Federal Register / Vol. 89, No. 177 / Thursday, September 12, 2024 / Notices 74351 

25 17 CFR 200.30–3(a)(12). 

For the Commission, by the Division of 

Trading and Markets, pursuant to delegated 

authority.25

Sherry R. Haywood, 

Assistant Secretary. 

[FR Doc. 2024–20638 Filed 9–11–24; 8:45 am] 

BILLING CODE 8011–01–P 

SOCIAL SECURITY ADMINISTRATION 

[Docket No: SSA–2024–0031] 

Agency Information Collection 

Activities: Proposed 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 

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. You 

may submit your comments online 

through https://www.reginfo.gov/public/ 

do/PRAMain, referencing Docket ID 

Number [SSA–2024–0031]. 

(SSA) Social Security Administration, 

OLCA, Attn: Reports Clearance Director, 

Mail Stop 3253 Altmeyer, 6401 Security 

Blvd., Baltimore, MD 21235, Fax: 833– 

410–1631. Email address: 

OR.Reports.Clearance@ssa.gov. Or you 

may submit your comments online 

through https://www.reginfo.gov/public/ 

do/PRAmain by clicking on Currently 

under Review—Open for Public 

Comments and choosing to click on one 

of SSA’s published items. 

Please reference Docket ID Number 

[SSA–2024–0031] in your submitted 

response. 

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 November 12, 2024. 

Individuals can obtain copies of the 

collection instruments by writing to the 

above email address. 

1. Work Activity Report— 

Employee—20 CFR 404.1520(b), 

404.1571–404.1576, 404.1584–404.1593, 

and 416.971–404.976—0960–0059. 

Section 223(d) of the Social Security Act 

(Act) defines the term ‘‘disability’’ as the 

inability to engage in any substantial 

gainful activity (SGA) by reason of any 

medically determinable physical or 

mental impairment which one expects 

to result in death, or which lasted or is 

expected to last for a continuous period 

of not less than 12 months. Social 

Security Disability (SSDI) and 

Supplemental Security Income (SSI) 

applicants or recipients can become 

entitled to payments based on their 

inability to engage in SGA because of a 

physical or mental condition. SSA uses 

Form SSA–821–BK to obtain work 

information during the initial claims 

process; the continuing disability 

review process; post-adjudicative work 

issue actions; and for Supplemental 

Security Income (SSI) claims involving 

work issues. SSA reviews and evaluates 

the data to determine if the applicant or 

recipient meets the disability 

requirements of the law. The 

respondents are applicants or recipients 

of Title II Social Security Disability, and 

Title XVI SSI applicants. 

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) 

Average 

theoretical 

hourly cost 

amount 

(dollars) * 

Average 

wait time 

in field office 

or for 

teleservice 

centers 

(minutes) ** 

Total annual 

opportunity 

cost 

(dollars) *** 

SSA–821–BK In Office 64,330 1 30 32,165 * $13.30 ** 24 *** 770,030 

SSA–821–BK Phone .... 128,660 1 30 64,330 * 13.30 ** 19 *** 1,397,458 

SSA–821–BK Returned 

Via Mail ..................... 192,990 1 40 128,660 * 13.30 ........................ *** 1,710,380 

SSA–821–BK Electronic ......................... 25,320 1 45 18,990 * 13.30 ........................ *** 252,567 

Totals .................... 411,300 ........................ ........................ 244,145 ........................ ........................ *** 4,130,435 

* We based this figure on the average of both DI payments based on SSA’s current FY 2024 data (https://mwww.ba.ssa.gov/legislation/ 

2024FactSheet.pdf), and U.S. worker’s hourly wages, as reported by Bureau of Labor Statistics data (https://www.bls.gov/oes/current/oes_

nat.htm). 

** We based this figure on averaging the average FY 2024 wait times for field offices, based on SSA’s current management information data. 

*** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; 

rather, these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual 

charge to respondents to complete the application. 

2. Claimant’s Medication—20 CFR 

404.1512, 416.912—0960–0289. To 

receive Old Age Survivors and 

Disability Insurance (OASDI) and SSI 

payments, the relevant State Disability 

Determination Service (DDS) or field 

office (FO) must first adjudicate 

claimants’ applications. If the DDS or 

FO denies an initial application, the 

claimants may request for 

reconsideration of the initial denial. At 

that time, the claimants may submit 

addition documentation to further 

justify their claims. If the DDS denies 

the claim at the reconsideration level, 

the claimant may then request a hearing 

before a judge. Before the hearing, SSA 

allows the claimant to submit additional 

evidence to support their claim. In 

addition, since judges must obtain 

information from the claimant to update 

and complete their medical record and 

to verify the accuracy of the 

information, SSA also sends the 

claimant Form HA–4632, Claimant’s 

Medications, to request information 

from the claimant regarding the current 

medications they use. This information 

helps the judge overseeing the case to 

fully investigate: (1) the claimant’s 


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74352 Federal Register / Vol. 89, No. 177 / Thursday, September 12, 2024 / Notices 

medical treatment and (2) the effects of 

the medications on the claimant’s 

medical impairments and functional 

capacity. The judge makes the 

completed form a part of the 

documentary evidence of record, 

placing it in the official record of the 

proceedings as an exhibit. The 

respondents are applicants (or their 

representatives) for OASDI or SSI 

payments who request a hearing to 

contest an agency denial of their claim. 

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) 

Average 

theoretical 

hourly cost 

amount 

(dollars) * 

Average 

wait time 

in field 

office 

(minutes) ** 

Total annual 

opportunity 

cost 

(dollars) *** 

HA–4632—PDF/paper 

version ...................... 51,000 1 20 17,000 * $13.30 ** 21 *** $463,505 

Electronic Records Express Submissions ... 249,000 1 20 83,000 * 31.48 ........................ *** 2,612,840 

Totals .................... 300,000 ........................ ........................ 100,000 ........................ ........................ *** 3,076,345 

* We based this figure on the average DI payments based on SSA’s current data (https://www.ssa.gov/legislation/2024FactSheet.pdf) and on 

the average U.S. worker’s hourly wages, as reported by Bureau of Labor Statistics data (https://www.bls.gov/oes/current/oes_nat.htm). 

** We based this figure on averaging both the average FY 2024 wait times for field offices and teleservice centers, based on SSA’s current 

management information data. 

*** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; 

rather, these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual 

charge to respondents to complete the application. 

3. Questionnaire for Children 

Claiming SSI Benefits—20 CFR 

416.912(a)—0960–0499. Sections 1614 

and 1631 of the Act allows SSA to 

determine the eligibility of an 

applicant’s claim for SSI payments. 

Parents or legal guardians seeking to 

obtain or retain SSI eligibility for their 

children use Form SSA–3881–BK to 

provide SSA with the addresses of nonmedical sources such as schools, 

counselors, agencies, organizations, or 

therapists who would have information 

about a child’s functioning. SSA uses 

this information to help determine a 

child’s claim or continuing eligibility 

for SSI. The respondents are the parents, 

guardians, or other caretakers of: (1) 

applicants who appeal SSI childhood 

disability decisions; or (2) recipients 

undergoing a continuing disability 

review. 

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) 

Average 

theoretical 

hourly cost 

amount 

(dollars) * 

Average 

wait time 

in field 

office 

(minutes) ** 

Total annual 

opportunity 

cost 

(dollars) *** 

SSA–3881–BK (Paper 

Version) .................... 98,307 1 30 49,154 * $31.48 ** 24 *** $2,785,256 

SSA–3881–BK (Intranet 

Version) .................... 52,936 1 30 26,468 * 31.48 ** 21 *** 1,416,474 

Totals .................... 151,243 ........................ ........................ 75,622 ........................ ........................ *** 4,201,730 

* We based this figure on average U.S. worker’s hourly wages, as reported by Bureau of Labor Statistics data (https://www.bls.gov/oes/current/ 

oes_nat.htm). 

** We based this figure on the average FY 2024 wait times for field offices and hearings office, as well as by averaging both the average FY 

2024 wait times for field offices (24 minutes) and teleservice centers (19 minutes), based on SSA’s current management information data. 

*** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; 

rather, these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual 

charge to respondents to complete the application. 

4. Requests for Self-Employment 

Information, Employee Information, and 

Employer Information—20 CFR 

422.120—0960–0508. When SSA cannot 

identify Form W–2 wage data for an 

individual, we place the data in an 

earnings suspense file and contact the 

individual (and certain instances the 

employer) to obtain the correct 

information. If the respondent furnishes 

the name and Social Security Number 

(SSN) information that agrees with 

SSA’s records, or provides information 

that resolves the discrepancy, SSA adds 

the reported earnings to the 

respondent’s Social Security record. We 

use Forms SSA–L2765, SSA–L3365, and 

SSA–L4002 for this purpose. The 

respondents are self-employed 

individuals and employees whose name 

and SSN information do not agree with 

their employer’s and SSA’s records. 

Type of Request: Revision of an OMB 

approved information collection. 

Modality of completion Number of 

respondents 

Frequency 

of response 

Average 

burden per 

response 

(minutes) 

Estimated 

total annual 

burden 

(hours) 

Average 

theoretical 

hourly cost 

amount 

(dollars) ** 

Total annual 

opportunity 

cost 

(dollars) *** 

SSA–L2765 * ................ 1 1 10 1 ** $31.48 ........................ *** $31.48 

SSA–L3365 * ................ 1 1 10 1 ** 31.48 ........................ *** 31.48 

SSA–L4002 * ................ 1 1 10 1 ** 31.48 ........................ *** 31.48 


ddrumheller on DSK120RN23PROD with NOTICES1
Federal Register / Vol. 89, No. 177 / Thursday, September 12, 2024 / Notices 74353 

Modality of completion Number of 

respondents 

Frequency 

of response 

Average 

burden per 

response 

(minutes) 

Estimated 

total annual 

burden 

(hours) 

Average 

theoretical 

hourly cost 

amount 

(dollars) ** 

Total annual 

opportunity 

cost 

(dollars) *** 

Totals .................... 1 ........................ ........................ 3 ........................ ........................ *** 94 

* SSA does not currently send out any of these collections; however, we included 1 hour burden placeholders for each collection, in the event 

we need to send these notices out in the near future. 

** We based this figure on average U.S. worker’s hourly wages, as reported by Bureau of Labor Statistics data (https://www.bls.gov/oes/current/oes_nat.htm). 

*** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; 

rather, these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual 

charge to respondents to complete the application. 

5. Function Report—Child (Birth to 

1st Birthday, Age 1 to 3rd Birthday, Age 

3 to 6th Birthday, Age 6 to 12th 

Birthday, Age 12 to 18th Birthday)—20 

CFR 416.912 and 416.924a(a)(2)—0960– 

0542. As part of SSA’s disability 

determination process, we use Forms 

SSA–3375–BK through SSA–3379–BK 

to request information from a child’s 

parent or guardian for children applying 

for SSI. The five different versions of the 

form contain questions about the child’s 

day-to-day functioning appropriate to a 

particular age group; thus, respondents 

use only one version of the form for 

each child. The adjudicative team 

(disability examiners and medical or 

psychological consultants) of State 

disability determination services offices 

collect the information on the 

appropriate version of this form (in 

conjunction with medical and other 

evidence) to form a complete picture of 

the children’s ability to function and 

their impairment-related limitations. 

The adjudicative team uses the 

completed profile to determine: (1) if 

each child’s impairment(s) results in 

marked and severe functional 

limitations; and (2) whether each child 

is disabled. The respondents are parents 

and guardians of child applicants for 

SSI. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of completion 

(paper & Intranet 

versions) 

Number of 

respondents 

Frequency 

of response 

Average 

burden per 

response 

(minutes) 

Estimated 

total annual 

burden 

(hours) 

Average 

theoretical 

hourly cost 

amount 

(dollars) * 

Average 

wait time 

in field office 

or teleservice 

center 

(minutes) ** 

Total annual 

opportunity 

cost 

(dollars) *** 

SSA–3375 .................... 26,864 1 20 8,955 * $31.48 ** 21 *** $577,878 

SSA–3376 .................... 53,347 1 20 17,782 * 31.48 ** 21 *** 1,147,540 

SSA–3377 .................... 108,745 1 20 36,248 * 31.48 ** 21 *** 2,339,247 

SSA–3378 .................... 193,800 1 20 64,600 * 31.48 ** 21 *** 4,168,896 

SSA–3379 .................... 142,006 1 20 47,335 * 31.48 ** 21 *** 3,054,725 

Totals .................... 524,762 ........................ ........................ 174,921 ........................ ........................ *** 11,288,286 

* We based this figure on the average U.S. worker’s hourly wages, as reported by Bureau of Labor Statistics data (https://www.bls.gov/oes/current/oes_nat.htm). 

** We based this figure on the average FY 2024 wait times for field offices (24 minutes) and Teleservice Centers (19 minutes), based on SSA’s 

current management information data. 

*** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; 

rather, these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual 

charge to respondents to complete the application. 

6. Representative Payee Report of 

Benefits and Dedicated Account—20 

CFR 416.546, 416.635, 416.640, and 

416.665—0960–0576. SSA requires 

representative payees (RPs) to manage 

the dedicated account in accordance 

with our rules, including using the 

funds for permitted expenditures and 

reporting on the use of funds. When the 

SSI recipient requires a dedicated 

account, SSA notifies the RP to inform 

them of the need to open the dedicated 

account and of the rules for managing a 

dedicated account, including the 

required submission of a written report 

accounting for the use of money paid to 

Social Security or Supplemental 

Security Income (SSI) recipients into the 

dedicated account. SSA allows the 

respondent to submit their own written 

report, or use Form SSA–6233, which 

simplifies the process for the 

respondents. SSA uses Form SSA–6233 

to: (1) ensure the RPs use the payments 

for the recipient’s current maintenance 

and personal needs and properly 

conserves the remainder; and (2) 

confirm the funds paid into the 

dedicated account are spent and saved 

in compliance with the law. 

Respondents are RPs for SSI and Social 

Security recipients. 

Type of Request: Revision of an OMBapproved information collection. 


ddrumheller on DSK120RN23PROD with NOTICES1
74354 Federal Register / Vol. 89, No. 177 / Thursday, September 12, 2024 / Notices 

Modality of completion Number of 

respondents 

Frequency 

of response 

Average 

burden per 

response 

(minutes) 

Estimated 

total annual 

burden 

(hours) 

Average 

theoretical 

hourly cost 

amount 

(dollars) * 

Average 

wait time 

in field 

office or 

for 

teleservice 

centers 

(minutes) ** 

Total annual 

opportunity 

cost 

(dollars) *** 

SSA–6233 .................... 68,000 1 20 22,667 * $31.48 ** 21 *** $1,462,781 

* We based this figure on average U.S. worker’s hourly wages, as reported by Bureau of Labor Statistics data (https://www.bls.gov/oes/current/ 

oes_nat.htm#00-0000). 

** We based this figure on averaging both the average FY 2024 wait times for field offices (24 minutes) and teleservice centers (19 minutes), 

based on SSA’s current management information data. 

*** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; 

rather, these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual 

charge to respondents to complete the application. 

7. Sheltered Workshop Wage 

Reporting—0960–0771. Sheltered 

workshops are private non-profit 

organizations or institutions that 

implement a recognized program of 

rehabilitation for handicapped workers 

or provide such workers with 

remunerative employment or other 

occupational rehabilitating activity of an 

educational or therapeutic nature. 

Sheltered workshops perform a service 

for their clients by reporting monthly 

wages directly to SSA. SSA uses the 

information these workshops provide to 

verify and post monthly wages to SSI 

recipient’s records. Most workshops 

report monthly wage totals to their local 

SSA office, so we can adjust the client’s 

SSI payment amount in a timely manner 

and prevent overpayments. Sheltered 

workshops are motivated to report 

wages voluntarily as a service to their 

clients. Respondents are sheltered 

workshops that report monthly wages 

for services performed in the workshop. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of completion Number of 

respondents 

Frequency 

of response 

Total 

number of 

responses 

Average 

burden per 

response 

(minutes) 

Estimated 

total annual 

burden 

(hours) 

Average 

theoretical 

hourly cost 

amount 

(dollars) * 

Average 

wait time 

in field 

office 

(minutes) ** 

Total annual 

opportunity 

cost 

(dollars) *** 

Sheltered Workshop 

Wage Reporting ........... 244 12 2,928 15 732 * $23.28 ** 24 *** $19,322 

* We based this on average Rehabilitation Counselors hourly salary, as reported in Bureau of Labor Statistics data (https://www.bls.gov/oes/ 

current/oes211015.htm) 

** We based this figure on the average FY 2024 wait times for field offices, based on SSA’s current management information data.

*** This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; 

rather, these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual 

charge to respondents to complete the application. 

Dated: September 9, 2024. 

Naomi Sipple, 

Reports Clearance Officer, Social Security 

Administration. 

[FR Doc. 2024–20713 Filed 9–11–24; 8:45 am] 

BILLING CODE 4191–02–P 

DEPARTMENT OF STATE 

[Public Notice: 12534] 

Notice of Determinations; Additional 

Culturally Significant Object Being 

Imported for Exhibition— 

Determinations: ‘‘Tamara de Lempicka’’ 

Exhibition 

SUMMARY: On July 10, 2024, notice was 

published in the Federal Register of 

determinations pertaining to certain 

objects to be included in an exhibition 

entitled ‘‘Tamara de Lempicka.’’ Notice 

is hereby given of the following 

determinations: I hereby determine that 

a certain additional object being 

imported from abroad pursuant to an 

agreement with its foreign owner or 

custodian for temporary display in the 

aforesaid exhibition at the Fine Arts 

Museums of San Francisco, de Young 

Museum, San Francisco, California; the 

Museum of Fine Arts, Houston, in 

Houston, Texas; and at possible 

additional exhibitions or venues yet to 

be determined, is of cultural 

significance, and, further, that its 

temporary exhibition or display within 

the United States as aforementioned is 

in the national interest. I have ordered 

that Public Notice of these 

determinations be published in the 

Federal Register. 

FOR FURTHER INFORMATION CONTACT: 

Reed Liriano, Program Coordinator, 

Office of the Legal Adviser, U.S. 

Department of State (telephone: 202– 

632–6471; email: section2459@

state.gov). The mailing address is U.S. 

Department of State, L/PD, 2200 C 

Street, NW (SA–5), Suite 5H03, 

Washington, DC 20522–0505. 

SUPPLEMENTARY INFORMATION: The 

foregoing determinations were made 

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 Delegation of 

Authority No. 523 of December 22, 

2021. The notice of determinations 

published on July 10, 2024, appears at 

89 FR 56784. 

Nicole L. Elkon, 

Deputy Assistant Secretary for Professional 

and Cultural Exchanges, Bureau of 

Educational and Cultural Affairs, Department 

of State. 

[FR Doc. 2024–20647 Filed 9–11–24; 8:45 am] 

BILLING CODE 4710–05–P 


ddrumheller on DSK120RN23PROD with NOTICES1