58578 Federal Register / Vol. 69, No. 189 / Thursday, September 30, 2004 / Notices 

United States Small Business 

Administration. 

Jeffrey D. Pierson, 

Associate Administrator for Investment.

[FR Doc. 04–21996 Filed 9–29–04; 8:45 am] 

BILLING CODE 8025–01–M

SOCIAL SECURITY ADMINISTRATION

Agency Information Collection 

Activities: Proposed Request and 

Comment Request 

The Social Security Administration 

(SSA) publishes a list of information 

collection packages that will require 

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. The information collection 

packages that may be included in this 

notice are for new 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 on ways 

to minimize burden on respondents, 

including the use of automated 

collection techniques or other forms of 

information technology. Written 

comments and recommendations 

regarding the information collections 

should be submitted to the OMB Desk 

Officer and the SSA Reports Clearance 

Officer. The information can be mailed 

and/or faxed to the individuals at the 

addresses and fax numbers listed below:

(OMB), Office of Management and 

Budget, Attn: Desk Officer for SSA, 

New Executive Building, Room 

10235, 725 17th St., NW, Washington, 

DC 20503, Fax: 202–395–6974. 

(SSA), Social Security Administration, 

DCFAM, Attn: Reports Clearance 

Officer, 1338 Annex Building, 6401 

Security Blvd., Baltimore, MD 21235, 

Fax: 410–965–6400.

I. The information collections listed 

below have been submitted to OMB for 

clearance. Your comments on the 

information collections would be most 

useful if received by OMB and SSA 

within 30 days from the date of this 

publication. You can obtain a copy of 

the OMB clearance packages by calling 

the SSA Reports Clearance Officer at 

410–965–0454, or by writing to the 

address listed above. 

1. Application for Help with Medicare 

Prescription Drug Plan Costs—0960–

NEW. The Medicare Prescription Drug, 

Improvement, and Modernization Act of 

2003 (Pub. L. 108–173; MMA) 

establishes a new Medicare Part D 

program for voluntary prescription drug 

coverage for premium, deductible and 

cost-sharing subsidies for certain lowincome individuals. The MMA 

stipulates that subsidies must be 

available for individuals who are 

eligible for the program and who meet 

eligibility criteria for help with 

premium, deductible, and/or copayment costs. Form SSA–1020, the 

Application for Help with Medicare 

Prescription Drug Plan Costs, collects 

information about an applicant’s 

resources and is used by SSA to 

determine eligibility for this assistance. 

The respondents are individuals who 

are eligible for enrollment in the new 

program and are requesting assistance 

with the related costs.

Note: Since publishing the 60-day Federal 

Register Notice (69 FR 45879), SSA has 

decided to conduct a pilot test of form SSA–

1020 in March 2005. This test is intended to 

assist SSA in: (1) determining how eligible 

individuals will respond to its Part D 

Subsidy application outreach (scheduled to 

begin in June 2005) and (2) testing its systems 

processing of the SSA–1020 application. SSA 

will use the information to make actual 

subsidy eligibility determinations. The 

Agency will conduct the test with 

approximately 2,000 beneficiaries potentially 

eligible for Part D cost-sharing subsidies by 

providing them with copies of form SSA–

1020.

Type of Request: New information 

collection. 

Number of Respondents: 5,000,000. 

Frequency of Response: 1. 

Average Burden Per Response: 35 

minutes. 

Estimated Annual Burden: 2,916,667 

hours. 

2. Appeal of Determination for Help 

with Medicare Prescription Drug Plan 

Costs—0960–NEW. The Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003 (Public Law 

108–173; MMA) establishes a new 

Medicare Part D program for voluntary 

prescription drug coverage for premium, 

deductible and cost-sharing subsidies 

for certain low-income individuals. The 

MMA stipulates that subsidies must be 

available for individuals who are 

eligible for the program and who meet 

eligibility criteria for help with 

premium, deductible, and/or copayment costs. Form SSA–1021, the 

Appeal of Determination for Help with 

Medicare Prescription Drug Plan Costs, 

was developed to obtain information 

from individuals who appeal SSA’s 

decisions regarding eligibility or 

continuing eligibility for a Medicare 

Part D subsidy. The respondents are 

applicants who are appealing SSA’s 

eligibility or continuing eligibility 

decisions. 

Type of Request: New information 

collection. 

Number of Respondents: 75,000. 

Frequency of Response: 1. 

Average Burden Per Response: 10 

minutes. 

Estimated Annual Burden: 12,500 

hours.

Dated: September 24, 2004. 

Elizabeth A. Davidson, 

Reports Clearance Officer, Social Security 

Administration.

[FR Doc. 04–21910 Filed 9–29–04; 8:45 am] 

BILLING CODE 4191–02–P

DEPARTMENT OF STATE

[Public Notice 4848] 

Culturally Significant Objects Imported 

for Exhibition Determinations: ‘‘The 

Arts and Crafts Movement in Europe 

and America: Design for the Modern 

World, 1880–1920’’

AGENCY: Department of State.

ACTION: Notice.

SUMMARY: Notice is hereby given of the 

following determinations: Pursuant to 

the authority vested in me by the Act of 

October 19, 1965 (79 Stat. 985; 22 U.S.C. 

2459), Executive Order 12047 of March 

27, 1978, the Foreign Affairs Reform and 

Restructuring Act of 1998 (112 Stat. 

2681, et seq.; 22 U.S.C. 6501 note, et 

seq.), Delegation of Authority No. 234 of 

October 1, 1999, Delegation of Authority 

No. 236 of October 19, 1999, as 

amended, and Delegation of Authority 

No. 257 of April 15, 2003 [68 FR 19875], 

I hereby determine that the objects to be 

included in the exhibition ‘‘The Arts 

and Crafts Movement in Europe and 

America: Design for the Modern World, 

1880–1920,’’ imported from abroad for 

temporary exhibition within the United 

States, are of cultural significance. The 

objects are imported pursuant to a loan 

agreement with the foreign owner. I also 

determine that the exhibition or display 

of the exhibit objects at the Los Angeles 

County Museum of Art, Los Angeles, 

CA, from on or about December 19, 

2004, to on or about March 27, 2005; 

Delaware Art Museum, Wilmington, DE, 

from on or about June 17, 2005, to on 

or about September 11, 2005; Cincinnati 

Art Museum, Cincinnati, OH, from on or 

about October 21, 2005, to on or about 

January 15, 2006, and at possible 

additional venues yet to be determined, 

is in the national interest. Public Notice 

of these Determinations is ordered to be 

published in the Federal Register.

FOR FURTHER INFORMATION CONTACT: For 

further information, including a list of 

the exhibit objects, contact Julianne