82 FR 3838 - Agency Information Collection Activities: Proposed Request and Comment Request
SOCIAL SECURITY ADMINISTRATION Federal Register Volume 82, Issue 8 (January 12, 2017)
Federal Register Volume 82, Issue 8 (January 12, 2017)
| Page Range | 3838-3840 | |
| FR Document | 2017-00500 |
[Federal Register Volume 82, Number 8 (Thursday, January 12, 2017)] [Notices] [Pages 3838-3840] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2017-00500] ======================================================================= ----------------------------------------------------------------------- SOCIAL SECURITY ADMINISTRATION [Docket No: SSA-2017-0001] Agency Information Collection Activities: Proposed Request and Comment Request The Social Security Administration (SSA) publishes a list of information collection packages requiring clearance by the Office of Management and Budget (OMB) in compliance with Public Law 104-13, the Paperwork Reduction Act of 1995, effective October 1, 1995. This notice includes revisions 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: [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-2017-0001]. 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 March 13, 2017. Individuals can obtain copies of the collection instruments by writing to the above email address. 1. State Mental Institution Policy Review Booklet--20 CFR 404.2035, 404.2065, 416.635, & 416.665--0960-0110. SSA uses Form SSA-9584-BK: (1) To determine if the policies and practices of a state mental institution acting as a representative payee for SSA beneficiaries conform to SSA's regulations in the use of benefits; (2) to confirm institutions are performing other duties and responsibilities required of representative payees; and (3) as the basis for conducting onsite reviews of the institutions and preparing subsequent reports of findings. The respondents are state mental institutions serving as representative payees for Social Security beneficiaries and Supplemental Security Income (SSI) 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-9584-BK................................. 69 1 60 69 ---------------------------------------------------------------------------------------------------------------- [[Page 3839]] 2. Statement of Death by Funeral Director--20 CFR 404.715 and 404.720--0960-0142. When an SSA-insured worker dies, the funeral director or funeral home responsible for the worker's burial or cremation completes Form SSA-721 and sends it to SSA. SSA uses this information for three purposes: (1) To establish proof of death for the insured worker; (2) to determine if the insured individual was receiving any pre-death benefits SSA needs to terminate; and (3) to ascertain which surviving family member is eligible for the lump-sum death payment or for other death benefits. The respondents are funeral directors who handled death arrangements for the insured individuals. 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-721..................................... 703,638 1 4 46,909 ---------------------------------------------------------------------------------------------------------------- 3. Employee Identification Statement--20 CFR 404.702--0960-0473. When two or more individuals report earnings under the same Social Security Number (SSN), SSA collects information on Form SSA-4156 to credit the earnings to the correct individual and SSN. We send the SSA- 4156 to the employer to: (1) Identify the employees involved; (2) resolve the discrepancy; and (3) credit the earnings to the correct SSN. The respondents are employers involved in erroneous wage reporting for an employee. 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-4156.................................... 4,750 1 10 792 ---------------------------------------------------------------------------------------------------------------- 4. Employee Work Activity Questionnaire--20 CFR 404.1574, 404.1592--0960-0483. SSI recipients qualify for payments when a verified physical or mental impairment prevents them from working. If disability claimants attempt to return to work after receiving payments, but are unable to continue working, they submit the SSA-3033, Employee Work Activity Questionnaire, so SSA can evaluate their work attempt. SSA also uses this form to evaluate unsuccessful subsidy work and determine applicants' continuing eligibility for disability payments. The respondents are employers of Social Security disability beneficiaries and SSI recipients who unsuccessfully attempted to return to work. 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-3033-BK................................. 15,000 1 15 3,750 ---------------------------------------------------------------------------------------------------------------- 5. Epidemiological Research Report--20 CFR 401.165--0960-0701. Section 1106(d) of the Social Security Act directs the Social Security Administration (SSA) to provide support to researchers involved in epidemiological or similar research. Specifically, when, in consultation with the Department of Health and Human Services, we determine a study contributes to a national health interest, SSA furnishes information to determine if a study subject appears in SSA administrative records as alive or deceased (vital status). SSA charges a small fee per request for providing this information. SSA's Internet application questions solicit the information SSA needs to provide the data and to collect the fees. The respondents are qualified health and scientific researchers who apply to receive vital status information about individuals from Social Security administrative data records. Type of Request: Revision of an OMB-approved information collection. ---------------------------------------------------------------------------------------------------------------- Estimated Number of Frequency of Average burden total annual Modality of completion respondents response per response burden (minutes) (hours) ---------------------------------------------------------------------------------------------------------------- State & Local Government--Interent Application.. 15 1 120 30 Private Entities--Internet Application.......... 10 1 120 20 --------------------------------------------------------------- Totals...................................... 25 .............. .............. 50 ---------------------------------------------------------------------------------------------------------------- Cost Burden:Average annual cost per respondent (based on SSA data): $3,500. Total estimated annual cost burden: $87,500. 6.Request for Medical Treatment in an SSA Employee Health Facility: Patient Self-Administered or Staff [[Page 3840]] Administered Care--0960-0772. SSA operates onsite Employee Health Clinics (EHC) in eight different States. These clinics provide health care for all SSA employees including treatments of personal medical conditions when authorized through a physician. Form SSA-5072 is the employee's personal physician's order form. The information we collect on Form SSA-5072 gives the nurses the guidance they need by law to perform certain medical procedures and to administer prescription medications such as allergy immunotherapy. In addition, the form allows the medical officer to determine whether they can administer treatment safely and appropriately in the SSA EHCs. Respondents are physicians of SSA employees who need to have medical treatment in an SSA EHC. Type of Request: Revision of an OMB-approved information collection. ---------------------------------------------------------------------------------------------------------------- Estimated Number of Frequency of Number of Average burden total annual Modality of collection respondents response responses per response burden (minutes) (hours) ---------------------------------------------------------------------------------------------------------------- SSA-5072 Annually............... 25 1 25 5 2 SSA-5072 Bi-Annually............ 75 2 150 5 13 ------------------------------------------------------------------------------- Totals...................... 100 .............. .............. .............. 15 ---------------------------------------------------------------------------------------------------------------- II. SSA submitted the information collections below to OMB for clearance. Your comments regarding the information collections would be most useful if OMB and SSA receive them 30 days from the date of this publication. To be sure we consider your comments, we must receive them no later than February 13, 2017. Individuals can obtain copies of the OMB clearance package by writing to [email protected]. 1. Petition to Obtain Approval of a Fee for Representing a Claimant Before the Social Security Administration--20 CFR 404.1720 and 404.1725; 20 CFR 416.1520 and 416.1525--0960-0104. A Social Security claimant's representative, whether an attorney or a non-attorney, uses Form SSA-1560-U4 to petition SSA for authorization to charge and collect a fee. A claimant may also use the form to agree or disagree with the requested fee amount or other information the representative provides on the form. The SSA official responsible for setting the fee uses the information from the form to determine a reasonable fee amount representatives may charge for their services. The respondents are attorneys and non-attorneys who represent Social Security claimants. Type of Request: Revision of an OMB-approved information collection. ---------------------------------------------------------------------------------------------------------------- Average burden Estimated total Modality of collection Number of Frequency of per response annual burden respondents response (minutes) (hours) ---------------------------------------------------------------------------------------------------------------- SSA-1560-U4................................. 44,365 1 30 22,183 ---------------------------------------------------------------------------------------------------------------- 2. Requests for Self-Employment Information, Employee Information, Employer Information--20 CFR 422.120--0960-0508. When SSA cannot identify Form W-2 wage data for an individual, we place the data in an earnings suspense file and contact the individual (and in certain instances the employer) to obtain the correct information. If the respondent furnishes the name and SSN information that agrees with SSA's records, or provides information that resolves the discrepancy, SSA adds the reported earnings to the respondent's Social Security record. We use Forms SSA-L2765, SSA-L3365, and SSA-L4002 for this purpose. The respondents are self-employed individuals and employees whose name and SSN information do not agree with their employer's and SSA's records. Type of Request: Revision of an OMB approved information collection. ---------------------------------------------------------------------------------------------------------------- Estimated Number of Frequency of Average burden total annual Modality of completion respondents response per response burden (minutes) (hours) ---------------------------------------------------------------------------------------------------------------- SSA-L2765....................................... 12,321 1 10 2,054 SSA-L3365....................................... 179,749 1 10 29,958 SSA-L4002....................................... 121,679 1 10 20,280 --------------------------------------------------------------- Totals...................................... 313,749 .............. .............. 52,292 ---------------------------------------------------------------------------------------------------------------- Dated: January 9, 2017. Naomi R. Sipple, Reports Clearance Officer, Social Security Administration. [FR Doc. 2017-00500 Filed 1-11-17; 8:45 am] BILLING CODE 4191-02-P
![3838 Federal Register / Vol. 82, No. 8 / Thursday, January 12, 2017 / Notices
on the existing collection of information information shall have practical utility; quality, utility, and clarity; and ways to
provided for in Rule 8c–1 (17 CFR (b) the accuracy of the Commission’s minimize burden on respondents,
240.8c–1), under the Securities estimates of the burden of the proposed including the use of automated
Exchange Act of 1934 (‘‘Exchange Act’’) collection of information; (c) ways to collection techniques or other forms of
(15 U.S.C. 78a et seq.). The Commission enhance the quality, utility, and clarity information technology. Mail, email, or
plans to submit this existing collection of the information collected; and (d) fax your comments and
of information to the Office of ways to minimize the burden of the recommendations on the information
Management and Budget (‘‘OMB’’) for collection of information on collection(s) to the OMB Desk Officer
extension and approval. respondents, including through the use and SSA Reports Clearance Officer at
Rule 8c–1 generally prohibits a of automated collection techniques or the following addresses or fax numbers.
broker-dealer from using its customers’ other forms of information technology. (OMB), Office of Management and
securities as collateral to finance its own Consideration will be given to Budget, Attn: Desk Officer for SSA,
trading, speculating, or underwriting comments and suggestions submitted in Fax: 202–395–6974, Email address:
transactions. More specifically, Rule 8c– writing within 60 days of this OIRA_Submission@omb.eop.gov
1 states three main principles: (1) A publication.
(SSA), Social Security Administration,
broker-dealer is prohibited from An agency may not conduct or
OLCA, Attn: Reports Clearance
commingling the securities of different sponsor, and a person is not required to
Director, 3100 West High Rise, 6401
customers as collateral for a loan respond to, a collection of information
Security Blvd., Baltimore, MD 21235,
without the consent of each customer; under the PRA unless it displays a
Fax: 410–966–2830, Email address:
(2) a broker-dealer cannot commingle currently valid OMB control number.
OR.Reports.Clearance@ssa.gov
customers’ securities with its own Please direct your written comments
securities under the same pledge; and to: Pamela Dyson, Director/Chief Or you may submit your comments
(3) a broker-dealer can only pledge its Information Officer, Securities and online through www.regulations.gov,
customers’ securities to the extent that Exchange Commission, c/o Remi Pavlik- referencing Docket ID Number [SSA–
customers are in debt to the broker- Simon, 100 F Street NE., Washington, 2017–0001].
dealer.1 DC 20549, or send an email to: PRA_ I. The information collections below
The information required by Rule 8c– Mailbox@sec.gov. are pending at SSA. SSA will submit
1 is necessary for the execution of the them to OMB within 60 days from the
Dated: January 3, 2017.
Commission’s mandate under the date of this notice. To be sure we
Eduardo A. Aleman, consider your comments, we must
Exchange Act to prevent broker-dealers
Assistant Secretary. receive them no later than March 13,
from hypothecating or arranging for the
hypothecation of any securities carried [FR Doc. 2017–00469 Filed 1–11–17; 8:45 am] 2017. Individuals can obtain copies of
for the account of any customer under BILLING CODE 8011–01–P the collection instruments by writing to
certain circumstances. In addition, the the above email address.
information required by Rule 8c–1 1. State Mental Institution Policy
provides important investor protections. SOCIAL SECURITY ADMINISTRATION Review Booklet—20 CFR 404.2035,
There are approximately 60 404.2065, 416.635, & 416.665—0960–
[Docket No: SSA–2017–0001] 0110. SSA uses Form SSA–9584–BK: (1)
respondents as of year-end 2015 (i.e.,
broker-dealers that conducted business Agency Information Collection To determine if the policies and
with the public, filed Part II of the Activities: Proposed Request and practices of a state mental institution
FOCUS Report, did not claim an Comment Request acting as a representative payee for SSA
exemption from the Reserve Formula beneficiaries conform to SSA’s
computation, and reported that they had The Social Security Administration regulations in the use of benefits; (2) to
a bank loan during at least one quarter (SSA) publishes a list of information confirm institutions are performing
of the current year). Each respondent collection packages requiring clearance other duties and responsibilities
makes an estimated 45 annual by the Office of Management and required of representative payees; and
responses, for an aggregate total of 2,700 Budget (OMB) in compliance with (3) as the basis for conducting onsite
responses per year.2 Each response takes Public Law 104–13, the Paperwork reviews of the institutions and
approximately 0.5 hours to complete. Reduction Act of 1995, effective October preparing subsequent reports of
Therefore, the total third-party reporting 1, 1995. This notice includes revisions findings. The respondents are state
burden per year is 1,350 burden hours.3 of OMB-approved information mental institutions serving as
Written comments are invited on: (a) collections. representative payees for Social Security
Whether the proposed collection of SSA is soliciting comments on the beneficiaries and Supplemental Security
information is necessary for the proper accuracy of the agency’s burden Income (SSI) recipients.
performance of the functions of the estimate; the need for the information; Type of Request: Revision of an OMB-
Commission, including whether the its practical utility; ways to enhance its approved information collection.
Average Estimated total
Number of Frequency of burden per
Modality of completion annual burden
respondents response response (hours)
(minutes)
mstockstill on DSK3G9T082PROD with NOTICES
SSA–9584–BK ................................................................................................. 69 1 60 69
1 See Exchange Act Release No. 2690 (November 2 60 respondents × 45 annual responses = 2,700 3 2,700 responses × 0.5 hours = 1,350 hours.
15, 1940); Exchange Act Release No. 9428 aggregate total of annual responses.
(December 29, 1971).
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![3840 Federal Register / Vol. 82, No. 8 / Thursday, January 12, 2017 / Notices
Administered Care—0960–0772. SSA physician’s order form. The information administer treatment safely and
operates onsite Employee Health Clinics we collect on Form SSA–5072 gives the appropriately in the SSA EHCs.
(EHC) in eight different States. These nurses the guidance they need by law to Respondents are physicians of SSA
clinics provide health care for all SSA perform certain medical procedures and employees who need to have medical
employees including treatments of to administer prescription medications treatment in an SSA EHC.
personal medical conditions when such as allergy immunotherapy. In
Type of Request: Revision of an OMB-
authorized through a physician. Form addition, the form allows the medical
SSA–5072 is the employee’s personal officer to determine whether they can approved information collection.
Average Estimated total
Number of Frequency of Number of burden per
Modality of collection annual burden
respondents response responses response (hours)
(minutes)
SSA–5072 Annually ............................................................. 25 1 25 5 2
SSA–5072 Bi-Annually ......................................................... 75 2 150 5 13
Totals ............................................................................ 100 ........................ ........................ ........................ 15
II. SSA submitted the information 1. Petition to Obtain Approval of a information the representative provides
collections below to OMB for clearance. Fee for Representing a Claimant Before on the form. The SSA official
Your comments regarding the the Social Security Administration—20 responsible for setting the fee uses the
information collections would be most CFR 404.1720 and 404.1725; 20 CFR information from the form to determine
useful if OMB and SSA receive them 30 416.1520 and 416.1525—0960–0104. A a reasonable fee amount representatives
days from the date of this publication. Social Security claimant’s may charge for their services. The
To be sure we consider your comments, representative, whether an attorney or a respondents are attorneys and non-
we must receive them no later than non-attorney, uses Form SSA–1560–U4 attorneys who represent Social Security
February 13, 2017. Individuals can to petition SSA for authorization to claimants.
obtain copies of the OMB clearance charge and collect a fee. A claimant may
package by writing to also use the form to agree or disagree Type of Request: Revision of an OMB-
OR.Reports.Clearance@ssa.gov. with the requested fee amount or other approved information collection.
Average Estimated total
Number of Frequency of burden per
Modality of collection annual burden
respondents response response (hours)
(minutes)
SSA–1560–U4 ................................................................................................. 44,365 1 30 22,183
2. Requests for Self-Employment employer) to obtain the correct L2765, SSA–L3365, and SSA–L4002 for
Information, Employee Information, information. If the respondent furnishes this purpose. The respondents are self-
Employer Information—20 CFR the name and SSN information that employed individuals and employees
422.120—0960–0508. When SSA cannot agrees with SSA’s records, or provides whose name and SSN information do
identify Form W–2 wage data for an information that resolves the not agree with their employer’s and
individual, we place the data in an discrepancy, SSA adds the reported SSA’s records.
earnings suspense file and contact the earnings to the respondent’s Social Type of Request: Revision of an OMB
individual (and in certain instances the Security record. We use Forms SSA– approved information collection.
Average Estimated total
Number of Frequency of burden per
Modality of completion annual burden
respondents response response (hours)
(minutes)
SSA–L2765 ...................................................................................................... 12,321 1 10 2,054
SSA–L3365 ...................................................................................................... 179,749 1 10 29,958
SSA–L4002 ...................................................................................................... 121,679 1 10 20,280
Totals ........................................................................................................ 313,749 ........................ ........................ 52,292
Dated: January 9, 2017. DEPARTMENT OF STATE 2001, as amended by Executive Order
Naomi R. Sipple, 13268 of July 2, 2002, and Executive
Reports Clearance Officer, Social Security [Public Notice 9850] Order 13284 of January 23, 2003, I
mstockstill on DSK3G9T082PROD with NOTICES
Administration. hereby determine that the person known
E.O. 13224 Designation of Mustafa as Mustafa Mughniyeh, also known as
[FR Doc. 2017–00500 Filed 1–11–17; 8:45 am]
Mughniyeh, aka Mustafa Mughniyah as Mustafa Mughniyah, committed, or
BILLING CODE 4191–02–P a Specially Designated Global Terrorist
poses a significant risk of committing,
Acting under the authority of and in acts of terrorism that threaten the
accordance with section 1(b) of security of U.S. nationals or the national
Executive Order 13224 of September 23, security, foreign policy, or economy of
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Document Created: 2017-03-21 14:40:41
Document Modified: 2017-03-21 14:40:41
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| Collection | Federal Register | |
| sudoc Class | AE 2.7: GS 4.107: AE 2.106: | |
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| Section | Notices | |
| FR Citation | 82 FR 3838 |
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