21616 Federal Register / Vol. 77, No. 69 / Tuesday, April 10, 2012 / Notices 

10 15 U.S.C. 78s(b)(3)(A)(ii). 11 17 CFR 200.30–3(a)(12). 

in a non-discriminatory manner with 

respect to the execution of complex 

orders. 

The Exchange also believes it is fair 

and equitable not to charge a taker fee, 

nor provide a maker rebate, to PMMs 

when they trade report a public 

customer order in compliance with their 

linkage obligations. The PMM neither 

receives a financial benefit in the form 

of a rebate from performing its 

obligations, nor is it subject to the 

burden of paying the taker fee. The 

Exchange believe this is the most fair 

way to approach the PMM trade report 

function under the maker/taker pricing 

model, as categorizing the PMM trade 

report as a maker or taker would either 

provide an inequitable benefit to PMMs 

or place an inequitable burden on 

PMMs. The proposal to codify the 

application of the maker/taker pricing 

model to PMM trade reports will add 

transparency to the Exchange’s 

Schedule of Fees. 

B. Self-Regulatory Organization’s 

Statement on Burden on Competition 

The proposed rule change does not 

impose any burden on competition that 

is not necessary or appropriate in 

furtherance of the purposes of the Act. 

C. Self-Regulatory Organization’s 

Statement on Comments on the 

Proposed Rule Change Received From 

Members, Participants, or Others 

The Exchange has not solicited, and 

does not intend to solicit, comments on 

this proposed rule change. The 

Exchange has not received any 

unsolicited written comments from 

members or other interested parties. 

III. Date of Effectiveness of the 

Proposed Rule Change and Timing for 

Commission Action 

The foregoing rule change has become 

effective pursuant to Section 

19(b)(3)(A)(ii) of the Act.10 At any time 

within 60 days of the filing of such 

proposed rule change, the Commission 

summarily may temporarily suspend 

such rule change if it appears to the 

Commission that such action is 

necessary or appropriate in the public 

interest, for the protection of investors, 

or otherwise in furtherance of the 

purposes of the Act. If the Commission 

takes such action, the Commission shall 

institute proceedings to determine 

whether the proposed rule should be 

approved or disapproved. 

IV. Solicitation of Comments 

Interested persons are invited to 

submit written data, views, and 

arguments concerning the foregoing, 

including whether the proposed rule 

change is consistent with the Act. 

Comments may be submitted by any of 

the following methods: 

Electronic Comments 

• Use the Commission’s Internet 

comment form (http://www.sec.gov/ 

rules/sro.shtml); or 

• Send an email to rulecomments@sec.gov. Please include File 

Number SR–ISE–2012–29 on the subject 

line. 

Paper Comments 

• Send paper comments in triplicate 

to Elizabeth M. Murphy, Secretary, 

Securities and Exchange Commission, 

100 F Street NE., Washington, DC 

20549–1090. 

All submissions should refer to File 

Number SR–ISE–2012–29. This file 

number should be included on the 

subject line if email is used. To help the 

Commission process and review your 

comments more efficiently, please use 

only one method. The Commission will 

post all comments on the Commission’s 

Internet Web site (http://www.sec.gov/ 

rules/sro.shtml). Copies of the 

submission, all subsequent 

amendments, all written statements 

with respect to the proposed rule 

change that are filed with the 

Commission, and all written 

communications relating to the 

proposed rule change between the 

Commission and any person, other than 

those that may be withheld from the 

public in accordance with the 

provisions of 5 U.S.C. 552, will be 

available for Web site viewing and 

printing in the Commission’s Public 

Reference Room, 100 F Street NE., 

Washington, DC 20549, on official 

business days between the hours of 10 

a.m. and 3 p.m. Copies of the filing also 

will be available for inspection and 

copying at the principal office of the 

Exchange. All comments received will 

be posted without change; the 

Commission does not edit personal 

identifying information from 

submissions. You should submit only 

information that you wish to make 

available publicly. All submissions 

should refer to File Number SR–ISE– 

2012–29 and should be submitted on or 

before May 1, 2012. 

For the Commission, by the Division of 

Trading and Markets, pursuant to delegated 

authority.11

Kevin M. O’Neill, 

Deputy Secretary. 

[FR Doc. 2012–8522 Filed 4–9–12; 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 of 1995, effective October 

1, 1995. This notice includes revisions 

and one extension of 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, Email address: 

OIRA_Submission@omb.eop.gov. 

(SSA), Social Security Administration, 

DCRDP, Attn: Reports Clearance 

Director, 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 June 11, 

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 Workers’ 

Compensation/Public Disability Benefit 

Information—20 CFR 404.408(e)—0960– 

0098. Claimants for Social Security 

disability payments who are also 

receiving Worker’s Compensation/ 

Public Disability Benefits (WC/PDB) 


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Federal Register / Vol. 77, No. 69 / Tuesday, April 10, 2012 / Notices 21617 

must notify SSA about their WC/PDB, 

so the agency can compute the correct 

reduction of Social Security disability 

payments. SSA considers the claimants 

the primary sources of verification; 

therefore, if claimants provide necessary 

evidence, such as a copy of their award 

notice, benefit check, etc., that is 

sufficient. 

In cases where claimants cannot 

provide such evidence, SSA uses form 

SSA–1709. The entity paying the WC/ 

PDB benefits, its agent, (such as an 

insurance carrier), or an administering 

public agency complete this form. The 

respondents are Federal, State, and local 

agencies, insurance carriers, and public 

or private self-insured companies 

administering WC/PDB benefits to 

disability claimants. 

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–1709 ........................................................................................................ 120,000 1 15 30,000 

2. Claimant’s Medication—20 CFR 

404.1512, 416.912—0960–0289. In cases 

where claimants request a hearing after 

denial of their claim for Social Security 

benefits, SSA uses Form HA–4632 to 

obtain information from the claimant 

about medications they are using. This 

information helps the administrative 

law judge overseeing the case to fully 

investigate (1) the claimant’s medical 

treatment and (2) the effects of the 

medications on the claimant’s medical 

impairment and functional capacity. 

The respondents are applicants (or their 

representatives) for Social Security 

benefits or payments requesting a 

hearing to contest an agency denial of 

their claim. 

Type of Request: Revision of an OMBapproved information collection. 

Collection method Number of 

respondents 

Frequency 

of response 

Average 

burden per 

response 

(minutes) 

Estimated 

total annual 

burden (hours) 

HA–4632 (paper) ............................................................................................. 20,000 1 15 5,000 

Electronic Records Express ............................................................................ 180,000 1 15 45,000 

Total .......................................................................................................... 200,000 ........................ ........................ 50,000 

3. Representative Payee Report— 

Special Veterans Benefits—20 CFR 

408.665—0960–0621. Title VIII of the 

Social Security Act allows for payment 

of monthly Social Security benefits to 

qualified World War II veterans residing 

outside the United States. An SSAappointed representative payee may 

receive and manage the monthly 

payment for the beneficiary’s use and 

benefit. SSA uses the information from 

Form SSA–2001–F6 to determine if the 

payee is using the benefits properly on 

behalf of the beneficiary. Respondents 

are persons or organizations who act on 

behalf of beneficiaries who receive 

Special Veterans Benefits and live 

outside the United States. 

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–2001–F6 .................................................................................................. 100 1 10 17 

4. Representative Payment Policies 

Regulation—20 CFR 404.2011, 

404.2025, 416.611, 416.625—0960– 

0679. If SSA determines it may cause 

substantial harm for beneficiaries to 

receive their payments directly, 

beneficiaries may dispute that decision. 

To do so, beneficiaries must provide 

SSA with information the agency will 

use to re-evaluate its determination. In 

addition, after SSA selects a 

representative payee to receive benefits 

on a beneficiary’s behalf, the payees 

provide SSA with information on their 

continuing relationship and 

responsibility for the beneficiaries, and 

explain how they use the beneficiaries’ 

payments. This Information Collection 

Request includes the CFR citations that 

mandate the above provisions. 

Type of Request: Extension of an 

OMB-approved information collection. 

CFR Section Number of 

respondents 

Frequency 

of response 

Average 

burden per 

response 

(minutes) 

Estimated 

annual 

burden 

(hours) 

404.2011(a)(1), 416.611(a)(1) ......................................................................... 250 1 15 63 

404.2025, 416.625 ........................................................................................... 3,000 1 6 300 

Totals ........................................................................................................ 3,250 ........................ ........................ 363 


srobinson on DSK4SPTVN1PROD with NOTICES
21618 Federal Register / Vol. 77, No. 69 / Tuesday, April 10, 2012 / Notices 

II. SSA submitted the information 

collection below to OMB for clearance. 

Your comments regarding the 

information collection 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 May 10, 2012. Individuals 

can obtain copies of the OMB clearance 

packages by calling the SSA Reports 

Clearance Director at 410–965–8783 or 

by writing to the above email address. 

Third Party Liability Information 

Statement—42 CFR 433.136–433.139— 

0960–0323. States may enter into 

agreements with the Commissioner of 

Social Security to make Medicaid 

eligibility determinations for aged, 

blind, and disabled beneficiaries in 

those states. Applications for and 

redeterminations of SSI eligibility in 

jurisdictions with such agreements are 

applications and redeterminations of 

Medicaid eligibility. 

To reduce Medicaid costs, Medicaid 

state agencies must identify third party 

insurers liable for medical care or 

services for Medicaid beneficiaries. 

Regulations at 42 CFR 433.136–433.139 

require Medicaid state agencies to 

obtain this information on Medicaid 

applications and redeterminations as a 

condition of Medicaid eligibility. The 

Medicaid state agencies use the 

information to bill third parties liable 

for medical care, support, or services for 

a beneficiary to guarantee that Medicaid 

remains the payer of last resort. Under 

the Medicaid agreements, SSA obtains 

third party liability information using 

Form SSA–8019, and provides that 

information to the Medicaid state 

agencies. The respondents are SSI 

claimants and recipients. 

Note: This is a correction notice: SSA 

published this information collection as an 

extension on January 31, 2012 at 77 FR 4854. 

Since we are revising the Privacy Act 

Statement, this is now a revision of an OMBapproved information collection. 

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–8012 Paper form ..................................................................................... 130 1 5 11 

Modernized SSI Claims System (MSSICS) ..................................................... 66,904 1 5 5,575 

Totals ........................................................................................................ 67,034 ........................ ........................ 5,586 

Dated: April 5, 2012. 

Faye Lipsky, 

Reports Clearance Director, Office of 

Regulations and Reports Clearance, Social 

Security Administration. 

[FR Doc. 2012–8546 Filed 4–9–12; 8:45 am] 

BILLING CODE 4191–02–P 

DEPARTMENT OF STATE 

[Public Notice 7843] 

60-Day Notice of Proposed Information 

Collection: Civilian Response Corps 

Database In-Processing Electronic 

Form, OMB Control Number 1405– 

0168, Form DS–4096 

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 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: 

Civilian Response Corps Database InProcessing Electronic Form. 

• OMB Control Number: 1405–0168. 

• Type of Request: Extension of a 

Currently Approved Collection. 

• Originating Office: Bureau of 

Conflict and Stabilization Operations 

(CSO). 

• Form Numbers: DS–4096. 

• Respondents: Individuals who are 

members of or apply for one or more of 

the three components of the Civilian 

Response Corps (Active, Standby and 

Expert Corps). 

• Estimated Number of Respondents: 

2000 per year. 

• Estimated Number of Responses: 

2000 per year. 

• Average Hours per Response: 1 

hour. 

• Total Estimated Burden: 2000 

Hours. 

• Frequency: On occasion. 

• Obligation to Respond: Required to 

receive benefits. 

DATE(S): The Department will accept 

comments from the public up to 60 days 

from April 10, 2012. 

ADDRESSES FOR COMMENTS AND FURTHER

INFORMATION: You may submit 

comments and request for further 

information by either of the following 

methods: 

• Email: CRCcomments@state.gov. 

• Mail (paper, disk, or CD–ROM 

submissions): CRC Comments, Suite 

1150, 1900 North Kent Street, Rosslyn, 

VA 22202. 

You must include the DS form 

number (if applicable), information 

collection title, and OMB control 

number in any correspondence. 

SUPPLEMENTARY INFORMATION: We are 

soliciting public comments to permit 

the Department to: 

• Evaluate whether the proposed 

information collection is necessary for 

the proper performance of our 

functions. 

• Evaluate the accuracy of our 

estimate of the burden of the 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 technology. 

Abstract of proposed collection: 

The information collected is an 

important part of the Department’s 

responsibility to coordinate U.S. 

Government planning; institutionalize 

U.S. conflict prevention and 

stabilization capacity; and help stabilize 

societies in transition from conflict or 

civil strife so they can reach a 

sustainable path toward peace, 

democracy, and a market economy. The 

information gathered will be used to 

identify Civilian Response Corps 

members who are available to 

participate in CRC missions. 

Methodology: 

Respondents will complete an 

electronic DS–4096 application via the 

Web site (www.crs.state.gov). 

Dated: March 30, 2012. 

John C. Roberts, 

Director of Civilian Response Operations, 

Office of the Coordinator for Reconstruction 

& Stabilization, Department of State. 

[FR Doc. 2012–8635 Filed 4–9–12; 8:45 am] 

BILLING CODE 4710–02–P 


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