Federal Register / Vol. 75, No. 245 / Wednesday, December 22, 2010 / Notices 80563 

nine (9) members will be appointed for 

a term of 2 years and eleven (11) 

members will be appointed for a term of 

3 years. Thereafter, members will be 

appointed for two (2) year terms and 

may not serve more than three (3) terms 

unless SBA terminates membership 

sooner. 

Nomination Process 

Nominees should send a letter of selfnomination or a letter of nomination 

from a peer, professional organization or 

society or member of Congress. This 

letter must indicate which category the 

nominee will represent and highlight 

accomplishments and experience 

working with small businesses in urban 

or rural underserved communities, 

including personal experience as a 

small business owner located in an 

underserved community. The letter 

should also include the following 

information: full name of nominee, 

occupation, physical address, telephone 

number, and e-mail address. 

All nominees are subject to a conflict 

of interest determination by SBA and 

will not be considered eligible until 

such determination is made. Nominees 

may be asked to submit additional 

information. Nominations must be sent 

to Dan Jones at 

underservedcouncil@sba.gov. 

Dated: December 16, 2010. 

Dan Jones, 

SBA Committee Management Officer. 

[FR Doc. 2010–32097 Filed 12–21–10; 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 requiring clearance 

by the Office of Management and 

Budget (OMB) in compliance with 

Public Law (Pub. L.) 104–13, the 

Paperwork Reduction Act of 1995, 

effective October 1, 1995. This notice 

includes revisions 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, 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, 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 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 February 22, 

2011. Individuals can obtain copies of 

the collection instruments by calling the 

SSA Reports Clearance Officer at 410– 

965–8783 or by writing to the above 

email 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 and 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 and determine the effectiveness 

of the annual earnings test, and uses the 

results in developing ongoing 

improvements in the process. SSA 

sends each beneficiary an appointment 

letter for the interview. About 25 

percent of respondents will have faceto-face contact reviews and receive one 

of the following letters for an 

appointment: SSA–L8550–U3 

(Appointment Letter—Sample 

Individual), SSA–L8551–U3 

(Appointment Letter—Sample Family), 

or the SSA–L8552–U3 (Appointment 

Letter—Rep Payee). The other 75 

percent of respondents will receive a 

notice for a telephone contact review: 

either the SSA–L8553–U3 (Beneficiary 

Telephone Contact), or the SSA–L8554– 

U3 (Rep Payee Telephone Contact) 

notice. 

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) that 

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) so SSA 

can obtain information to verify the 

beneficiary’s correct payment amount, if 

necessary; and 

(3) SSA–8552 (Interview 

Confirmation) to confirm or reschedule 

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. 

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 


srobinson on DSKHWCL6B1PROD with NOTICES
80564 Federal Register / Vol. 75, No. 245 / Wednesday, December 22, 2010 / Notices 

Form number Number of 

responses 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Total annual 

burden 

(hours) 

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. Request for Social Security 

Earnings Information—20 CFR 404.810 

& 401.100—0960–0525. The Social 

Security Act permits wage earners, or 

their authorized representative, to 

request Social Security earnings 

information from SSA using Form SSA– 

7050. SSA uses the information to verify 

the requestor’s right to access the 

information and to produce the earnings 

statement. The respondents are wage 

earners and their authorized 

representatives. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 60,400. 

Frequency of Response: 1. 

Average Burden per Response: 11 

minutes. 

Estimated Annual Burden: 11,073. 

3. 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 program service centers also 

use Form SSA–131 for awards and postentitlement events requiring special 

wage payment verification from 

employers. While we need this 

information to ensure the correct 

payment of benefits, we do not require 

employers to respond. The respondents 

are large and small businesses that make 

special wage payments to retirees. 

Type of Request: Extension of an 

OMB-approved information collection. 

Modality of completion 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 

4. Methods for Conducting Personal 

Conferences When Waiver of Recovery 

of a Title II or Title XVI Overpayment 

Cannot Be Approved—20 CFR 

404.506(e)(3), 404.506(f)(8), 

416.557(c)(3), and 416.557(d)(8)—0960– 

0769. SSA conducts personal 

conferences when we cannot approve a 

waiver of recovery of a title II or title 

XVI overpayment. We are required to 

give overpaid Social Security 

beneficiaries and Supplemental Security 

Income (SSI) recipients the right to 

request a waiver of recovery and 

automatically schedule a personal 

conference if we cannot approve their 

request for waiver of overpayment. We 

conduct these conferences face-to-face, 

by telephone, or by video 

teleconference. Social Security 

beneficiaries and recipients or their 

representatives may provide documents 

to demonstrate they are without fault in 

causing the overpayment and do not 

have the ability to repay the debt. They 

may submit these documents by printed 

form (SSA–632 (OMB # 0960–0037), 

Request for Waiver of Overpayment 

Recovery; SSA–795 (OMB # 0960– 

0045), Statement of Claimant or Other 

Person, or personal statement submitted 

by mail, telephone, personal contact, or 

other suitable method, such as fax or 

email. This information collection 

satisfies the requirements for request for 

waiver of recovery of an overpayment 

and allows individuals to pursue further 

levels of administrative appeal via 

personal conference. Respondents are 

Social Security beneficiaries and SSI 

recipients or their representatives 

seeking reconsideration of an SSA 

waiver decision. 

Type of Request: Extension of an 

OMB-approved information collection. 

Title/section & collection description Number of 

responses 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Total annual 

burden 

(hours) 

Personal conference 404.506(e)(3) submittal of additional documents for 

consideration at personal conferences ........................................................ 150,000 1 30 75,000 

Personal conference 404.506(f)(8) submittal of additional mitigating financial 

information and verifications for consideration at personal conferences .... 75,000 1 30 37,500 

Personal conference 416.557(c)(3) submittal of additional documents for 

consideration at personal conferences ........................................................ 100,000 1 30 50,000 

Personal conference 416.557(d)(8) submittal of additional mitigating financial information and verifications for consideration at personal conferences ........................................................................................................ 50,000 1 30 25,000 

Total .......................................................................................................... 375,000 187,500 


srobinson on DSKHWCL6B1PROD with NOTICES
Federal Register / Vol. 75, No. 245 / Wednesday, December 22, 2010 / Notices 80565 

II. SSA has 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 January 21, 2011. You can 

obtain a copy of the OMB clearance 

packages by calling the SSA Reports 

Clearance Officer at 410–965–8783 or 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 the information 

collected on Form SSA–9584–BK to 

determine whether: 1) 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; and 2) 

the institution is performing other 

duties and responsibilities required of a 

representative payee. SSA also uses the 

information as the basis for conducting 

onsite reviews of the institution and 

preparing subsequent reports of 

findings. The respondents are State 

mental institutions serving as 

representative payees for Social Security 

beneficiaries and SSI recipients. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 88. 

Frequency of Response: 1. 

Average Burden per Response: 60 

minutes. 

Estimated Annual Burden: 88 hours. 

2. 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 the SSA–4156 so we can 

credit earnings to the correct individual 

and the correct SSN. We send this form 

to the employer to identify the 

employees involved, to resolve the 

discrepancy, and to post earnings to the 

correct SSN. The respondents are 

employers reporting erroneous wage 

information for an employee. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 4,750. 

Frequency of Response: 1. 

Average Burden per Response: 10 

minutes. 

Estimated Annual Burden: 792 hours. 

3. Modified Benefit Formula 

Questionnaire—Employer—20 CFR 401 

& 402—0960–0477. SSA collects 

information on Form SSA–58 to verify 

the claimant’s allegations on Form SSA– 

150 (OMB # 0906–0395, Modified 

Benefits Formula Questionnaire). SSA 

uses the SSA–58 to determine if the 

modified benefit formula is applicable 

and when to apply it to a person’s 

benefit. SSA sends Form SSA–58 to an 

employer for pension-related 

information, if the claimant is unable to 

provide it. The respondents are 

employers of people who are eligible 

after 1985 for both Social Security 

benefits and a pension based on work 

not covered by SSA. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 30,000. 

Frequency of Response: 1. 

Average Burden per Response: 20 

minutes. 

Estimated Average Burden: 10,000 

hours. 

4. Work Activity Report (SelfEmployed Person)—20 CFR 404.1520(b), 

20 CFR 1571–.1576, 20 CFR 404.1584– 

.1593, and 20 CFR 416.971–.976—0960– 

0598. SSA uses the information on Form 

SSA–820–U4 to determine initial or 

continuing eligibility for SSI payments 

or Social Security disability benefits. 

Under titles II and XVI of the Social 

Security Act, applicants for disability 

benefits and SSI payments must prove 

they cannot perform any kind of 

substantial gainful activity (SGA) 

generally available in the national 

economy for which we expect them to 

qualify based on age, education, and 

work experience. SSA needs 

information about this work to 

determine whether the applicant was (or 

is) engaging in SGA. Working, after a 

claimant becomes entitled, can cause 

SSA to discontinue disability benefits or 

SSI payments. Using information from 

Form SSA–820–U4, SSA can determine 

if we should stop the respondent’s 

payments. The respondents are 

applicants and claimants for SSI or 

Social Security disability benefits. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 100,000. 

Frequency of Response: 1. 

Average Burden per Response: 30 

minutes. 

Estimated Annual Burden: 50,000 

hours. 

Dated: December 16, 2010. 

Faye Lipsky, 

Reports Clearance Officer, Center for Reports 

Clearance, Social Security Administration. 

[FR Doc. 2010–32107 Filed 12–21–10; 8:45 am] 

BILLING CODE 4191–02–P 

DEPARTMENT OF STATE 

[Public Notice: 7272] 

60-Day Notice of Proposed Renewal of 

Information Collection: Form DS–0064, 

Statement Regarding a Lost or Stolen 

Passport, 1405–0014. 

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 renewal 

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: 

Statement Regarding a Lost or Stolen 

Passport. 

• OMB Control Number: 1405–0014. 

• Type of Request: Extension of a 

Currently Approved Collection. 

• Originating Office: CA/PPT/PMO/ 

PC. 

• Form Number: DS–0064. 

• Respondents: Individuals or 

Households. 

• Estimated Number of Respondents: 

122,500. 

• Estimated Number of Responses: 

122,500. 

• Average Hours Per Response: 5 

minutes. 

• Total Estimated Burden: 10,208 

hours. 

• Frequency: On occasion. 

• Obligation to Respond: Required to 

Obtain a Benefit. 

DATES: The Department will accept 

comments from the public up to 60 days 

from December 22, 2010. 

ADDRESSES: You may submit comments 

by any of the following methods: 

• E-mail: PPT-FormsOfficer@state.gov. 

• Mail (paper, disk, or CD–ROM 

submissions): Passport Forms 

Management Officer, U.S. Department of 

State, Office of Program Management 

and Operational Support, 2100 

Pennsylvania Avenue, NW., Room 3031, 

Washington, DC 20037. 

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 


srobinson on DSKHWCL6B1PROD with NOTICES