1296 Federal Register / Vol. 78, No. 5 / Tuesday, January 8, 2013 / Notices 

14 17 CFR 200.30–3(a)(12). 

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 20549–1090, on official 

business days between the hours of 

10:00 a.m. and 3:00 p.m. Copies of such 

filing also will be available for 

inspection and copying at BX’s 

principal office. 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–BX– 

2012–074, and should be submitted on 

or before January 29, 2013. 

For the Commission, by the Division of 

Trading and Markets, pursuant to delegated 

authority.14

Kevin M. O’Neill, 

Deputy Secretary. 

[FR Doc. 2013–00077 Filed 1–7–13; 8:45 am] 

BILLING CODE 8011–01–P 

SECURITIES AND EXCHANGE 

COMMISSION 

[Release No. 34–68457; File No. SR–CBOE– 

2012–120] 

Self-Regulatory Organizations; 

Chicago Board Options Exchange, 

Incorporated; Notice of Filing of a 

Proposed Rule Change, as Modified by 

Amendment No. 2, To Allow the Listing 

and Trading of a P.M.-Settled S&P 500 

Index Option Product 

December 18, 2012. 

Correction 

In notice document 2012–30887 

appearing on pages 76135–76139 in the 

issue of December 26, 2012, make the 

following correction: 

On page 76139, in the first column, in 

the last full paragraph, in the last line, 

‘‘January 14, 2013’’ should read 

‘‘January 16, 2013’’. 

[FR Doc. C1–2012–30887 Filed 1–7–13; 8:45 am] 

BILLING CODE 1505–01–D 

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 

to 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: 

OR.Reports.Clearance@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 11, 

2013. Individuals can obtain copies of 

the collection instruments by writing to 

the above email address. 

1. Supplemental Statement Regarding 

Farming Activities of Person Living 

Outside the U.S.A.—0960–0103. When a 

beneficiary or claimant reports farm 

work from outside the United States, 

SSA documents this work on Form 

SSA–7163A–F4. Specifically, SSA uses 

the form to determine if we should 

apply foreign work deductions to the 

recipient’s title II benefits. We collect 

the information either annually or every 

other year, depending on the 

respondent’s country of residence. 

Respondents are Social Security 

recipients engaged in farming activities 

outside the United States. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of completion Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–7163A–F4 ............................................................................................... 1,000 1 60 1,000 

2. International Direct Deposit—31 

CFR 210—0960–0686. SSA’s 

International Direct Deposit (IDD) 

Program allows beneficiaries living 

abroad to receive their payments via 

direct deposit to an account at a 

financial institution outside the United 

States. SSA uses Form SSA–1199- 

(Country) to enroll title II beneficiaries 

residing abroad in IDD, and to obtain 

the direct deposit information for 

foreign accounts. Routing account 

number information varies slightly for 

each foreign country, so we use a 

variation of the Treasury Department’s 

Form SF–1199A per country. The 

respondents are Social Security 

beneficiaries residing abroad who want 

SSA to deposit their benefits payments 

directly to a foreign financial 

institution. 

Type of Request: Revision of an OMBapproved information collection. 


srobinson on DSK4SPTVN1PROD with 
Federal Register / Vol. 78, No. 5 / Tuesday, January 8, 2013 / Notices 1297 

Modality of completion Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–1199-(Country) ........................................................................................ 5,000 1 5 417 

3. Certificate of Incapacity—5 CFR 

890.302(d)—0960–0739. Rules 

governing the Federal Employee Health 

Benefits (FEHB) plan require a 

physician to verify the disability of 

Federal employees’ children ages 26 and 

over for such children to retain health 

benefits under their employed parents’ 

plans. The physician must verify that 

the adult child’s disability: (1) Pre-dates 

the child’s 26th birthday; (2) is very 

serious; and (3) will continue for at least 

one year. Physicians use Form SSA– 

604, Certificate of Incapacity, to 

document this information. The 

respondents are physicians of SSA 

employees’ children ages 26 or over 

who are seeking to retain health benefits 

under their parent’s FEHB plan 

coverage. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of completion Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–604 .......................................................................................................... 50 1 45 38 

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 

February 7, 2013. Individuals can obtain 

copies of the OMB clearance packages 

by writing to 

OR.Reports.Clearance@ssa.gov. 

1. Child Relationship Statement—20 

CFR 404.355 & 404.731—0960–0116. To 

help determine a child’s entitlement to 

Social Security benefits, SSA uses 

criteria under section 216(h)(3) of the 

Social Security Act (Act), deemed child 

provision. SSA may deem a child to an 

insured individual if: (1) The insured 

individual presents SSA with 

satisfactory evidence of parenthood and 

was living with or contributing to the 

child’s support at certain specified 

times; or (2) the insured individual (a) 

acknowledged the child in writing; (b) 

was court decreed as the child’s parent; 

or (c) was court ordered to support the 

child. To obtain this information, SSA 

uses Form SSA–2519, Child 

Relationship Statement. Respondents 

are people with knowledge of the 

relationship between certain individuals 

filing for Social Security benefits and 

their alleged biological children. 

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–2519 ........................................................................................................ 50,000 1 15 12,500 

2. Pain Report Child—20 CFR 

404.1512 and 416.912—0960–0540. 

Before SSA can make a disability 

determination for a child, we require 

evidence from Supplemental Security 

Income (SSI) applicants or claimants to 

prove their disability. Form SSA–3371– 

BK provides disability interviewers, and 

SSI applicants or claimants in self-help 

situations, with a convenient way to 

record information on claimants’ pain or 

other symptoms. The State disability 

determination services adjudicators and 

administrative law judges then use the 

information from Form SSA–3371–BK 

to assess the effects of symptoms on 

function for purposes of determining 

disability under the Act. The 

respondents are applicants for, or 

claimants of, SSI payments. 

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–3371 ........................................................................................................ 250,000 1 15 62,500 

3. Internet Request for Replacement of 

Forms SSA–1099/SSA—1042S—20 CFR 

401.—0960–0583. Title II beneficiaries 

use Forms SSA–1099 and SSA–1042S, 

Social Security Benefit Statement, to 

determine if their Social Security 

benefits are taxable, and the amount 

they need to report to the Internal 

Revenue Service. In cases where the 

original forms are unavailable (e.g., lost, 

stolen, mutilated), an individual may 

use SSA’s Internet request form or 

automated telephone application to 

request a replacement SSA–1099 and 

SSA–1042S. SSA uses the information 

from the Internet and automated 

telephone requests to verify the identity 

of the requestor and to provide 


srobinson on DSK4SPTVN1PROD with 
1298 Federal Register / Vol. 78, No. 5 / Tuesday, January 8, 2013 / Notices 

replacement copies of the forms. The 

Internet and automated telephone 

options reduce requests to the National 

800 Number Network (N8NN) and visits 

to local Social Security field offices 

(FO). The respondents are title II 

beneficiaries who wish to request a 

replacement SSA–1099 or SSA–1042S 

via the Internet or telephone. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of completion Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

Internet Requestors ......................................................................................... 145,390 1 10 24,232

Automated Telephone Requestors .................................................................. 190,413 1 2 6,347 

Live calls to the N8NN ..................................................................................... 566,667 1 3 28,333 

Live calls to local FOs ..................................................................................... 783,333 1 3 39,167 

Other (program service centers) ...................................................................... 90,000 1 3 4,500 

Totals ........................................................................................................ 1,775,803 ........................ ........................ 102,579 

4. Important Information About Your 

Appeal, Waiver Rights, and Repayment 

Options—20 CFR 404.502–521—0960– 

0779. When SSA accidentally overpays 

beneficiaries, the agency informs them 

of the following rights: (1) The right to 

reconsideration of the overpayment 

determination; (2) the right to request a 

waiver of recovery and the automatic 

scheduling of a personal conference if 

SSA cannot approve a request for 

waiver; and (3) the availability of a 

different rate of withholding when SSA 

proposes the full withholding rate. SSA 

uses Form SSA–3105, Important 

Information About Your Appeal, Waiver 

Rights, and Repayment Options, to 

explain these rights to overpaid 

individuals and allow them to notify 

SSA of their decision(s) regarding these 

rights. The respondents are overpaid 

claimants requesting a waiver of 

recovery for the overpayment, 

reconsideration of the fact of the 

overpayment, or a lesser rate of 

withholding of the overpayment. 

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–3105 ........................................................................................................ 80,000 1 15 20,000 

Dated: January 3, 2013. 

Faye Lipsky, 

Reports Clearance Director, Social Security 

Administration. 

[FR Doc. 2013–00162 Filed 1–7–13; 8:45 am] 

BILLING CODE 4191–02–P 

DEPARTMENT OF STATE 

[Public Notice 8142] 

Advisory Committee on Historical 

Diplomatic Documentation; Notice of 

Meeting 

Summary: The Advisory Committee 

on Historical Diplomatic Documentation 

will meet on February 25–26, June 3–4, 

September 9–10, and December 9–10, 

2013, at the Department of State, 2201 

‘‘C’’ Street NW., Washington, DC. The 

Committee’s sessions in the afternoon of 

Monday, February 25, 2013; in the 

morning of Tuesday, February 26, 2013; 

in the afternoon of Monday, June 3, 

2013; in the morning of Tuesday, June 

4, 2013; in the afternoon of Monday, 

September 9, 2013; in the morning of 

Tuesday, September 10, 2013; in the 

afternoon of Monday, December 9, 2013; 

and in the morning of Tuesday, 

December 10, 2013, will be closed in 

accordance with Section 10(d) of the 

Federal Advisory Committee Act (Pub. 

L. 92–463). The agenda calls for 

discussions of agency declassification 

decisions concerning the Foreign 

Relations series and other 

declassification issues. These are 

matters properly classified and not 

subject to public disclosure under 5 

U.S.C. 552b(c)(1) and the public interest 

requires that such activities be withheld 

from disclosure. 

The Committee will meet in open 

session from 11:00 a.m. until 12:00 noon 

in Conference Room 1205 of the 

Department of State, 2201 ‘‘C’’ Street 

NW., Washington, DC, on the following 

dates: Monday, February 25, 2013; 

Monday, June 3, 2013; Monday, 

September 9, 2013; and Monday, 

December 9, 2013, to discuss 

unclassified matters concerning 

declassification and transfer of 

Department of State records to the 

National Archives and Records 

Administration and the status of the 

Foreign Relations series. 

Prior notification and a valid 

government-issued photo ID (such as 

driver’s license, passport, U.S. 

government or military ID) are required 

for entrance into the building. Members 

of the public planning to attend 

meetings on the following dates, please 

RSVP as follows: for February 25, please 

notify Colby Prevost, Office of the 

Historian (202–663–1147) no later than 

February 21, 2013; for June 3, please 

notify Colby Prevost, Office of the 

Historian (202–663–1147) no later than 

May 30, 2013; for September 9, please 

notify Colby Prevost, Office of the 

Historian (202–663–1147) no later than 

September 5, 2013and for December 9, 

please notify Colby Prevost, Office of 

the Historian (202–663–1147) no later 

than December 5, 2013. When 

responding, please provide date of birth, 

valid government-issued photo 

identification number and type (such as 

driver’s license number/state, passport 

number/country, or U.S. government ID 

number/agency or military ID number/ 

branch), and relevant telephone 

numbers. If you cannot provide one of 

the specified forms of ID, please consult 

with Colby Prevost for acceptable 

alternative forms of picture 

identification. 

In addition, any requests for 

reasonable accommodation should be 

made no later than the following dates: 

February 19 for the February 25–26 

meeting; May 28 for the June 3–4 


srobinson on DSK4SPTVN1PROD with