supplemental Security Income (SSI) recipients who
wish to return to work and achieve self-sufficiency, SSA established
the Work Incentives Planning and Assistance (WIPA) program. This
community based, work incentive, planning and assistance project
collects identifying claimant information via project sites and
community work incentives coordinators (CWIC). SSA uses this
information to ensure proper management of the project, with particular
emphasis on administration, budgeting, and training. In addition,
project sites and CWIC's collect data from SSDI beneficiaries and SSI
recipients on background employment, training, benefits, and work
incentives. SSA is interested in identifying SSDI beneficiary and SSI
recipient outcomes under the WIPA program, to determine the extent to
which beneficiaries with disabilities and SSI recipients achieve their
employment, financial, and healthcare goals. SSA will also use the data
in its analysis and future planning for SSDI and SSI programs.
Respondents are SSDI beneficiaries, SSI recipients, community project
sites, and employment advisors.
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)
----------------------------------------------------------------------------------------------------------------
Small Site (Under 150 beneficiaries served) (SSA- 4,800 1 20 1,600
4565; SSA-4566; SSA-4567)......................
Medium Site (150-599 beneficiaries served) (SSA- 7,500 1 20 2,500
4565; SSA-4566; SSA-4567)......................
Large Site (600 or more beneficiaries served) 17,700 1 20 5,900
(SSA-4565; SSA-4566; SSA-4567).................
---------------------------------------------------------------
Total Sites................................. 30,000 .............. .............. 10,000
SSDI & SSI Beneficiaries........................ 30,000 1 25 12,500
Help Line....................................... 30,000 1 5 2,500
---------------------------------------------------------------
Total....................................... 90,000 .............. .............. 25,000
----------------------------------------------------------------------------------------------------------------
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 August 19, 2019. Individuals can obtain copies of
the OMB clearance packages by writing to [email protected].
1. Real Property Current Market Value Estimate--0960-0471. SSA
considers an individual's resources when evaluating eligibility for
Supplemental Security Income (SSI) payments. The value of an
individual's resources, including non-home real property, is one of the
eligibility requirements for SSI payments. SSA obtains current market
value estimates of the claimant's real property through Form SSA-L2794.
We allow respondents to use readily available records to complete the
form, or we can accept their best estimates. We use this form as part
of initial applications and in post-entitlement situations. The
respondents are small business operators in real estate; state and
local government employees tasked with assessing real property values;
and other individuals knowledgeable about local real estate values.
Type of Request: Extension 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-L2794................................... 300 1 20 100
----------------------------------------------------------------------------------------------------------------
2. Child Care Dropout Questionnaire--20 CFR 404.211(e)(4) --0960-
0474. If individuals applying for Title II disability benefits care for
their own or their spouse's children under age 3, and have no steady
earnings during the time they care for those children, they may exclude
that period of care from the disability computation period. We call
this the child-care dropout exclusion. SSA uses the information from
Form SSA-4162 to determine if an individual qualifies for this
exclusion. Respondents are applicants for Title II disability benefits.
Type of Request: Revision of an OMB-approved information
collection.
[[Page 34471]]
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4162.................................... 2,000 1 5 167
----------------------------------------------------------------------------------------------------------------
3. Medical Report on Adult with Allegation of Human
Immunodeficiency Virus Infection; Medical Report on Child with
Allegation of Human Immunodeficiency Virus Infection--20 CFR 416.933--
20 CFR 416.934--0960-0500. Section 1631(e)(i) of the Social Security
Act authorizes the Commissioner of SSA to gather information to make a
determination about an applicant's claim for SSI payments; this
procedure is the Presumptive Disability (PD). SSA uses Forms SSA-4814-
F5 and SSA-4815-F6 to collect information necessary to determine if an
individual with human immunodeficiency virus infection, who is applying
for SSI disability benefits, meets the requirements for PD. The
respondents are the medical sources of the applicants for SSI
disability payments.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average Estimated
Number of Frequency of burden per total annual
Modality of completion respondents response response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4814-F5..................................... 9,600 1 8 1,280
SSA-4815-F6..................................... 80 1 10 13
---------------------------------------------------------------
Totals...................................... 9,680 .............. .............. 1,293
----------------------------------------------------------------------------------------------------------------
4. Beneficiary Recontact Report--20 CFR 404.703 & 404.705--0960-
0502. SSA investigates recipients of disability payments to determine
their continuing eligibility for payments. Research indicates
recipients may fail to report circumstances that affect their
eligibility. Two such cases are: (1) When parents receiving disability
benefits for their child marry; and (2) the removal of an entitled
child from parents' care. SSA uses Form SSA-1588-SM to ask mothers or
fathers about both their marital status and children under their care,
to detect overpayments and avoid continuing payment to those are no
longer entitled. Respondents are recipients of mothers' or fathers'
Social Security benefits.
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-1588-SM................................. 76,944 1 5 6,412
----------------------------------------------------------------------------------------------------------------
5. Certification of Contents of Document(s) or Record(s)--20 CFR
404.715--0960-0689. SSA established procedures for individuals to
provide the evidence necessary to establish their rights to Social
Security benefits. Examples of such evidence categories include age,
relationship, citizenship, marriage, death, and military service. Form
SSA-704 allows SSA employees; State record custodians; and other
custodians of evidentiary documents to certify and record information
from original documents and records under their custodial ownership to
establish these types of evidence. SSA uses Form SSA-704 in situations
where individuals cannot produce the original evidentiary documentation
required to establish benefits eligibility. The respondents are State
record custodians and other custodians of evidentiary documents.
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-704..................................... 293 1 10 49
----------------------------------------------------------------------------------------------------------------
6. Registration for Appointed Representative Services and Direct
Payment--0960-0732. SSA uses Form SSA-1699 to register appointed
representatives of claimants before SSA who:
Want to register for direct payment of fees;
Registered for direct payment of fees prior to 10/31/09,
but need to update their information;
Registered as appointed representatives on or after 10/31/
09, but need to update their information; or
Received a notice from SSA instructing them to complete
this form.
By registering these individuals, SSA: (1) Authenticates and
authorizes them to do business with us; (2) allows them to access our
records for the claimants they represent; (3) facilitates direct
payment of authorized fees to appointed representatives; and, (4)
collects the information we need to meet Internal Revenue Service (IRS)
requirements to
[[Page 34472]]
issue specific IRS forms if we pay an appointed representative in
excess of a specific amount ($600). The respondents are appointed
representatives who want to use Form SSA-1699 for any of the purposes
cited in this Notice.
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-1699.................................... 17,700 1 20 5,900
----------------------------------------------------------------------------------------------------------------
7. Certificate of Incapacity--5 CFR 890.302(d)--0960-0739. Rules
governing the Federal Employee Health Benefits (FEHB) plan require a
physician to verify the disability of Federal employees' children ages
26 and over for these children to retain health benefits under their
employed parents' plans. The physician must verify the adult child's
disability: (1) Pre-dates the child's 26th birthday; (2) is very
serious; and (3) will continue for at least one year. Physicians use
Form SSA-604, the Certificate of Incapacity, to document and certify
this information, and the Social Security Administration uses the
information provided to determine the eligibility for these children,
ages 26 and over, for coverage under a parent's FEHB plan. The
respondents are physicians of SSA employees' children ages 26 or over
who are seeking to retain health benefits under their parent's FEHB
coverage.
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-604..................................... 50 1 45 38
----------------------------------------------------------------------------------------------------------------
Dated: July 12, 2019.
Naomi Sipple,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2019-15249 Filed 7-17-19; 8:45 am]
BILLING CODE 4191-02-P
