Federal Register / Vol. 74, No. 179 / Thursday, September 17, 2009 / Notices 47799 

and reporting requirements, prepare 

reports, and to retrieve and supply 

payroll and leave information as 

required for Agency needs. 

ROUTINE USES OF RECORDS MAINTAINED IN THE

SYSTEM, INCLUDING CATEGORIES OF USERS AND

THE PURPOSES OF SUCH USES: 

We may disclose information in this 

system of records to other Government 

agencies, commercial or credit 

organizations, or to prospective 

employers to verify employment. 

We may disclose information in this 

system of records to Federal, State, and 

local taxing authorities concerning 

compensation to employees or to 

contractors; to the Office of Personnel 

Management, Department of the 

Treasury, Department of Labor, and 

other Federal agencies concerning pay, 

benefits, and retirement of employees; 

to Federal employees’ health benefits 

carriers concerning health insurance of 

employees; to financial organizations 

concerning employee savings account 

allotments and net pay to checking 

accounts; to State human resource 

offices administering unemployment 

compensation programs; to educational 

and training organizations concerning 

employee qualifications and identity for 

specific courses; and to heirs, executors, 

and legal representatives of 

beneficiaries. 

We may disclose information in this 

system of records to the Office of Child 

Support Enforcement, Administration 

for Children and Families, Department 

of Health and Human Services, Federal 

Parent Locator System (FPLS), and 

Federal Tax Offset System for use in 

locating individuals and identifying 

their income sources, to establish 

paternity, establish and modify orders of 

support, and for enforcement actions. 

We may disclose information in this 

system of records to the Office of Child 

Support Enforcement for release to the 

Social Security Administration for 

verifying Social Security numbers in 

connection with the operation of the 

FPLS by the Office of Child Support 

Enforcement. 

We may disclose information in this 

system of records to the Office of Child 

Support Enforcement for release to the 

Department of the Treasury to 

administer the Earned Income Tax 

Credit Program (section 32, Internal 

Revenue Code of 1986) and to verify a 

claim with respect to employment in a 

tax return. 

Additional routine uses are listed in 

the ‘‘General Statement of Routine 

Uses.’’ 

DISCLOSURE TO CONSUMER REPORTING

AGENCIES: 

We may disclose information from 

this system, under 5 U.S.C. 552a(b)(12), 

to consumer reporting agencies as 

defined in the Fair Credit Reporting Act, 

15 U.S.C. 1681a(f), or the Federal Claims 

Collection Act of 1966, as amended, 31 

U.S.C. 3701(a)(3), in accordance with 31 

U.S.C. 3711(f). 

POLICIES AND PRACTICES FOR STORING, 

RETRIEVING, ACCESSING, RETAINING, AND

DISPOSING OF RECORDS IN THE SYSTEM: 

STORAGE: 

We maintain records in file folders or 

on a computerized database. 

RETRIEVABILITY: 

Retrievable by name or Social 

Security number. 

SAFEGUARDS: 

Access is limited to those whose 

official duties require access. File 

cabinets and rooms are locked during 

non-duty hours. Computers are 

protected by firewalls and passwords. 

RETENTION AND DISPOSAL: 

In accordance with National Archives 

and Records Administration General 

Records schedule requirements. 

SYSTEM MANAGER(S) AND ADDRESS: 

Director, Office of Management 

Services, Farm Credit Administration, 

McLean, VA 22102–5090. 

NOTIFICATION PROCEDURE: 

Direct all inquiries about this system 

of records to: Privacy Act Officer, Farm 

Credit Administration, McLean, VA 

22102–5090. 

RECORD ACCESS PROCEDURES: 

To obtain a record, contact: Privacy 

Act Officer, Farm Credit 

Administration, 1501 Farm Credit Drive, 

McLean, VA 22102–5090, as provided 

in 12 CFR part 603. 

CONTESTING RECORD PROCEDURES: 

Direct requests for amendments to a 

record to: Privacy Act Officer, Farm 

Credit Administration, 1501 Farm 

Credit Drive, McLean, VA 22102–5090, 

as provided in 12 CFR part 603. 

RECORD SOURCE CATEGORIES: 

Information in this system of records 

either comes from the individual to 

whom it applies or comes from 

information supplied by Agency 

officials. FCA employee on whom the 

record is maintained. FCA employees 

who approve the records. 

EXEMPTIONS CLAIMED FOR THE SYSTEM: 

None. 

Dated: September 11, 2009. 

Roland E. Smith, 

Secretary, Farm Credit Administration Board. 

[FR Doc. E9–22361 Filed 9–16–09; 8:45 am] 

BILLING CODE 6705–01–P 

FEDERAL COMMUNICATIONS 

COMMISSION 

Performance Review Board 

As required by the Civil Service 

Reform Act of 1978 (Pub. L. 95–454), 

Chairman Julius Genachowski 

appointed the following executives to 

the Performance Review Board (PRB): 

Mary Beth Richards, Julius Knapp and 

Ruth Milkman. 

Federal Communications Commission. 

Marlene H. Dortch, 

Secretary. 

[FR Doc. E9–22404 Filed 9–16–09; 8:45 am] 

BILLING CODE 6712–01–P 

OFFICE OF GOVERNMENT ETHICS 

Proposed Collection; Comment 

Request for Unmodified Qualified Trust 

Model Certificates and Model Trust 

Documents 

AGENCY: Office of Government Ethics 

(OGE). 

ACTION: Notice. 

SUMMARY: The Office of Government 

Ethics is publishing this first round 

notice and seeking comment on the 

twelve executive branch OGE model 

certificates and model documents for 

qualified trusts. OGE intends to submit 

these forms for extension of approval for 

three years by the Office of Management 

and Budget (OMB) under the Paperwork 

Reduction Act. OGE is proposing no 

changes to these forms at this time. As 

in the past, OGE will notify filers of an 

update to the privacy information 

contained in the existing forms, and will 

post a notification thereof on its Web 

site. 

DATES: Written comments by the public 

and the agencies on this proposed 

extension are invited and must be 

received by November 16, 2009. 

ADDRESSES: You may submit comments 

to OGE on this paperwork notice by any 

of the following methods: 

E-mail: usoge@oge.gov. (Include 

reference to ‘‘Qualified trust model 

certificates and model trust documents 

paperwork comment’’ in the subject line 

of the message). 

Fax: 202–482–9237. 

Mail, Hand Delivery/Courier: Office of 

Government Ethics, Suite 500, 1201 


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47800 Federal Register / Vol. 74, No. 179 / Thursday, September 17, 2009 / Notices 

New York Avenue, NW., Washington, 

DC 20005–3917, Attention: Paul D. 

Ledvina, Records Officer. 

FOR FURTHER INFORMATION CONTACT: Mr. 

Ledvina at the Office of Government 

Ethics; telephone: 202–482–9247; TTY: 

800–877–8339; Fax: 202–482–9237; Email: pledvina@oge.gov. The model 

certificates of independence and 

compliance for qualified trusts are 

codified in appendixes A, B, and C to 

5 CFR part 2634. Copies of the model 

trust documents are available as one set 

of OGE publications through the Ethics 

Documents section of OGE’s Web site at 

http://www.usoge.gov. Copies of the 

qualified trust model certificates and the 

model trust documents may also be 

obtained, without charge, by contacting 

Mr. Ledvina. 

SUPPLEMENTARY INFORMATION: The Office 

of Government Ethics is planning to 

submit, after this first round notice and 

comment period, all twelve qualified 

trust model certificates and model 

documents described below (all of 

which are included under OMB 

paperwork control number 3209–0007) 

for a three-year extension of approval by 

OMB under the Paperwork Reduction 

Act (44 U.S.C. chapter 35). At that time, 

OGE will publish a second paperwork 

notice in the Federal Register to inform 

the public and the agencies. The current 

paperwork approval, last granted by 

OMB in 2007, for the model certificates 

and model trust documents is scheduled 

to expire at the end of October 2009. 

OGE is proposing no changes to the 

twelve qualified trust certificates and 

model documents at this time. 

In 2003, OGE updated the OGE/ 

GOVT–1 system of records notice 

(covering SF 278 Public Financial 

Disclosure Reports and other nameretrieved ethics program records), 

including the revision of one of the 

existing routine uses and the addition of 

the three new routine uses. As a result, 

the Privacy Act Statement on each of the 

qualified trust model certificates and 

documents, which includes paraphrases 

of the routine uses, is affected. OGE has 

not incorporated this update into the 

qualified trust model certificates and 

documents at this time, since a more 

thorough revision of these information 

collections is planned within the next 

three years. Upon distribution of the 

trust model certificates and documents, 

OGE will continue to inform users of the 

update to the Privacy Act Statement. 

OGE will also post a notification thereof 

on its Web site to accompany the model 

certificates and documents. 

OGE is the supervising ethics office 

for the executive branch of the Federal 

Government under the Ethics in 

Government Act of 1978 (Ethics Act). 

Presidential nominees to executive 

branch positions subject to Senate 

confirmation and any other executive 

branch officials may seek OGE approval 

for Ethics Act qualified blind or 

diversified trusts as one means to be 

used to avoid conflicts of interest. 

OGE is the sponsoring agency for the 

model certificates and model trust 

documents for qualified blind and 

diversified trusts of executive branch 

officials set up under section 102(f) of 

the Ethics Act, 5 U.S.C. app. § 102(f), 

and OGE’s implementing financial 

disclosure regulations at subpart D of 5 

CFR part 2634. The various model 

certificates and model trust documents 

are utilized by OGE and settlors, 

trustees and other fiduciaries in 

establishing and administering these 

qualified trusts. 

There are two categories of 

information collection requirements that 

OGE plans to submit for renewed 

paperwork approval, each with its own 

related reporting model certificates or 

model trust documents which are 

subject to paperwork review and 

approval by OMB. The OGE regulatory 

citations for these two categories, 

together with identification of the forms 

used for their implementation, are as 

follows: 

i. Qualified trust certifications—5 CFR 

2634.401(d)(2), 2634.403(b)(11), 

2634.404(c)(11), 2634.406(a)(3) and (b), 

2634.408, 2634.409 and appendixes A 

and B to part 2634 (the two 

implementing forms, the Certificate of 

Independence and Certificate of 

Compliance, are codified respectively in 

the cited appendixes; see also the 

Privacy Act and Paperwork Reduction 

Act notices thereto in appendix C); and 

ii. Qualified trust communications 

and model provisions and agreements— 

5 CFR 2634.401(c)(1)(i) and (d)(2), 

2634.403(b), 2634.404(c), 2634.408 and 

2634.409 (the ten implementing forms 

are the: (A) Blind Trust 

Communications (Expedited Procedure 

for Securing Approval of Proposed 

Communications); (B) Model Qualified 

Blind Trust Provisions; (C) Model 

Qualified Diversified Trust Provisions; 

(D) Model Qualified Blind Trust 

Provisions (For Use in the Case of 

Multiple Fiduciaries); (E) Model 

Qualified Blind Trust Provisions (For 

Use in the Case of an Irrevocable PreExisting Trust); (F) Model Qualified 

Diversified Trust Provisions (Hybrid 

Version); (G) Model Qualified 

Diversified Trust Provisions (For Use in 

the Case of Multiple Fiduciaries); (H) 

Model Qualified Diversified Trust 

Provisions (For Use in the Case of an 

Irrevocable Pre-Existing Trust); (I) 

Model Confidentiality Agreement 

Provisions (For Use in the Case of a 

Privately Owned Business); and (J) 

Model Confidentiality Agreement 

Provisions (For Use in the Case of 

Investment Management Activities). As 

noted above, blank copies of each of 

these model documents are posted on 

OGE’s Web site. 

The communications formats and the 

confidentiality agreements (items ii.(A), 

(I) and (J) above), once completed, 

would not be available to the public 

because they contain sensitive, 

confidential information. All the other 

completed model trust certificates and 

model trust documents (except for any 

trust provisions that relate to the 

testamentary disposition of trust assets) 

are retained and made publicly 

available based upon a proper Ethics 

Act request (by filling out an OGE Form 

201 access form) until the periods for 

retention of all other reports (usually the 

SF 278 Public Financial Disclosure 

Reports) of the individual establishing 

the trust have lapsed (generally six years 

after the filing of the last other report). 

See 5 CFR 2634.603(g)(2) of OGE’s 

executive branch financial disclosure 

regulation. 

The Office of Government Ethics 

administers the qualified trust program 

for the executive branch. At the present 

time, there are no active filers using the 

trust model certificates and documents, 

in part reflecting the routine departure 

of high-level filers from the previous 

Administration. However, OGE intends 

to submit to OMB a request for 

extension of approval for two reasons. 

First, under OMB’s implementing 

regulations for the Paperwork Reduction 

Act, at 5 CFR 1320.3(c)(4)(i), any 

recordkeeping, reporting or disclosure 

requirement contained in a sponsoring 

agency rule of general applicability is 

deemed to meet the minimum threshold 

of ten or more persons. Second, OGE 

does anticipate possible limited use of 

these forms during the forthcoming 

three-year period 2010–2012. Therefore, 

the estimated burden figures, 

representing branchwide 

implementation of the forms, will 

remain the same as previously reported 

by OGE in its prior first and second 

round paperwork renewal notice for the 

trust forms in 2007 (72 FR 27132–27134 

(May 14, 2007) and 72 FR 46489–46490 

(August 20, 2007)). The estimate is 

based on the amount of time imposed 

on a trust administrator or private 

representative. 

i. Trust Certificates: 

A. Certificate of Independence: Total 

filers (executive branch): 5; private 

citizen filers (100%): 5; private citizen 

burden hours (20 minutes/certificate): 2. 


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Federal Register / Vol. 74, No. 179 / Thursday, September 17, 2009 / Notices 47801 

B. Certificate of Compliance: Total 

filers (executive branch): 10; private 

citizen filers (100%): 10; private citizen 

burden hours (20 minutes/certificate): 3; 

and 

ii. Model Qualified Trust Documents: 

A. Blind Trust Communications: Total 

users (executive branch): 5; private 

citizen users (100%): 5; 

communications documents (private 

citizens): 25 (based on an average of five 

communications per user, per year); 

private citizen burden hours (20 

minutes/communication): 8. 

B. Model Qualified Blind Trust: Total 

users (executive branch): 2; private 

citizen users (100%): 2; private citizen 

burden hours (100 hours/model): 200. 

C. Model Qualified Diversified Trust: 

Total users (executive branch): 1; 

private citizen users (100%): 1; private 

citizen burden hours (100 hours/model): 

100. 

D.–H. Of the five remaining model 

qualified trust documents: total users 

(executive branch): 2; private citizen 

users (100%): 2; private citizen burden 

hours (100 hours/model): 200. 

I.–J. Of the two model confidentiality 

agreements: total users (executive 

branch): 1; private citizen users (100%): 

1; private citizen burden hours (50 

hours/agreement): 50. 

However, the total annual reporting 

hour burden on filers themselves is zero 

and not the 563 hours estimated above 

because OGE’s estimating methodology 

reflects the fact that all respondents hire 

private trust administrators or other 

private representatives to set up and 

maintain the qualified blind and 

diversified trusts. Respondents 

themselves, typically incoming private 

citizen Presidential nominees, therefore 

incur no hour burden. The estimated 

total annual cost burden to respondents 

resulting from the collection of 

information is $1,000,000. Those who 

use the model documents for guidance 

are private trust administrators or other 

private representatives hired to set up 

and maintain the qualified blind and 

diversified trusts of executive branch 

officials who seek to establish such 

qualified trusts. The cost burden figure 

is based primarily on OGE’s knowledge 

of the typical trust administrator fee 

structure (an average of 1 percent of 

total assets) and OGE’s experience with 

administration of the qualified trust 

program. The $1,000,000 annual cost 

figure is based on OGE’s estimate of an 

average of five possible active trusts 

anticipated to be under administration 

for each of the next two years with 

combined total assets of $100,000,000. 

However, OGE notes that the $1,000,000 

figure is a cost estimate for the overall 

administration of the trusts, only a 

portion of which relates to information 

collection and reporting. For want of a 

precise way to break out the costs 

directly associated with information 

collection, OGE is continuing to report 

to OMB the full $1,000,000 estimate for 

paperwork clearance purposes. 

Public comment is invited on each 

aspect of the model qualified trust 

certificates and model trust documents, 

and underlying regulatory provisions, as 

set forth in this notice, including 

specific views on the need for and 

practical utility of this set of collections 

of information, the accuracy of OGE’s 

burden estimate, the potential for 

enhancement of quality, utility and 

clarity of the information collected, and 

the minimization of burden (including 

the use of information technology). 

Comments received in response to 

this notice will be summarized for, and 

may be included with, the OGE request 

for extension of the OMB paperwork 

approval for the set of the various 

existing qualified trust model 

certificates, the model communications 

package, and the model trust 

documents. The comments will also 

become a matter of public record. 

Approved: September 4, 2009. 

Robert I. Cusick, 

Director, Office of Government Ethics. 

[FR Doc. E9–22266 Filed 9–16–09; 8:45 am] 

BILLING CODE 6345–03–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Indian Health Service 

Request for Public Comment: 60–Day 

Proposed Information Collection: 

Indian Health Service Contract Health 

Services Report 

AGENCY: Indian Health Service. 

ACTION: Notice. 

SUMMARY: In compliance with Section 

3506(c)(2)(A) of the Paperwork 

Reduction Act of 1995 which requires a 

60-day advance opportunity for public 

comment on the proposed information 

collection project, the Indian Health 

Service (IHS) is publishing for comment 

a summary of a proposed information 

collection to be submitted to the Office 

of Management and Budget (OMB) for 

review. 

Proposed Collection: Title: 0917– 

0002, ‘‘Indian Health Service Contract 

Health Services Report.’’ Type of 

Information Collection Request: Three 

year renewal, with change of currently 

approved information collection, 0917– 

0002, ‘‘Indian Health Service Contract 

Health Services Report’’ Form 

Number(s): IHS–843–1A. Reporting 

formats are contained in an IHS 

Contract Health Services Manual 

Exhibit and IHS Web site. Need and Use 

of Information Collection: The IHS 

Contract Health Services Program needs 

this information to certify that the 

health care services requested and 

authorized by the IHS have been 

performed by the Contract Health 

Services provider(s); to have providers 

validate services provided; to process 

payments for health care services 

performed by such providers; and to 

serve as a legal document for health and 

medical care authorized by IHS and 

rendered by health care providers under 

contract with the IHS. 

Affected Public: Patients, health and 

medical care providers or Tribal 

Governments. 

Type of Respondents: Health and 

medical care providers. 

The table below provides: Types of 

data collection instruments, Estimated 

number of respondents, Number of 

responses per respondent, Annual 

number of responses, Average burden 

hour per response, and Total annual 

burden hours. 

Data collection instrument(s) 

Estimated 

number of 

respondents 

Responses 

per 

respondent 

Annual 

number of 

responses 

Average burden hour 

per 

response* 

Total annual 

burden hours 

IHS–843–1A ......................................................................... 7,424 51 326,145 0.05 (3 mins) 16,307 

IDS** .................................................................................... 15,157 1 15,157 0.05 (3 mins) 757 

Total .............................................................................. 22,581 ........................ ........................ ........................ 17,064 

* For ease of understanding, burden hours are also provided in actual minutes. 

** Inpatient Discharge Summary (IDS) 


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