22936 Federal Register / Vol. 78, No. 74 / Wednesday, April 17, 2013 / Notices 

Modality of completion Number of 

respondents Frequency of response Number of responses 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

Demonstration Enrollment Form ....... 8,000 Subjects will only fill this form out 1 

time.

8,000 5 666 

Consent Form ................................... 8,000 Subjects will only fill this form out 1 

time.

8,000 2 266 

Totals ......................................... 8,000 ........................................................... 16,000 ........................ 932 

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 30 

days from the date of this publication. 

To be sure we consider your comments, 

we must receive them no later than May 

17, 2013. Individuals can obtain copies 

of the OMB clearance packages by 

writing to 

OR.Reports.Clearance@ssa.gov. 

1. Request for Change in Time/Place 

of Disability Hearing—20 CFR 

404.914(c)(2) and 416.1414(c)(2)—0960– 

0348. At the request of the claimants or 

their representative, SSA schedules 

evidentiary hearings at the 

reconsideration level for claimants of 

title II benefits or title XVI payments 

when we deny their claims for 

disability. When claimants or their 

representatives find they are unable to 

attend the scheduled hearing, they 

complete Form SSA–769 to request a 

change in time or place of the hearing. 

SSA uses the information as a basis for 

granting or denying requests for changes 

and for rescheduling disability hearings. 

Respondents are claimants or their 

representatives who wish to request a 

change in the time or place of their 

hearing. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of collection Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–769 .......................................................................................................... 7,483 1 8 998 

2. Beneficiary Interview and Auditor’s 

Observations Form—0960–0630. SSA’s 

Office of the Inspector General collects 

information through Form SSA–322, the 

Beneficiary Interview and Auditor’s 

Observation form, to interview 

beneficiaries or their representative 

payees to determine if the payees are 

complying with their duties and 

responsibilities. SSA randomly selects 

SSI recipients and Social Security 

beneficiaries who have representative 

payees as respondents for this 

collection. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of collection Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–322 .......................................................................................................... 1,000 1 15 250

Dated: April 12, 2013. 

Faye Lipsky, 

Reports Clearance Director, Social Security 

Administration. 

[FR Doc. 2013–08982 Filed 4–16–13; 8:45 am] 

BILLING CODE 4191–02–P 

DEPARTMENT OF STATE 

[Public Notice 8277] 

60-Day Notice of Proposed Information 

Collection: Application for a U.S. 

Passport 

ACTION: Notice of request for public 

comment. 

SUMMARY: The Department of State is 

seeking Office of Management and 

Budget (OMB) approval for the 

information collection described below. 

In accordance with the Paperwork 

Reduction Act of 1995, we are 

requesting comments on this collection 

from all interested individuals and 

organizations. The purpose of this 

notice is to allow 60 days for public 

comment preceding submission of the 

collection to OMB. 

DATES: The Department will accept 

comments from the public up to June 

17, 2013. 

ADDRESSES: You may submit comments 

by any of the following methods: 

• Web: Persons with access to the 

Internet may use the Federal Docket 

Management System (FDMS) to 

comment on this notice by going to 

www.Regulations.gov. You can search 

for the document by entering ‘‘Public 

Notice 8277’’ in the Search bar. If 

necessary, use the Narrow by Agency 

filter option on the Results page. 

• Email: PPTFormsOfficer@state.gov 

• Mail: PPT Forms Officer, U.S. 

Department of State, 2100 Pennsylvania 

Avenue NW., Room 3030, Washington, 

DC 20037 

• Fax: (202) 663–2410 

• Hand Delivery or Courier: PPT 

Forms Officer, U.S. Department of State, 

2100 Pennsylvania Avenue NW., Room 

3030, Washington, DC 20037 

You must include the DS form 

number (if applicable), information 

collection title, and the 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 collection 

instrument and supporting documents, 


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Federal Register / Vol. 78, No. 74 / Wednesday, April 17, 2013 / Notices 22937 

to PPT Forms Officer, U.S. Department 

of State, 2100 Pennsylvania Avenue 

NW., Room 3030, Washington, DC 

20037, who may be reached on (202) 

663–2457 or at 

PPTFormsOfficer@state.gov. 

SUPPLEMENTARY INFORMATION: 

• Title of Information Collection: 

Application for a U.S. Passport. 

• OMB Control Number: 1405–0004. 

• Type of Request: Revision of a 

Currently Approved Collection. 

• Originating Office: Bureau of 

Consular Affairs, Passport Services, 

Office of Program Management and 

Operational Support, Program 

Coordination Division (CA/PPT/PMO/ 

PC). 

• Form Number: DS–11. 

• Respondents: Individuals or 

households. 

• Estimated Number of Respondents: 

10,351,043 respondents per year. 

• Estimated Number of Responses: 

10,351,043 responses per year. 

• Average Time Per Response: 1.41 

hours, or 85 minutes per response. 

• Total Estimated Burden Time: 

14,594,971 hours per year. 

• Frequency: On occasion. 

• Obligation to Respond: Required to 

obtain or retain a benefit. 

We are soliciting public comments to 

permit the Department to: 

• Evaluate whether the proposed 

information collection is necessary for 

the proper functions of the Department. 

• Evaluate the accuracy of our 

estimate of the time and cost burden for 

this proposed collection, including the 

validity of the methodology and 

assumptions used. 

• Enhance the quality, utility, and 

clarity of the information to be 

collected. 

• Minimize the reporting burden on 

those who are to respond, including the 

use of automated collection techniques 

or other forms of information 

technology. 

Please note that comments submitted 

in response to this Notice are public 

record. Before including any detailed 

personal information, you should be 

aware that your comments as submitted, 

including your personal information, 

will be available for public review. 

Abstract of proposed collection: The 

DS–11 solicits data necessary for 

Passport Services to issue a United 

States passport (book and/or card 

format) in the exercise of authorities 

granted to the Secretary of State in 22 

United States Code (U.S.C.) Section 

211a et seq. and Executive Order (E.O.) 

11295 (August 5, 1966) for the issuance 

of passports to U.S. nationals. 

The issuance of U.S. passports 

requires the determination of identity, 

nationality, and entitlement with 

reference to the provisions of Title III of 

the Immigration and Nationality Act 

(INA) (8 U.S.C. sections 1401–1504), the 

14th Amendment to the Constitution of 

the United States, other applicable 

treaties and laws, and implementing 

regulations at 22 CFR parts 50 and 51. 

The specific regulations pertaining to 

the Application for a U.S. Passport are 

at 22 CFR 51.20 through 51.28. 

Methodology: The information 

collected on the DS–11 is used to 

facilitate the issuance of passports to 

U.S. citizens and nationals. The primary 

purpose of soliciting the information is 

to establish citizenship, identity, and 

entitlement to the issuance of the U.S. 

passport or related service, and to 

properly administer and enforce the 

laws pertaining to the issuance thereof. 

Passport Services collects information 

from U.S. citizens and non-citizen 

nationals when they complete and 

submit the Application for a U.S. 

Passport. Passport applicants can either 

download the DS–11 from the internet 

or obtain one from an Acceptance 

Facility/Passport Agency. The form 

must be completed and executed at an 

acceptance facility or passport agency, 

and submitted with evidence of 

citizenship and identity. 

Additional Information: In addition to 

general format changes, the following 

content changes have been made to the 

form: 

• Page 1 Instructions—The following 

heading and section were moved from 

page 3 to page 1 and have been revised 

to now read: 

Æ LOST OR STOLEN—You are 

required to submit a Form DS–64, 

Statement Regarding a Lost or Stolen 

Passport, when your valid or potentially 

valid U.S. Passport book or U.S. 

Passport card cannot be submitted with 

this application. 

Æ IN MY POSSESSION—If your most 

recent passport book and/or passport 

card was issued less than 15 years ago 

and you were over the age of 16 at the 

time of issuance, you may be eligible to 

use Form DS–82 to renew your passport 

by mail. If your most recent passport is 

valid and needs additional pages, you 

can submit your passport, form DS– 

4085 and the current fee. 

• Page 1 Instructions—In the ‘‘Special 

Requirements For Children’’ section, ‘‘If 

Only One Parent Appears * * *’’, the 

words ‘‘government-issued photo’’ were 

added between the words ‘‘parent’s’’ 

and ‘‘identification’’. 

• Page 2 Instructions—Under the 

heading ‘‘1. Proof of Citizenship’’, first 

section, the word ‘‘Country’’ in the last 

sentence has been replaced with the 

word ‘‘county’’. 

• Page 3 Instructions—Under the 

heading ‘‘Protect Yourself Against 

Identity Theft! * * *’’, the statement, 

‘‘For more information or to report 

* * *’’ has been revised to now read 

‘‘For more information regarding 

reporting a lost or stolen U.S. passport 

book or passport card and the Form DS– 

64, your eligibility to submit a Form 

DS–82 or how to request additional visa 

pages, call NPIC at 1–877–487–2778 or 

visit travel.state.gov’’. 

• Page 3 Instructions—At the bottom 

of the page, added a new heading and 

section: ‘‘Special Notice to U.S. Passport 

Card Applicants Only’’, regarding the 24 

character name limit. 

• Page 1 Form—In the photo box, the 

words ‘‘Attach a recent color 

photograph’’ have been replaced with 

‘‘Attach a color photograph taken within 

the last six months’’. 

• Page 2 Form—Line Item 14 ‘‘Travel 

Plans’’ has been renumbered as Line 

Item 18. Also, the words ‘‘Date of Trip’’ 

have been replaced with ‘‘Departure 

Date’’, and the words ‘‘Duration of Trip’’ 

have been replaced with ‘‘Return Date’’. 

• Page 2 Form—Line Item 18 

‘‘Permanent Address’’ has been 

renumbered as Line Item 19. 

• Page 2 Form, under the heading, 

‘‘PLEASE DO NOT WRITE BELOW 

THIS LINE—FOR ISSUING OFFICE 

ONLY’’, the following changes have 

occurred: 

Æ The ‘‘checkbox’’ and words ‘‘Sole 

Parent’’ have been deleted. 

Æ Beside ‘‘Report of Birth’’, the 

numbers ‘‘240’’, ‘‘545’’, and ‘‘1350’’ 

have been deleted. 

Æ The ‘‘DS–60’’ checkbox has been 

replaced with ‘‘IRL’’. 

The Department estimates that these 

changes will not result in an increase in 

the current burden time of 85 minutes. 

Dated: March 19, 2013. 

Brenda S. Sprague, 

Deputy Assistant Secretary for Passport 

Services, Bureau of Consular Affairs, 

Department of State. 

[FR Doc. 2013–09039 Filed 4–16–13; 8:45 am] 

BILLING CODE 4710–06–P 

DEPARTMENT OF STATE 

[Public Notice 8276] 

60-Day Notice of Proposed Information 

Collection: Application for Additional 

Visa Pages or Miscellaneous Passport 

Services 

ACTION: Notice of request for public 

comment. 

SUMMARY: The Department of State is 

seeking Office of Management and 


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