66712 Federal Register / Vol. 62, No. 244 / Friday, December 19, 1997 / Notices

Percent

Businesses with credit available

elsewhere ................................ 8.000

Businesses and non-profit organizations without credit available elsewhere ........................ 4.000

Others (including non-profit organizations) with credit available

elsewhere ................................ 7.125

For Economic Injury:

Businesses and small agricultural

cooperatives without credit

available elsewhere ................. 4.000

The numbers assigned to this disaster

for physical damages are 299705 for

Virginia and 299805 for North Carolina.

For economic injury the numbers are

967700 for Virginia and 967800 for

North Carolina.

(Catalog of Federal Domestic Assistance

Program Nos. 59002 and 59008)

Dated: December 10, 1997.

Ginger Lew,

Acting Administrator.

[FR Doc. 97–33164 Filed 12–18–97; 8:45 am]

BILLING CODE 8025–01–P

SOCIAL SECURITY ADMINISTRATION

Information Collection Activities:

Proposed Collection Requests and

Comment Requests

This notice lists information

collection packages that will require

submission to the Office of Management

and Budget (OMB), as well as

information collection packages

submitted to OMB for clearance, in

compliance with PL. 104–13 effective

October 1, 1995, The Paperwork

Reduction Act of 1995.

I. The information collection(s) listed

below require(s) extension(s) of the

current OMB approval(s) or are

proposed new collection(s):

1. Report by Former Representative

Payee—0960–0112. The Social Security

Administration (SSA) collects the

information on Form SSA–625 when a

mental facility is terminating its payee

services and a successor payee is to be

named. The information is needed to

determine the proper disposition of any

conserved funds. The respondents are

State institutions or agencies which are

no longer serving as representative

payee for beneficiaries who are

incapable of managing benefits.

Number of Respondents: 8,000.

Frequency of Response: 1.

Average Burden Per Response: 15

minutes.

Estimated Average Burden: 2,000

hours.

2. Pre-1957 Military Service Federal

Benefit Questionnaire—0960–0120.

Form SSA–2512 is used by SSA to

solicit sufficient information to make a

determination of eligibility for military

wage credits. Sections 217(a) and (e) of

the Social Security Act provide for

crediting military service to the wage

earner’s record and for using the data in

the claims adjudication process to grant

gratuitous military wage credits, when

applicable. The respondents are

individuals who are applying for Social

Security benefits on a record where the

wage earner has pre-1957 military

service.

Number of Respondents: 56,000.

Frequency of Response: 1.

Average Burden Per Response: 10

minutes.

Estimated Average Burden: 9,333

hours.

3. Request for Earnings and Benefit

Estimate Statement—0960–0466. Form

SSA–7004 is used by members of the

public to request information about

their Social Security earnings records

and to get an estimate of their potential

benefits. SSA provides information, in

response to the request, from the

individual’s personal Social Security

record. The respondents are Social

Security numberholders who have

covered earnings on record.

Number of Respondents: 3,350,000.

Frequency of Response: 1.

Average Burden Per Response: 5

minutes.

Estimated Average Burden: 279,167

hours.

4. Certificate of Support—0960–0001.

The information collected on Form

SSA–760–F4 is used to determine

whether the deceased worker provided

one-half support required for

entitlement to parent’s or spouse’s

benefits. The information will also be

used to determine whether the

Government pension offset would apply

to the applicant’s benefit payment. The

respondents are parents of deceased

workers or spouses who may be subject

to Government pension offset.

Number of Respondents: 18,000.

Frequency of Response: 1.

Average Burden Per Response: 15

minutes.

Estimated Average Burden: 4,500

hours.

Written comments and

recommendations regarding the

information collection(s) should be sent

within 60 days from the date of this

publication, directly to the SSA Reports

Clearance Officer at the following

address: Social Security Administration,

DCFAM, Attn: Nicholas E. Tagliareni,

6401 Security Blvd., 1–A–21 Operations

Bldg., Baltimore, MD 21235.

In addition to your comments on the

accuracy of the agency’s burden

estimate, we are soliciting comments on

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.

II. The information collection(s) listed

below have been submitted to OMB:

1. Request to Resolve Questionable

Quarters of Coverage (SSA–512);

Request for Quarters of Coverage History

Based on Relationship (SSA–513)—

0960–0575. The Personal Responsibility

and Work Opportunity Reconciliation

Act states that aliens admitted for lawful

residence who have worked and earned

40 qualifying quarters of coverage (QCs)

for Social Security purposes can

generally receive State benefits. QCs can

also be allocated to a spouse and/or to

a child under age 18, if needed to obtain

40 qualifying QCs for the alien. Form

SSA–512 is used by the States to request

clarification from SSA on questionable

QCs. Form SSA–513 is used by States to

request QC information for an alien’s

spouse or parent in cases where the

spouse or parent does not sign a consent

form giving permission to access his/her

social security records. The respondents

are State agencies which require QC

information in order to determine

eligibility for benefits.

SSA–512 SSA–513

Number of Responses .............................................................................................................................. 200,000 ..................... 350,000.

Frequency of Response ............................................................................................................................ 1 ................................ 1.

Average Burden Per Response ................................................................................................................ 2 minutes ................... 2 minutes.

Estimated Annual Burden ......................................................................................................................... 6,667 hours ............... 11,667 hours.

2. Application for Retirement

Insurance Benefits—0960–0007. The

information on Form SSA–1 is used by

SSA to determine an individual’s

entitlement to retirement insurance
Federal Register / Vol. 62, No. 244 / Friday, December 19, 1997 / Notices 66713

benefits. The respondents are applicants

for retirement benefits.

Number of Respondents: 1,600,000.

Frequency of Response: 1.

Average Burden Per Response: 10.5

minutes.

Estimated Annual Burden: 280,000

hours.

3. Physician’s/Medical Officer’s

Statement, Patient’s Capability to

Manage Benefits—0960–0024. SSA uses

the information on Form SSA–787 to

determine whether an individual is

capable of handling his/her benefits.

The information is also used for leads in

selecting a representative payee. The

respondents are physicians of the

beneficiaries or medical officers of

institutions where beneficiaries reside.

Number of Respondents: 120,000.

Frequency of Response: 1.

Average Burden Per Response: 10

minutes.

Estimated Annual Burden: 20,000

hours.

4. Claimant’s Statement When

Request for Hearing Is Filed and The

Issue Is Disability—0960–0316. SSA

requires that applicants for disability

benefits provide the updated medical

information requested on Form HA–

4486, to facilitate processing their Old

Age, Survivors and Disability Insurance

(OASDI) and Supplemental Security

Income (SSI) claims. This information

also enables the Administrative Law

Judge hearing the case to fully inquire

into the claimant’s medical condition.

The respondents are applicants for

OASDI and SSI Benefits.

Number of Respondents: 283,460.

Frequency of Response: 1.

Average Burden Per Response: 15

minutes.

Estimated Annual Burden: 70,865

hours.

5. Representative Payee Report of

Benefits and Dedicated Account—0960–

0576. Form SSA–6233 is used by SSA

to ensure that payment of SSI benefits

is made to a relative, another person, or

an organization when the best interests

of the beneficiary would be served. The

form is also used to ensure that the

representative payee is using the

benefits received for the beneficiary’s

current maintenance and personal needs

and that expenditures of funds from the

dedicated account are in compliance

with the law. The respondents are

individual and organizational

representative payees required by law to

establish a separate (‘‘dedicated’’)

account in a financial institution for

certain past-due SSI monthly benefits.

Number of Respondents: 30,000.

Frequency of Response: 1.

Average Burden Per Response: 20

minutes.

Estimated Annual Burden: 10,000

hours.

6. Application for a Social Security

Card—0960–0066. The information

collected by SSA on Form SS–5 is used

to assign a Social Security Number and

issue a card. The Social Security

Number is used to keep an accurate

record of each individual’s earnings for

the payment of benefits and for

administrative purposes as an identifier

for health-maintenance and incomemaintenance programs, such as the

OASDI Programs, the SSI Program and

other programs administered by the

Federal government including Black

Lung, Medicare and veterans

compensation and pension programs.

The Social Security Number is also used

by the Internal Revenue Service as a

taxpayer identification number for those

individuals who are eligible to be

assigned a Social Security Number. The

respondents are applicants for a Social

Security Card.

Number of Respondents: 16 million.

Frequency of Response: 1.

Average Burden Per Response: 81⁄2

minutes-9 minutes.

Estimated Annual Burden: 2,275,000

hours.

7. Questionnaire for Children

Claiming SSI Benefits—0960–0499. The

information collected on form SSA–

3881 is used by SSA to evaluate

disability in children who apply for SSI

payments. The respondents are

individuals who apply for SSI benefits

for a disabled child.

Number of Respondents: 978,000.

Frequency of Response: 1.

Average Burden Per Response: 30

minutes.

Estimated Annual Burden: 489,000

hours.

Written comments and

recommendations regarding the

information collection(s) should be

directed within 30 days to the OMB

Desk Officer and SSA Reports Clearance

Officer at the following addresses:

(OMB)

Office of Management and Budget,

OIRA, Attn: Laura Oliven, New

Executive Office Building, Room

10230, 725 17th St., NW, Washington,

D.C. 20503

(SSA)

Social Security Administration,

DCFAM, Attn: Nicholas E. Tagliareni,

1–A–21 Operations Bldg., 6401

Security Blvd., Baltimore, MD 21235

To receive a copy of any of the forms

or clearance packages, call the SSA

Reports Clearance Officer on (410) 965–

4125 or write to him at the address

listed above.

Dated: December 11, 1997.

Nicholas E. Tagliareni,

Reports Clearance Officer, Social Security

Administration.

[FR Doc. 97–32967 Filed 12–18–97; 8:45 am]

BILLING CODE 4190–29–P

DEPARTMENT OF STATE

[Public Notice 2667]

Determination With Respect to

Countries Providing Sanctuary to

Indicted War Criminals

Pursuant to the authority vested in me

by section 573(d) of the Foreign

Operations, Export Financing, and

Related Programs Appropriations Act,

1998 (Public Law 105–118), I hereby

determine that Serbia and Montenegro

and the Republika Srpska Entity of

Bosnia and Herzegovina and failed to

take necessary and significant steps to

apprehend and transfer to the

International Criminal Tribunal for the

Former Yugoslavia (the ‘‘Tribunal’’) all

persons who have been publicly

indicted by the Tribunal.

This determination shall be provided

to the Congress and published in the

Federal Register.

Dated: December 4, 1997.

Madeleine Albright,

Secretary of State.

[FR Doc. 97–33204 Filed 12–18–97; 8:45 am]

BILLING CODE 4710–01–M

DEPARTMENT OF TRANSPORTATION

Federal Highway Administration

Environmental Impact Statement:

Orange County, New York

AGENCY: Federal Highway

Administration (FHWA), New York

State Department of Transportation

(NYSDOT), New York State Thruway

Authority (NYSTA).

ACTION: Notice of Intent.

SUMMARY: The FHWA is issuing this

notice to advise the public that an

environmental impact statement will be

prepared for a proposed bridge/highway

project in Orange County, New York.

FOR FURTHER INFORMATION CONTACT:

Harold J. Brown, Division

Administrator, Federal Highway

Administration, New York Division, Leo

W. O’Brien Federal Building, 9th Floor,

Clinton Avenue and North Pearl Street,

Albany, New York 12207, Telephone

(518) 431–4127.

or

Philip J. Clark, Director, Design

Division, New York State Department of