Federal Register / Vol. 69, No. 215 / Monday, November 8, 2004 / Notices 64801

numbered declaration is hereby 

amended to establish the incident 

period for this disaster as beginning 

September 27, 2004, and continuing 

through September 30, 2004. 

All other information remains the 

same, i.e., the deadline for filing 

applications for physical damage is 

December 17, 2004 and for economic 

injury the deadline is July 18, 2005.

(Catalog of Federal Domestic Assistance 

Program Nos. 59002 and 59008).

Dated: November 1, 2004. 

Herbert L. Mitchell, 

Associate Administrator for Disaster 

Assistance.

[FR Doc. 04–24816 Filed 11–5–04; 8:45 am] 

BILLING CODE 8025–01–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 that will require 

clearance by the Office of Management 

and Budget (OMB) in compliance with 

Pub. L. 104–13 effective October 1, 

1995, The Paperwork Reduction Act of 

1995. The information collection 

packages that may be included in this 

notice are for new information 

collections, revisions to OMB-approved 

information collections, and extensions 

(no change) 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 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 collection(s) 

should be submitted to the OMB Desk 

Officer and the SSA Reports Clearance 

Officer.

(OMB), Office of Management and 

Budget, Attn: Desk Officer for SSA, 

Fax: 202–395–6974. 

(SSA), Social Security Administration, 

DCFAM, Attn: Reports Clearance 

Officer, 1338 Annex Bldg., 6401 

Security Blvd., Baltimore, MD 21235; 

Fax: 410–965–6400.

I. The information collections listed 

below are pending at SSA and will be 

submitted to OMB January 7, 2005. 

Therefore, your comments should be 

submitted to SSA by this date. You can 

obtain copies of the collection 

instruments by calling the SSA Reports 

Clearance Officer at 410–965–0454, or 

by writing to the address listed above. 

1. Disability Determination and 

Transmittal—20 CFR 404.1615(e), 

416.1015(f)—0960–0437. The 

information collected on Form SSA–

831–C3/U3 is used by SSA to document 

the State agency determination as to 

whether an individual who applies for 

disability benefits is eligible for those 

benefits based on his/her alleged 

disability. SSA also uses the 

information for program management 

and evaluation. The respondents are 

State Disability Determination Services 

adjudicating Title II and Title XVI 

disability determinations for SSA. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 3,155,120. 

Frequency of Response: 1. 

Average Burden Per Response: 15 

minutes. 

Estimated Average Burden: 788,780 

hours. 

2. Non-Attorney Representative 

Demonstration Project Application—

0960–NEW. Section 303 of the Social 

Security Protection Act of 2004 (SSPA) 

provides for a 5-year demonstration 

project to be conducted by SSA under 

which the direct payment of SSAapproved fees is extended to certain 

non-attorney claimant representatives. 

Under the SSPA, to be eligible for direct 

payment of fees, a non-attorney 

representative must fulfill the following 

statutory requirements: (1) Possess a 

bachelors degree or have equivalent 

qualifications derived from training and 

work experience; (2) pass an 

examination that tests knowledge of the 

relevant provisions of the Social 

Security Act; (3) secure professional 

liability insurance or equivalent 

insurance; (4) pass a criminal 

background check; and (5) demonstrate 

completion of relevant continuing 

education courses. Through the services 

of a private contractor, SSA must collect 

the requested information to determine 

if a non-attorney representative has met 

the statutory requirements to be eligible 

for direct payment of fees for his or her 

claimant representation services. The 

information collection is needed to 

comply with the legislation. The 

respondents are non-attorney 

representatives who apply for direct 

payment of fees. 

Type of Request: New information 

collection. 

Number of Respondents: 500. 

Frequency of Response: 1. 

Average Burden Per Response: 1 hour.

Estimated Annual Burden: 500 hours. 

3. Request For Review of Hearing 

Decision/Order—20 CFR 404.967–.981, 

20 CFR 416.1467–.1481—0960–0277.

SSA collects the information on Form 

HA–520 from each claimant for Title II 

or Title XVI benefits who is dissatisfied 

with the hearing decision or the 

dismissal of a hearing request and wants 

to request review of the decision by the 

Appeals Council. An individual may 

request Appeals Council review by 

filing a written request. However, a 

completed HA–520 ensures that SSA 

receives the information necessary to 

establish that the claimant filed the 

request for review within the prescribed 

time, that the claimant is a proper party, 

and that the claimant has completed the 

requisite steps to permit review by the 

Appeals Council. The Appeals Council 

also uses the information provided by 

the claimant to document the claimant’s 

reason(s) for disagreeing with the ALJ 

decision or dismissal, to determine 

whether the claimant has additional 

evidence to submit, and to determine 

whether the claimant has a 

representative or wants to appoint one. 

Type of Request: Extension of an 

approved OMB information collection. 

Number of Respondents: 107,485. 

Frequency of Response: 1. 

Average Burden Per Response: 10 

minutes. 

Estimated Annual Burden: 17,914 

hours. 

4. State Mental Institution Policy 

Review—20 CFR 416 subpart U, 20 CFR 

416 subpart F, 20 CFR 404.2035 and 

.2065, 20 CFR 416.635 and .665—0960–

0110. SSA sends Form SSA–9584–BK to 

State mental institutions that participate 

in SSA’s representative payee onsite 

review program. As a representative 

payee, the State mental institution has 

the responsibility to receive and 

administer payments to beneficiaries 

who have been determined by SSA to be 

incapable of managing benefits. SSA is 

required by law and regulations to 

monitor representative payees’ use of 

benefits. Under the onsite review 

program, SSA conducts a triennial 

review of State mental institutions in 

order to determine whether the 

institutions’ policies and practices 

conform with SSA’s regulations in the 

use of benefits, and the other duties and 

responsibilities required of 

representative payees. 

The form obtains information needed 

by the SSA review team (comprised of 

representatives from SSA’s regional and 

field offices) and provides a basis for 

conducting the actual onsite review. In 

addition, the information is used in the 

preparation of the subsequent report of 

findings and recommendations, which 

is issued to the institutions. 

Type of Request: Extension of an 

approved OMB information collection.

64802 Federal Register / Vol. 69, No. 215 / Monday, November 8, 2004 / Notices 

Number of Respondents: 100. 

Frequency of Response: 1. 

Average Burden Per Response: 60 

minutes. 

Estimated Annual Burden: 100 hours. 

II. The information collections listed 

below have been submitted to OMB for 

clearance. Written comments and 

recommendations regarding the 

information collections should be 

submitted to the OMB Desk Officer and 

the SSA Reports Clearance Officer. In 

order for your comments to be 

considered, you must send them by 

December 8, 2004. You can obtain a 

copy of the OMB clearance package by 

calling the SSA Reports Clearance 

Officer at 410–965–0454, or by writing 

to the address listed above. 

1. Acknowledgement of Receipt 

(Notice of Hearing)—20 CFR 404.938 

and 416.1438—0960–0671. The 

information collected by form HA–504 

is used by the Social Security 

Administration to process requests for 

hearings about unfavorable 

determinations of entitlement or 

eligibility to disability payments. 

Specifically, this form is used to 

acknowledge receipt of the notice of 

hearing issued by an Administrative 

Law Judge. The respondents are 

applicants for Title II disability 

payments who want to have a hearing 

to appeal an unfavorable entitlement or 

eligibility decision. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 670,000. 

Frequency of Response: 1. 

Average Burden Per Response: 1 

minute. 

Estimated Annual Burden: 11,167 

hours. 

2. Early Intervention Project/

Employment Services Provider Survey/

0960–NEW.

Background 

The Employment Services Provider 

Survey is being conducted as part of a 

process demonstration authorized by 

the Ticket to Work and Work Incentives 

Improvement Act of 1999. The process 

demonstration, Early Intervention (EI), 

will provide employment services and 

supports to certain applicants for Social 

Security disability insurance. 

The purpose of the EI Project is to 

encourage applicants to begin the return 

to work process immediately after the 

onset of a disability. Many experts 

believe early intervention to be one of 

the most important factors in successful 

rehabilitation. Therefore, EI will 

immediately focus on a person’s ability 

to work as opposed to proving they are 

unable to work as they do during the 

existing Title II disability determination 

process. The proposed process 

demonstration is necessary to test the 

instruments and procedures targeted 

towards these objectives. 

The EI Survey 

Beginning in early 2005, EI will be 

piloted in three states. In New Mexico, 

EI will be piloted in the Albuquerque, 

Roswell/Carlsbad/Hobbs and Clovis 

areas. In Vermont, EI will be piloted 

throughout the entire state. In 

Wisconsin, EI will be piloted in the 

following counties: Green, Jefferson, 

Rock, Walworth, and Waukesha. 

Information collected through the EI 

survey will be used by SSA for the 

purposes of project design, 

implementation and evaluation. The 

information will assist in designing how 

linkages are formed between 

participants and providers for EI. SSA’s 

EI project staff will use the information 

to identify appropriate employment 

service providers for project 

participants. Project evaluators will use 

the information collected from the 

survey as a baseline assessment of the 

provider market in each area. The 

respondents to the EI survey are 

employment service providers in the 

pilot states. 

Type of Request: New information 

collection. 

Number of Respondents: 150. 

Frequency of Response: 1. 

Average Burden Per Response: 30 

minutes.

Estimated Annual Burden: 75 hours. 

3. Request for Hearing by 

Administrative Law Judge—20 CFR 

404.933 and 416.1433, 42 CFR 

405.722—0960–0269. The information 

collected by form HA–501 is used by 

SSA to process a request for a hearing 

on an unfavorable determination of 

entitlement or eligibility to benefits 

administered by SSA. The respondents 

are individuals whose claims for 

benefits are denied and who request a 

hearing to appeal the denial. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 667,236. 

Frequency of Response: 1. 

Average Burden Per Response: 10 

minutes. 

Estimated Annual Burden: 111,206 

hours. 

4. Contact with the Representative 

Payee and Contact with Beneficiary—

0960–0639. SSA will use the SSA–

L4945, Contact with the Representative 

Payee, and SSA–L4947, Contact with 

Beneficiary, to inform respondents and 

conduct quality reviews of payments 

made under the titles II and XVI 

programs. Cases for the review will be 

selected randomly and the information 

solicited will be used for verification of 

payment data on record in the claims 

folder and SSA’s Master Beneficiary 

Record. Form SSA–L4945 will be used 

to notify Representative Payees who 

have the responsibility of managing 

payments for a beneficiary that the case 

has been selected for the review process 

and to request the required information. 

Form SSA–L4947 will be used to notify 

beneficiaries that their case has been 

selected for the review process and 

request the needed information. Both 

letters contain information that must be 

verified and returned to SSA under the 

review process. The respondents are 

beneficiaries and representative payees 

for beneficiaries receiving Title II and 

Title XVI benefits. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 200. 

Frequency of Response: 1. 

Average Burden Per Response: 15 

minutes. 

Estimated Annual Burden: 50 hours. 

5. Employer Report of Special Wage 

Payments—20 404.428–404.429—0960–

0565. SSA gathers the information on 

Form SSA–131 to prevent earningsrelated overpayments to employees, and 

to avoid erroneous withholding of 

benefits. The respondents are employers 

who provide special wage payment 

verification. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 30,000. 

Frequency of Response: 1. 

Average Burden of Response: 20 

minutes. 

Estimated Average Burden: 10,000 

hours. 

6. Disability Hearing Officer’s Report 

of Disability Hearing (DC)—20 CFR 

416.1407—0906–0507. The information 

collected on form SSA–1204–BK is used 

by the Disability Hearing Officer (DHO) 

to conduct and document disability 

hearings, and to provide a structured 

format that covers all conceivable issues 

relating to Title XVI claims for disabled 

children. The completed SSA–1204–BK 

will aid the DHO in preparing the 

disability decision and will provide a 

record of what transpired in the hearing. 

The respondents are DHOs in the State 

Disability Determination Services. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 35,000. 

Frequency of Response: 1. 

Average Burden per Response: 60 

minutes. 

Estimated Average Burden: 35,000 

hours. 

7. Medical Report (Individual with 

Childhood Impairment)—20 CFR 

404.1512–404.1515, 20 CFR 416.912–

Federal Register / Vol. 69, No. 215 / Monday, November 8, 2004 / Notices 64803

416.915—0960–0102. The information 

collected on Form SSA–3827 is needed 

to determine the claimant’s physical 

and mental status prior to making a 

childhood disability determination. The 

respondents are medical sources. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 12,000. 

Frequency of Response: 1. 

Average Burden per Response: 30 

minutes. 

Estimated Average Burden: 6,000 

hours. 

8. RS/DI Quality Review Case 

Analysis: Sampled Number Holder, 

Auxiliaries/Survivors, Parents: 

Stewardship Annual Earnings Test 

Workbook—0960–0189. SSA uses the 

information collected by forms SSA–

2930, SSA–2931, and SSA–2932 to 

establish a national payment accuracy 

rate for all cases in payment status; to 

measure the accuracy rate for newly 

adjudicated claims for beneficiaries 

receiving old-age, survivors, or 

disability insurance; and to serve as a 

source of information regarding problem 

areas in the RSI/DI programs. Form 

SSA–4569 is used to evaluate and 

determine the effectiveness of the 

annual earnings test and to use the 

results to develop ongoing 

improvements in the process. The 

respondents are beneficiaries and 

representative payees for beneficiaries 

receiving old age, survivors, or 

disability insurance. 

Type of Request: Extension of an 

OMB-approved information collection.

Number of

respondents 

Frequency of

response 

Average

burden per

response

(minutes) 

Estimated

annual

burden (hours) 

SSA–2930 ........................................................................................................ 3,000 1 30 1,500

SSA–2931 ........................................................................................................ 1,500 1 30 750

SSA–2932 ........................................................................................................ 650 1 20 217

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

Totals ........................................................................................................ 5,475 ........................ ........................ 2,521

Total Estimated Annual Burden:

2,521 hours.

Dated: November 2, 2004. 

Elizabeth A. Davidson, 

Reports Clearance Officer, Social Security 

Administration.

[FR Doc. 04–24810 Filed 11–5–04; 8:45 am] 

BILLING CODE 4191–02–P

DEPARTMENT OF STATE

[Public Notice 4887] 

Culturally Significant Objects Imported 

for Exhibition Determinations: 

‘‘Salvador Dali’’

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 ‘‘Salvador 

Dali,’’ imported from abroad for 

temporary exhibition within the United 

States, are of cultural significance. The 

objects are imported pursuant to loan 

agreements with the foreign owners. I 

also determine that the exhibition or 

display of the exhibit objects at the 

Philadelphia Museum of Art, from on or 

about February 16, 2005 until on or 

about May 30, 2005, 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 the Office of 

the Legal Adviser, U.S. Department of 

State, (telephone: 202/619–6982). The 

address is U.S. Department of State, SA–

44, 301 4th Street, SW., Room 700, 

Washington, DC 20547–0001.

C. Miller Crouch, 

Principal Deputy Assistant Secretary for 

Educational and Cultural Affairs, Department 

of State.

[FR Doc. 04–24844 Filed 11–5–04; 8:45 am] 

BILLING CODE 4710–08–P

DEPARTMENT OF STATE

[Public Notice 4886] 

Bureau of Nonproliferation: 

Determination Under the Foreign 

Assistance Act and Several Foreign 

Operations and Related Programs 

Appropriations Acts

AGENCY: Department of State.

ACTION: Notice.

Pursuant to Section 654(c) of the 

Foreign Assistance Act of 1961, as 

amended, notice is hereby given that the 

Deputy Secretary of State has made a 

determination pursuant to section 620H 

of the Foreign Assistance Act, and 

Section 543 of the Foreign Operations, 

Export Financing and Related Programs 

Appropriations, Division D, of the 

Consolidated Appropriations 

Resolution, 2004 (Pub. L. 108–199) and 

similar provisions in previous year 

Foreign Operations, Export Financing, 

and Related Programs Appropriations 

Acts, and Executive Order 12163, as 

amended. The Deputy Secretary of State 

has concluded that publication of the 

determination would be harmful to the 

national security of the United States.

Dated: October 28, 2004. 

Susan F. Burk, 

Acting Assistant Secretary of State for 

Nonproliferation, Department of State.

[FR Doc. 04–24845 Filed 11–5–04; 8:45 am] 

BILLING CODE 4710–27–P

DEPARTMENT OF TRANSPORTATION

Federal Aviation Administration 

Notice of Availability of a Written Reevaluation of an Environmental 

Assessment and Finding of No 

Significant Impact/Record of Decision 

(FONSI/ROD) for the Evaluation of New 

Information Regarding a New 

Memorandum of Agreement Executed 

by the Federal Aviation Administration, 

Michigan State Historic Preservation 

Officer, and Lenawee County for the 

Lenawee County Airport located in 

Adrian, MI

AGENCY: Federal Aviation 

Administration, DOT.

ACTION: Notice of availability of a 

Written Re-evaluation of an 

Environmental Assessment and FONSI/