2114 Federal Register / Vol. 77, No. 9 / Friday, January 13, 2012 / Notices 

For the Commission, by the Division of 

Trading and Markets, pursuant to delegated 

authority.9

Kevin M. O’Neill, 

Deputy Secretary. 

[FR Doc. 2012–527 Filed 1–12–12; 8:45 am] 

BILLING CODE 8011–01–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 104–13, the Paperwork 

Reduction Act (PRA) of 1995, effective 

October 1, 1995. This notice includes 

revisions and one extension of OMBapproved information collections, 

information collections in use without 

an OMB number, and a new information 

collection. 

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, Email address: 

OIRA_Submission@omb.eop.gov. 

(SSA), Social Security Administration, 

DCRDP, Attn: Reports Clearance 

Officer, 107 Altmeyer Building, 6401 

Security Blvd., Baltimore, MD 21235, 

Fax: (410) 966–2830, Email 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 March 13, 2012. 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. Request for Documents or 

Information—20 CFR 404.703—0960– 

NEW. SSA asks individuals applying for 

Social Security benefits for additional 

information when the information they 

provided is incomplete or insufficient 

for us to determine their eligibility for 

benefits. SSA uses Form SSA–2118–U2, 

Request for Documents or Information, 

to request the additional documents or 

information we need to process 

individuals’ claims for benefits. 

Respondents are claimants for title II 

Social Security Old Age, Survivors, and 

Disability Insurance (OASDI) benefits. 

Type of Request: Existing collection in 

use without an OMB number. 

Collection instrument Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–2118–U2 ................................................................................................. 7,500 1 5 625 

2. Notice to Show Cause for Failure to 

Appear—20 CFR 404.938, 416.1438, 

404.957(a)(ii)—0960–NEW. In situations 

where claimants who requested a 

hearing before an administrative law 

judge (ALJ) fail to appear at their 

scheduled hearings, the ALJ may 

reschedule the hearing if the claimants 

establish good cause for missing the 

hearings. The claimants can provide a 

reason for not appearing at their 

scheduled hearings using Form HA– 

L90. If the ALJ determines the claimants 

established good cause for failure to 

appear at the hearings, the ALJ will 

schedule a supplemental hearing; if not, 

the ALJ makes a claims eligibility 

determination based on the claimants’ 

evidence of record. Respondents are 

claimants seeking to show cause for 

failure to appear at a scheduled hearing 

before an ALJ. 

Type of Request: Existing collection in 

use without an OMB number. 

Collection instrument Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

HA–L90 PDF/Paper ......................................................................................... 7,000 1 10 1,167 

Electronic Records Express ............................................................................ 28,000 1 10 4,667 

Total .......................................................................................................... 35,000 ........................ ........................ 5,834 

3. Permanent Residence in the United 

States Under Color of Law (PRUCOL)— 

20 CFR 416.1615 and 416.1618—0960– 

0451. As discussed in 20 CFR 416.1415 

and 416.1618 of the Code of Federal 

Regulations, PRUCOL aliens must 

present evidence of their alien status 

when they apply for Supplemental 

Security Income (SSI) payments, and 

periodically thereafter as part of the 

eligibility re-determination process for 

SSI. SSA verifies the validity of the 

PRUCOL evidence for grandfathered 

nonqualified aliens with the Department 

of Homeland Security (DHS). SSA 

determines whether the individual is 

PRUCOL based on the DHS response. 

Without this information, SSA is unable 

to determine whether the individual is 

eligible for SSI payments. Respondents 

are qualified and unqualified aliens who 

apply for SSI payments under PRUCOL. 

Type of Request: Extension of an 

OMB-approved information collection. 

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Federal Register / Vol. 77, No. 9 / Friday, January 13, 2012 / Notices 2115 

Collection instrument Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

Personal or Telephone Interview ..................................................................... 1,300 1 5 108 

II 

SSA submitted the information 

collections below to OMB for clearance. 

Your comments regarding 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 February 13, 2012. 

Individuals can obtain copies 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. Homeless with Schizophrenia 

Presumptive Disability Pilot 

Demonstration—45 CFR 46.101(b)(5)— 

0960—NEW. The Federal Strategic Plan 

to Prevent and End Homelessness 2010 

calls on Federal agencies to work in 

partnership with State and local 

governments and with the private sector 

to end homelessness. A specific 

objective of the Strategic Plan is to 

increase economic security by 

improving access to mainstream 

programs and services. 

In response to and in support of the 

President’s efforts to end homelessness, 

SSA has developed the Homeless with 

Schizophrenia Presumptive Disability 

Pilot Demonstration, which tests both 

administrative improvements to the SSI 

application process and interventions 

that provide financial stability to 

individuals who are homeless. The pilot 

will test strategies that would remove 

the barriers homeless adult applicants 

with schizophrenia or schizoaffective 

disorder experience when completing 

the SSI application process. 

SSA uses two key forms to conduct 

the demonstration: The Research 

Subject Information and Consent Form 

and the Schizophrenia Presumptive 

Disability Recommendation Form. The 

consent form provides assurances from 

the participants that they understand 

the demonstration project and 

voluntarily are consenting to participate 

in it. The Presumptive Disability 

Recommendation Form, filled out by a 

medical authority, provides information 

on how the applicant meets the 

disability criteria necessary to qualify 

for SSI benefits. SSA uses the 

information in making a presumptive 

disability determination. Respondents 

are homeless, adult SSI applicants with 

schizophrenia or schizoaffective 

disorder. 

Type of Request: Request for a new 

information collection. 

Collection instrument Number of 

respondents 

Frequency of 

response 

Number of 

responses 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

Consent Form ...................................................................... 200 1 (200) 120 400 

PD Recommendation Form ................................................. 16 13 (208) 10 35 

Totals ............................................................................ 216 ........................ (408) ........................ 435 

2. Partnership Questionnaire—20 CFR 

404.1080–1082—0960–0025. SSA 

considers partnership income in 

determining entitlement to Social 

Security benefits. SSA uses information 

from the SSA–7104 to determine several 

aspects of eligibility for benefits, 

including the accuracy of reported 

partnership earnings, the veracity of a 

retirement, and lag earnings. The 

respondents are applicants for, and 

recipients of, title II Social Security 

OASDI benefits. 

Type of Request: Revision of an OMBapproved information collection. 

Collection instrument Number of 

respondents 

Frequency of 

response 

(Number of 

responses) 

Average 

burden per 

response 

(minutes) 

SSA–7104 ........................................................................................................ 12,350 1 30 6,175 

3. Supplement to Claim of Person 

Outside the United States—20 CFR 

404.463, 20 CFR 422.505(b) and 20 CFR 

407.27(c)—0960–0051. Claimants or 

beneficiaries (both United States {U.S.} 

citizens and aliens entitled to benefits) 

living outside the U.S. complete Form 

SSA–21 as a supplement to an 

application for benefits. SSA collects 

the information to determine eligibility 

for U.S. Social Security benefits for 

those months an alien beneficiary or 

claimant is outside the U.S., and to 

determine if tax withholding applies. In 

addition, SSA uses the information to 

terminate Supplemental Medical 

Insurance coverage for recipients who 

request it, because they are, or will be, 

out of the U.S. The respondents are 

individuals entitled to Social Security 

benefits who are, will be, or have been 

residing outside the U.S. for three 

months or longer. 

Note: This is a correction notice. SSA 

published the incorrect burden information 

for this collection at 76 FR 65315, on 10/20/ 

11. We are correcting this error here. 

Type of Request: Revision of an OMBapproved information collection. 

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2116 Federal Register / Vol. 77, No. 9 / Friday, January 13, 2012 / Notices 

Collection instrument Number of 

responses 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–21 (non-residents) .................................................................................. 36,874 1 5 3,073 

SSA–21 (U.S. citizens and residents) ............................................................. 1,941 1 15 485 

Totals ........................................................................................................ 38,815 ........................ ........................ 3,558 

4. Statement of Funds You Provided 

to Another and Statement of Funds You 

Received—20 CFR 404.1520(b), 

404.1571–.1576, 404.1584–.1593 and 

416.971–.976—0960–0059. SSA uses the 

SSA–821–BK to collect recipient 

employment information to determine 

whether recipients worked after 

becoming disabled and, if so, whether 

the work is substantial gainful activity 

(SGA). SSA’s field offices use Form 

SSA–821–BK to obtain work 

information during the initial claims 

process, the continuing disability 

review process, and for SSI claims 

involving work issues. SSA’s processing 

centers and the Office of Disability and 

International Operations use the form to 

document post-adjudicative work issues 

with recipients. SSA reviews and 

evaluates the data to determine if the 

applicant or recipient meets the 

disability requirements of the law. The 

respondents are applicants and 

recipients of Title II Social Security and 

SSI disability payments. 

Note: This is a correction notice: SSA 

published the incorrect burden information 

for this collection at 76 FR 68805, on 

11/07/11. We provide the correct burden data 

below. 

Type of Request: Revision of an OMBapproved information collection. 

Collection instrument Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–821–BK ................................................................................................... 300,000 1 30 150,000 

5. Application for a Social Security 

Number Card, and the Social Security 

Number Application Process (SSNAP)— 

20 CFR 422.103–422.110—0960–0066. 

SSA collects information on the SS–5 

(used in the United States) and SS–5– 

FS (used outside the United States) to 

issue original or replacement Social 

Security cards. SSA also enters the 

application data into the Social Security 

Number Application Process (SSNAP) 

when applicants request a new or 

replacement card via telephone or in 

person. 

In addition, hospitals collect the same 

information on SSA’s behalf for 

newborn children through the 

Enumeration-at-Birth process. In this 

process, parents of newborns provide 

hospital birth registration clerks with 

information required to register these 

newborns. Hospitals send this 

information to State Bureaus of Vital 

Statistics (BVS), and they send the 

information to SSA’s National Computer 

Center. SSA then uploads the data to the 

SSA mainframe along with all other 

enumeration data, and we assign the 

newborn a Social Security Number 

(SSN) and issue a Social Security card. 

The respondents for this collection 

are applicants for original and 

replacement Social Security cards who 

use any of the modalities described 

above. 

Type of Request: Revision of an OMBapproved information collection. 

Application scenario Number of 

respondents 

Frequency of 

response 

Average burden 

per response 

(minutes) 

Estimated total 

annual burden 

(hours) 

Respondents who do not have to provide parents’ SSNs ............................ 10,500,000 1 8 .5 1,487,500 

Respondents whom we ask to provide parents’ SSNs (when applying for 

original SSN cards for children under age 18) .......................................... 400,000 1 9 60,000 

Applicants age 12 or older who need to answer additional questions so 

SSA can determine whether we previously assigned an SSN .................. 1,100,000 1 9 .5 174,167 

Applicants asking for a replacement SSN card beyond the new allowable 

limits (i.e., who must provide additional documentation to accompany 

the application) ........................................................................................... 600 1 60 600 

Authorization to SSA to obtain personal information cover letter ................. 500 1 15 125 

Authorization to SSA to obtain personal information follow-up cover letter .. 500 1 15 125 

Totals ...................................................................................................... 12,001,600 ........................ .......................... 1,722,517 

Cost Burden: The state BVSs incur 

costs of approximately $9.5 million for 

transmitting data to SSA’s mainframe. 

However, SSA reimburses the states for 

these costs. 

6. Application for Search of Census 

Records for Proof of Age—20 CFR 

404.716–0960–0097. When preferred 

evidence of age is not available or the 

available evidence is not convincing, 

SSA may ask the U.S. Department of 

Commerce, Bureau of the Census, to 

search its records to establish a 

claimant’s date of birth. SSA collects 

information from claimants using Form 

SSA–1535–U3 to provide the Census 

Bureau with sufficient identification 

information to allow an accurate search 

of census records. Additionally, the 

Census Bureau uses a completed, signed 

SSA–1535–U3 to bill SSA for the 

search. The respondents are applicants 

for Social Security benefits who need to 

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Federal Register / Vol. 77, No. 9 / Friday, January 13, 2012 / Notices 2117 

establish their date of birth as a factor 

of entitlement. 

Type of Request: Revision of an OMBapproved information collection. 

Collection instrument Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–1535–U3 ................................................................................................. 18,030 1 12 3,606 

7. Medical Report on Adult with 

Allegation of Human Immunodeficiency 

Virus Infection; Medical Report on 

Child with Allegation of Human 

Immunodeficiency Virus Infection—20 

CFR 416.933–20 CFR 416.934—0960– 

0500. SSA uses Forms SSA–4814–F5 

and SSA–4815–F6 to collect 

information necessary to determine if an 

individual with human 

immunodeficiency virus infection who 

is applying for SSI disability benefits, 

meets the requirements for presumptive 

disability payments. The respondents 

are the medical sources of the 

applicants for SSI disability payments. 

Collection instrument Number of 

responses 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–4814–F5 .................................................................................................. 46,200 1 10 7,700 

SSA–4815–F6 .................................................................................................. 12,900 1 10 2,150 

Totals ........................................................................................................ 59,100 ........................ ........................ 9,850 

8. Modified Benefit Formula 

Questionnaire—Foreign Pension— 

0960–0561. SSA uses Form SSA–308 to 

determine exactly how much (if any) of 

a foreign pension SSA may use to 

reduce the amount of title II Social 

Security retirement or disability benefits 

under the modified benefit formula. The 

respondents are applicants for title II 

Social Security retirement or disability 

benefits who have foreign pensions. 

Type of Request: Revision of an OMBapproved information collection. 

Collection instrument Number of 

responses 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–308 .......................................................................................................... 13,452 1 10 2,242 

9. Medicare Subsidy Quality Review 

Forms—20 CFR 418(b)(5)–0960–0707. 

The Medicare Modernization Act of 

2003 mandated the creation of the 

Medicare Part D prescription drug 

coverage program and provides certain 

subsidies for eligible Medicare 

beneficiaries to help pay for the cost of 

prescription drugs. As part of its 

stewardship duties of the Medicare Part 

D subsidy program, SSA must conduct 

periodic quality review checks of the 

information Medicare beneficiaries 

report on their subsidy applications 

(Form SSA–1020). SSA uses the 

Medicare Quality Review program to 

conduct these checks. The respondents 

are applicants for the Medicare Part D 

subsidy whom SSA chose to undergo a 

quality review. 

Type of Request: Revision of an OMBapproved information collection. 

Collection instrument Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes 

Estimated total 

annual burden 

(hours) 

SSA–9301 (Medicare Subsidy Quality Review Case Analysis Questionnaire) 3,500 1 30 1,750 

SSA–9302 (Notice of Quality Review Acknowledgement Form for those with 

Phones) ........................................................................................................ 3,500 1 15 875 

SSA–9303 (Notice of Quality Review Acknowledgement Form for those 

without Phones) ........................................................................................... 350 1 15 88 

SSA–9304 (Checklist of Required Information; burden accounted for with 

Forms SSA–9302, SSA–9303, SSA–9311, SSA–9314) ............................. ........................ ........................ ........................ ........................

SSA–9308 (Request for Information) .............................................................. 7,000 1 15 1,750 

SSA–9310 (Request for Documents) .............................................................. 3,500 1 5 292 

SSA–9311 (Notice of Appointment—Denial-Reviewer Will Call) .................... 450 1 15 113 

SSA–9312 (Notice of Appointment—Denial- Please Call Reviewer) .............. 50 1 15 13 

SSA–9313 (Notice of Quality Review Acknowledgement Form for those with 

Phones) ........................................................................................................ 2,500 1 15 625 

SSA–9314 (Notice of Quality Review Acknowledgement Form for those 

without Phones) ........................................................................................... 500 1 15 125 

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2118 Federal Register / Vol. 77, No. 9 / Friday, January 13, 2012 / Notices 

Collection instrument Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes 

Estimated total 

annual burden 

(hours) 

SSA–8510 (Authorization to the Social Security Administration to Obtain 

Personal Information) ................................................................................... 3,500 1 5 292 

Totals ........................................................................................................ 24,850 ........................ ........................ 5,923 

10. Application to Collect a Fee for 

Payee Service—20 CFR 416.640.640(a), 

416.1103(f)—0960–0719. Sections 

205(j)(4)(A) and (B) and 1631(a)(2) of the 

Social Security Act (Act) allow SSA to 

authorize certain organizational 

representative payees to collect a fee for 

providing payee services. Before an 

organization may collect this fee, they 

complete and submit Form SSA–445. 

SSA uses the information to determine 

whether to authorize or deny 

permission to collect fees for payee 

services. The respondents are private 

sector businesses or State and local 

government offices applying to become 

fee-for-service organizational 

representative payees. 

Type of Request: Revision of an OMBapproved information collection. 

Collection instrument Number of 

responses 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

Private sector business ................................................................................... 90 1 10 15 

State/local government offices ........................................................................ 10 1 10 2 

Totals ........................................................................................................ 100 ........................ ........................ 17 

Dated: January 10, 2012. 

Faye Lipsky, 

Reports Clearance Officer, Office of 

Regulations and Reports Clearance, Social 

Security Administration. 

[FR Doc. 2012–580 Filed 1–12–12; 8:45 am] 

BILLING CODE 4191–02–P 

DEPARTMENT OF STATE 

[Public Notice: 7755] 

Culturally Significant Objects Imported 

for Exhibition Determinations: ‘‘The 

Steins Collect: Matisse, Picasso and 

the Parisian Avant-Garde’’ 

ACTION: Notice, correction. 

SUMMARY: On April 1, 2011, notice was 

published on page 18292 of the Federal 

Register (volume 76, number 63) of 

determinations made by the Department 

of State pertaining to the exhibition 

‘‘The Steins Collect: Matisse, Picasso 

and the Parisian Avant-Garde.’’ This 

notice was corrected by a November 18, 

2011, notice published on page 71616 of 

the Federal Register (volume 76, 

number 223) as to the number of objects 

covered at the Metropolitan Museum of 

Art. These two referenced notices are 

now corrected as to additional objects to 

be included in the exhibition. 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. 236–3 of August 28, 2000 (and, as 

appropriate, Delegation of Authority No. 

257 of April 15, 2003), I hereby 

determine that additional objects to be 

included in the exhibition ‘‘The Steins 

Collect: Matisse, Picasso and the 

Parisian Avant-Garde’’ imported from 

abroad for temporary exhibition within 

the United States, are of cultural 

significance. The additional objects are 

imported pursuant to loan agreements 

with the foreign owners or custodians. 

I also determine that the exhibition or 

display of the additional exhibit objects 

at The Metropolitan Museum of Art, 

New York, NY, from on or about 

February 22, 2012, until on or about 

June 3, 2012, and at possible additional 

exhibitions or venues yet to be 

determined, is in the national interest. 

I have ordered that Public Notice of 

these Determinations be published in 

the Federal Register. 

FOR FURTHER INFORMATION CONTACT: For 

further information, including a list of 

the additional exhibit objects, contact 

Julie Simpson, Attorney-Adviser, Office 

of the Legal Adviser, U.S. Department of 

State (telephone: (202) 632–6467). The 

mailing address is U.S. Department of 

State, SA–5, L/PD, Fifth Floor (Suite 

5H03), Washington, DC 20522–0505. 

Dated: January 9, 2012. 

J. Adam Ereli, 

Principal Deputy Assistant Secretary, Bureau 

of Educational and Cultural Affairs, 

Department of State. 

[FR Doc. 2012–609 Filed 1–12–12; 8:45 am] 

BILLING CODE 4710–05–P 

DEPARTMENT OF STATE 

[Public Notice: 7754] 

In the Matter of the Designation of alQa’ida Kurdish Battalions (AQKB), 

Also Known as Kurdistan Brigades, 

Also Known as Kurdistan Battalion of 

Islamic State in Iraq, Also Known as 

Kurdistan Brigade of al-Qaeda in Iraq, 

as a Specially Designated Global 

Terrorist Pursuant to Section 1(b) of 

Executive Order 13224, as Amended 

Acting under the authority of and in 

accordance with section 1(b) of 

Executive Order 13224 of September 23, 

2001, as amended by Executive Order 

13268 of July 2, 2002, and Executive 

Order 13284 of January 23, 2003, I 

hereby determine that the entity known 

as al-Qa’ida Kurdish Battalions (AQKB), 

also known as Kurdistan Brigades, also 

known as, Kurdistan Battalion of 

Islamic State in Iraq, also known as 

Kurdistan Brigade of al-Qaeda in Iraq, 

committed, or poses a significant risk of 

committing, acts of terrorism that 

threaten the security of U.S. nationals or 

the national security, foreign policy, or 

economy of the United States. 

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