Federal Register / Vol. 76, No. 51 / Wednesday, March 16, 2011 / Notices 14441 

on the collection of information 

summarized below. The Commission 

plans to submit this existing collection 

of information to the Office of 

Management and Budget for extension 

and approval. 

Form 40–F (17 CFR 249.240f) is used 

by certain Canadian issuers to register a 

class of securities under to Section 12 of 

the Securities Exchange Act of 1934 

(‘‘Exchange Act’’) (15 U.S.C. 78l) or as an 

annual report pursuant to Section 13(a) 

or 15(d) of the Exchange Act (15 U.S.C. 

78m(a) or 78o(d)). The information 

required in the Form 40–F is used by 

investors in making investment 

decisions with respect to the securities 

of such Canadian companies. We 

estimate that Form 40–F takes 

approximately 427 hours per response 

and is filed by approximately 205 

respondents. We estimate that 25% of 

the 427 hours per response (106.75 

hours) is prepared by the issuer for a 

total reporting burden of 21,884 (106.75 

hours per response x 205 responses). 

Written comments are invited on: (a) 

Whether the proposed collection of 

information is necessary for the proper 

performance of the functions of the 

agency, including whether the 

information will have practical utility; 

(b) the accuracy of the agency’s estimate 

of the burden imposed by the collection 

of information; (c) ways to enhance the 

quality, utility, and clarity of the 

information collected; and (d) ways to 

minimize the burden of the collection of 

information on respondents, including 

through the use of automated collection 

techniques or other forms of information 

technology. Consideration will be given 

to comments and suggestions submitted 

in writing within 60 days of this 

publication. 

Please direct your written comments 

to Thomas Bayer, Chief Information 

Officer, Securities and Exchange 

Commission, C/O Remi Pavlik-Simon, 

6432 General Green Way, Alexandria, 

Virginia 22312; or send an e-mail to: 

PRA_Mailbox@sec.gov. 

Dated: March 10, 2011. 

Cathy H. Ahn, 

Deputy Secretary. 

[FR Doc. 2011–6074 Filed 3–15–11; 8:45 am] 

BILLING CODE 8011–01–P 

SOCIAL SECURITY ADMINISTRATION 

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 extensions 

of and a revision to 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, e-mail, 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, E-mail address: 

OIRA_Submission@omb.eop.gov. 

(SSA), Social Security Administration, 

DCBFM, Attn: Reports Clearance 

Officer, 1333 Annex Building, 6401 

Security Blvd., Baltimore, MD 21235, 

Fax: 410–965–6400, E-mail address: 

OPLM.RCO@ssa.gov. 

I. The information collection listed 

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 May 16, 

2011. Individuals can obtain copies of 

the collection instrument by calling the 

SSA Reports Clearance Officer at 410– 

965–8783 or by writing to the above email address. 

Statement Regarding Contributions— 

20 CFR 404.360–404.366 and 404.736— 

0960–0020. SSA examines a child’s 

current sources of support when 

determining the child’s entitlement to 

Social Security benefits. To make this 

determination, SSA collects information 

on Form SSA–783. The respondents are 

individuals providing information about 

a child’s sources of support. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 30,000. 

Frequency of Response: 1. 

Average Burden per Response: 17 

minutes. 

Estimated Annual Burden: 8,500 

hours. 

II. SSA submitted the information 

collections listed below to OMB for 

clearance. Your comments on the 

information collections would be most 

useful if OMB and SSA receive them 

within 30 days from the date of this 

publication. To be sure we consider 

your comments, we must receive them 

no later than April 15, 2011. You can 

obtain copies of the OMB clearance 

packages by calling the SSA Reports 

Clearance Officer at 410–965–8783 or by 

writing to the above e-mail address. 

1. RSI/DI Quality Review Case 

Analysis—Sampled Number Holder; 

Auxiliaries/Survivors; Parent; 

Stewardship Annual Earnings Test— 

0960–0189. SSA collects information on 

Forms SSA–2930, SSA–2931, and SSA– 

2932 to establish a national payment 

accuracy rate for all cases in payment 

status, and to serve as a source of 

information regarding problem areas in 

the Retirement Survivors Insurance 

(RSI) and Disability Insurance (DI) 

programs. SSA also uses the information 

to measure the accuracy rate for newly 

adjudicated RSI/DI cases. SSA collects 

information on Form SSA–4659 to 

evaluate the effectiveness of the annual 

earnings test and uses the results in 

developing ongoing improvements in 

the process. 

About 25 percent of respondents will 

have in-person reviews and receive one 

of the following appointment letters: 

SSA–L8550–U3 (Appointment Letter— 

Sample Individual), SSA–L8551–U3 

(Appointment Letter—Sample Family), 

or the SSA–L8552–U3 (Appointment 

Letter—Rep Payee). Seventy-five 

percent of respondents will receive a 

notice for a telephone review using the 

SSA–L8553–U3 (Beneficiary Telephone 

Contact) or the SSA–L8554–U3 (Rep 

Payee Telephone Contact). 

To help the beneficiary prepare for 

the interview, we include three forms 

with each notice: 

(1) SSA–85 (Information Needed to 

Review Your Social Security Claim) lists 

the information the beneficiary will 

need to gather for the interview; 

(2) SSA–2935 (Authorization to the 

Social Security Administration to 

Obtain Personal Information) verifies 

the beneficiary’s correct payment 

amount, if necessary; and 

(3) SSA–8552 (Interview 

Confirmation) confirms or reschedules 

the interview if necessary. 

The respondents are a statistically 

valid sample of all RSI/DI beneficiaries 

in current pay status or their 

representative payees. 

Type of Request: Revision of an OMBapproved information collection. 


jlentini on DSKJ8SOYB1PROD with NOTICES
14442 Federal Register / Vol. 76, No. 51 / Wednesday, March 16, 2011 / Notices 

Form number Number of 

responses 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Total annual 

burden (hours) 

SSA–2930 ........................................................................................................ 1,500 1 30 750 

SSA–2931 ........................................................................................................ 750 1 30 375 

SSA–2932 ........................................................................................................ 100 1 20 33 

SSA–4659 ........................................................................................................ 325 1 10 54 

SSA–L8550–U3 ............................................................................................... 385 1 5 32 

SSA–L8551–U3 ............................................................................................... 95 1 5 8 

SSA–L8552–U3 ............................................................................................... 35 1 5 3 

SSA–L8553–U3 ............................................................................................... 4,490 1 5 374 

SSA–L8554–U3 ............................................................................................... 670 1 5 56 

SSA–8552 ........................................................................................................ 2,350 1 5 196 

SSA–85 ............................................................................................................ 3,850 1 5 321

SSA–2935 ........................................................................................................ 2,350 1 5 196 

SSA–820/821 ................................................................................................... 400 1 15 100 

SSA–8510 ........................................................................................................ 800 1 5 67 

iClaim Stewardship Questions ......................................................................... 324 1 10 54 

Totals ........................................................................................................ 18,424 ........................ ........................ 2,619 

2. Employer Reports of Special Wage 

Payments—20 CFR 404.428—404.429— 

0960–0565. SSA collects information on 

the SSA–131 to prevent earnings-related 

overpayments and to avoid erroneous 

withholding of benefits. SSA field 

offices and processing centers also use 

Form SSA–131 for awards and postentitlement events requiring special 

wage payment verification from 

employers. The respondents are large 

and small businesses that make special 

wage payments to retirees. 

Type of Request: Extension of an 

OMB-approved information collection. 

Completed form Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Total annual 

burden (hours) 

Paper Version: SSA–131 (without #6) ............................................................. 105,000 1 20 35,000 

Paper Version: SSA–131 (#6 only) ................................................................. 1,050 1 2 35 

Electronic Version: BSO Special Wage Payments ......................................... 26 1 5 2 

Totals ........................................................................................................ 106,076 ........................ ........................ 35,037 

Dated: March 11, 2011. 

Faye Lipsky, 

Reports Clearance Officer, Center for Reports 

Clearance, Social Security Administration. 

[FR Doc. 2011–6082 Filed 3–15–11; 8:45 am] 

BILLING CODE 4191–02–P 

DEPARTMENT OF STATE 

[Public Notice: 7359] 

60-Day Notice of Proposed Information 

Collection: DS 6561 Pre-Assignment 

for Overseas Duty for Non Foreign 

Service Personnel; New Collection 

OMB Control Number 1405–XXXX 

ACTION: Notice of request for public 

comments. 

SUMMARY: The Department of State is 

seeking Office of Management and 

Budget (OMB) approval for the 

information collection described below. 

The purpose of this notice is to allow 60 

days for public comment in the Federal 

Register preceding submission to OMB. 

We are conducting this process in 

accordance with the Paperwork 

Reduction Act of 1995. 

• Title of Information Collection: PreAssignment for Overseas Duty BonForeign Service Personnel. 

• OMB Control Number: 1405–XXXX. 

• Type of Request: New Collection. 

• Originating Office: M/MED/CL. 

• Form Number: DS 6561. 

• Respondents: Overseas employees 

and family members, not in the Foreign 

Service. 

• Estimated Number of Respondents: 

8,000. 

• Estimated Number of Responses: 

8,000. 

• Average Hours Per Response: 1 

hour. 

• Total Estimated Burden: 8,000. 

• Frequency: Every 2–3 years. 

• Obligation to Respond: Mandatory 

to retain medical clearance. 

DATES: The Department will accept 

comments from the public up to 60 days 

from March 16, 2011. 

ADDRESSES: Office of MED Clearances 

SA 15 1800 North Kent St. Rosslyn, VA 

22209. You may submit comments by 

any of the following methods: 

• E-mail: mahoneybj@state.gov. 

• Mail (paper, disk, or CD–ROM 

submissions): 1800 N. Kent St. Rosslyn, 

VA 22209. 

• Fax: 703–875–4850. 

• Hand Delivery or Courier: [insert 

street address—this address is optional]. 

You must include the DS form 

number (if applicable), information 

collection title, and OMB control 

number in any correspondence. 

FOR FURTHER INFORMATION CONTACT: 

Direct requests for additional 

information regarding the collection 

listed in this notice, including requests 

for copies of the proposed information 

collection and supporting documents, to 

Barbara Mahoney Office of Medical 

Services SA 15, 1800 N. Kent St. 


jlentini on DSKJ8SOYB1PROD with NOTICES