2642 Federal Register / Vol. 74, No. 10 / Thursday, January 15, 2009 / Notices 

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 (Pub. L.) 104–13, the 

Paperwork Reduction Act of 1995, 

effective October 1, 1995. This notice 

includes a revision to an OMB-approved 

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 the burden on respondents, 

including the use of automated 

collection techniques or other forms of 

information technology. Mail, e-mail, or 

fax your comments and 

recommendations on the information 

collection(s) to the OMB Desk Officer 

and the SSA Reports Clearance Officer 

to the addresses or fax numbers listed 

below. 

(OMB), Office of Management and 

Budget, Attn: Desk Officer for SSA, 

Fax: 202–395–6974, E-mail address: 

OIRA_Submission@omb.eop.gov. 

(SSA), Social Security Administration, 

DCBFM, Attn: Reports Clearance 

Officer, 1332 Annex Building, 6401 

Security Blvd., Baltimore, MD 21235, 

Fax: 410–965–6400, E-mail address: 

OPLM.RCO@ssa.gov. 

I. The information collection below is 

pending at SSA. SSA will submit it to 

OMB within 60 days from the date of 

this notice. Therefore, your comments 

would be most helpful if you submit 

them to SSA within 60 days from the 

date of this publication. Individuals can 

obtain copies of the collection 

instrument by calling the SSA Reports 

Clearance Officer at 410–965–3758 or by 

writing to the e-mail address listed 

above. 

1. Physician’s/Medical Officer’s 

Statement of Patient’s Capability to 

Manage Benefits—20 CFR 404.2015 and 

416.615—0960–0024. SSA uses the 

information collected on Form SSA–787 

to determine an individual’s capability 

to handle his or her own benefits. This 

information assists SSA in determining 

the need for a representative payee. The 

respondents are physicians of the 

beneficiaries’ or medical officers of the 

institution in which the recipients 

reside. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 24,000. 

Frequency of Response: 1. 

Average Burden per Response: 15 

minutes. 

Estimated Annual Burden: 6,000 

hours. 

2. Letter to Employer Requesting Wage 

Information—20 CFR 404.726—0960– 

0138. SSA uses Form SSA–L4201 to 

collect information from employers to 

establish and/or verify wage information 

for Supplemental Security Income (SSI) 

claimants and recipients. SSA also uses 

the information to determine eligibility 

and proper payment for SSI. The 

respondents are employers of applicants 

for and recipients of SSI payments. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 133,000. 

Frequency of Response: 1. 

Average Burden per Response: 30 

minutes. 

Estimated Annual Burden: 66,500 

hours. 

3. Statement of Living Arrangements, 

In-Kind Support and Maintenance—20 

CFR 416.1130–416.1148—0960–0174. 

SSA uses Form SSA–8006–F4 to 

establish in-kind support and 

maintenance for SSI applicants and 

recipients. A recipient’s need is the 

basis for determining SSI payments. 

Need is measured, in part, by the 

amount of income an individual 

receives. Income includes in-kind 

support and maintenance in the form of 

food and shelter provided by other 

persons. Form SSA–8006–F4 collects 

information to ensure that recipients are 

eligible to receive SSI payments and to 

determine the correct amount of 

payments due. The information permits 

SSA Administrative Law Judges to 

determine the income value of in-kind 

support and maintenance received by 

SSI applicants and recipients. The 

respondents are individuals who apply 

for SSI payments, or complete an SSI 

eligibility redetermination. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 173,380. 

Frequency of Response: 1. 

Average Burden per Response: 7 

minutes. 

Estimated Annual Burden: 20,228 

hours. 

4. Supplemental Security Income 

(SSI) Claim Information Notice—20 CFR 

416.210—0960–0324. SSA uses Form 

SSA–L8050–U3 to collect information 

on whether an SSI recipient is using all 

sources of potential income for his or 

her own support. SSI supplements other 

income an individual has available. 

Respondents are SSI applicants or 

recipients who may be eligible for 

benefits from public or private 

programs. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 7,500. 

Frequency of Response: 1. 

Average Burden per Response: 10 

minutes. 

Estimated Annual Burden: 1,250 

hours. 

5. Permanent Residence Under Color 

of the Law (PRUCOL)—20 CFR 416.1615 

and 416.1618—0960–0451. As 

discussed in SSA regulations at 20 CFR 

416.1415 and 416.1618, a PRUCOL alien 

must present evidence of his/her alien 

status at application and periodically 

thereafter as part of the eligibility 

determination process for SSI. SSA 

verifies the validity of the evidence of 

PRUCOL for grandfathered nonqualified 

aliens with the Department of 

Homeland Security (DHS). Based on the 

DHS response, SSA will determine 

whether the individual is PRUCOL. 

Without this information, SSA is unable 

to determine whether the individual is 

eligible for SSI payments. The 

respondents are individuals who have 

alien status and live in the United Sates. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 1,300. 

Frequency of Response: 1. 

Average Burden per Response: 5 

minutes. 

Estimated Annual Burden: 108 hours. 

6. QuickStart Automated Enrollment 

System—31 CFR 210—0960–0564. The 

financial institutions (FIs) collect Direct 

Deposit (DD)/Electronic Funds Transfer 

(EFT) information from their depositors 

who are enrolling for the first time, or 

who are changing DD/EFT information. 

Information needed to enroll under 

QuickStart is included in the 

Department of Treasury’s Green Book, 

which is available online. The 

Department of Treasury’s Green Book 

provides the data elements the recipient 

completes in order to enroll in direct 

deposit. The recipient submits the DD/ 

EFT information electronically; 

therefore, it is not an SSA-prescribed 

form used to send information to 

Government agencies. SSA collects this 

information to facilitate electronic 

payment of funds. The respondents are 

Social Security, SSI recipients, and their 

FIs. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 3,950,000. 

Frequency of Response: 1. 

Average Burden per Response: 3 

minutes. 

Estimated Annual Burden: 197,500 

hours. 

7. Certification of Low Birth Weight 

for SSI Eligibility of Funds You 

Provided to Another and Statement of 


jlentini on PROD1PC65 with NOTICES
Federal Register / Vol. 74, No. 10 / Thursday, January 15, 2009 / Notices 2643 

Funds You Received—20 CFR 416.931, 

416.926a(m), (7) and (8) and 416.924— 

0960–0720. Form SSA–3830 assists 

hospitals and claimants who file on 

behalf of children in providing local 

field offices (FOs) and Disability 

Determination Services (DDSs) with 

medical information for determining 

disability of low birth weight infants. 

FOs use the forms as protective filing 

statements, and the medical information 

for making presumptive disability 

findings, which allow expedited 

payment to eligible claimants. DDSs use 

the medical information to determine 

disability and the most appropriate 

continuing disability review diaries. 

The respondents are hospitals that have 

information identifying low birth weight 

babies and medical conditions those 

babies may have. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 24,000. 

Frequency of Response: 1. 

Average Burden per Response: 15 

minutes. 

Estimated Annual Burden: 6,000 

hours. 

II. SSA has submitted the information 

collections listed below to OMB for 

clearance. Your comments on the 

information collections would be most 

useful if received by OMB and SSA 

within 30 days from the date of this 

publication. You can obtain a copy of 

the OMB clearance packages by calling 

the SSA Reports Clearance Officer at 

410–965–3758, or by writing to the 

above listed address. 

1. Application for Mother’s or Father’s 

Insurance Benefits—20 CFR 404.339– 

404.342, 20 CFR 404.601–404.603— 

0960–0003. The Social Security Act 

provides for the payment of monthly 

benefits to the widow or widower of an 

insured individual if the surviving 

spouse is caring for the deceased 

worker’s child who is entitled to Social 

Security benefits. SSA uses the 

information collected on Form SSA–5– 

F6 to entitle an individual to their 

mother’s or father’s insurance benefits 

under the Old Age, Survivors and 

Disability Insurance (OASDI) program. 

SSA published this information 

collection in the 60-day Federal 

Register Notice on October 27, 2008 at 

FR 63761 as an extension of an OMBapproved information collection. Since 

then SSA made revisions and has 

changed the type of request to a revision 

to an OMB-approved information 

collection. 

Type of Request: Revision of an OMBapproved information collection. 

Collection method Number of 

respondents 

Estimated 

completion 

time 

(minutes) 

Burden hours 

MCS ............................................................................................................................................. 26,045 15 6,511 

MCS/Signature Proxy .................................................................................................................. 26,044 14 6,077 

Paper ........................................................................................................................................... 1,611 15 403 

Totals .................................................................................................................................... 53,700 ........................ 12,991 

2. Supplement to Claim of Person 

Outside the United States—20 CFR 

404.460, 404.463, 422.505(b), 42 CFR 

407.27(c)—0960–0051. SSA uses the 

information it collects on Form SSA–21 

to determine continuing entitlement to 

Social Security benefits and the proper 

benefit amounts of alien beneficiaries 

living outside the United States. SSA 

also uses the information to determine 

whether benefits are subject to 

withholding tax. The respondents are 

individuals entitled to Social Security 

benefits who are, will be, or have been 

residing outside the United States. 

Type of Request: Revision of an OMB 

approved information collection. 

Number of Respondents: 35,000. 

Frequency of Response: 1. 

Average Burden per Response: 10 

minutes. 

Estimated Annual Burden: 5,833 

hours. 

3. Coverage of Employees of State and 

Local Governments—20 CFR 404, 

Subpart M—0960–0425. The Code of 

Federal Regulations at 20 CFR 404, 

Subpart M prescribes the rules for states 

submitting reports of deposits and 

related recordkeeping to SSA. States 

(and interstate instrumentalities) are 

required to provide wage and depositrelated contribution information for pre1987 periods. The respondents are state 

and local governments or interstate 

instrumentalities. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 52. 

Frequency of Response: 1. 

Average Burden per Response: 1 hour. 

Estimated Annual Burden: 52 hours. 

4. Marital Relationship 

Questionnaire—20 CFR 416.1826— 

0960–0460. SSA collects information on 

Form SSA–4178 to determine, for SSI 

purposes, whether unrelated 

individuals of the opposite sex who live 

together are holding themselves out to 

the public as husband and wife. SSA 

needs this information to determine 

whether we are making correct 

payments to SSI couples and 

individuals. The respondents are 

applicants for and recipients of SSI 

payments. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 5,100. 

Frequency of Response: 1. 

Average Burden per Response: 5 

minutes. 

Estimated Annual Burden: 425 hours. 

5. Medical Report on Child with 

Allegation of Human Immunodeficiency 

Virus Infection—20 CFR 416.993–416– 

994—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 (HIV) 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. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 59,100. 

Frequency of Response: 1. 

Average Burden per Response: 10 

minutes. 

Estimated Annual Burden: 9,850. 

6. Public Information Campaign— 

0960–0544. Periodically, SSA sends 

various public information materials, 

including public service 

announcements, news releases, and 

educational tapes, to public 

broadcasting systems so they can inform 

the public about various programs and 

activities conducted by SSA. SSA will 

frequently send follow-up business 

reply cards for these public information 

materials to obtain suggestions for 

improving them. The respondents are 

media sources who have received public 

information campaign materials (e.g., 

broadcast television and radio media 

sources). 


jlentini on PROD1PC65 with NOTICES
2644 Federal Register / Vol. 74, No. 10 / Thursday, January 15, 2009 / Notices 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 6,000. 

Frequency of Response: 2. 

Average Burden per Response: 1 

minute. 

Estimated Annual Burden: 200 hours. 

7. Application to Collect a Fee for 

Payee Services—416.640.640(a), 

416.1103(f)—0960–0719. SSA uses 

information it collects on Form SSA– 

445 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 a fee-for-service organizational 

representative payee. SSA published 

this information collection in the 60-day 

Federal Register Notice on September 

17, 2008 at FR 53919 as an extension of 

an OMB-approved information 

collection. Since then SSA made 

revisions and has changed the type of 

request to a revision to an OMBapproved information collection. 

Type of Request: Revision to an OMBapproved information collection. 

Number of Respondents: 100. 

Frequency of Response: 1. 

Average Burden per Response: 10 

minutes. 

Estimated Annual Burden: 17 hours. 

Dated: January 8, 2009. 

John Biles, 

Reports Clearance Officer, Center for Reports 

Clearance, Social Security Administration. 

[FR Doc. E9–596 Filed 1–14–09; 8:45 am] 

BILLING CODE 4191–02–P 

DEPARTMENT OF STATE 

[Public Notice 6481] 

Culturally Significant Objects Imported 

for Exhibition Determinations: 

‘‘Genghis Khan’’ 

SUMMARY: 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 of October 19, 1999, as 

amended, and Delegation of Authority 

No. 257 of April 15, 2003 [68 FR 19875], 

I hereby determine that the objects in 

the exhibition: ‘‘Genghis Khan,’’ 

imported from abroad for temporary 

exhibition within the United States, are 

of cultural significance. The objects are 

imported pursuant to a loan agreement 

with the foreign owner or custodian. I 

also determine that the exhibition or 

display of the exhibit objects at the 

Houston Museum of National Science, 

Houston, TX, from on or about February 

28, 2009, until on or about September 7, 

2009; Denver Museum of Nature and 

Science, Denver, CO, from on or about 

October 10, 2009, until on or about 

February 7, 2010, and at possible 

additional exhibitions or venues yet to 

be determined, is in the national 

interest. Public Notice of these 

Determinations is ordered to be 

published in the Federal Register. 

FOR FURTHER INFORMATION CONTACT: For 

further information, including a list of 

the exhibit objects, contact Julie 

Simpson, Attorney-Adviser, Office of 

the Legal Adviser, U.S. Department of 

State (telephone: (202–453–8050)). The 

address is U.S. Department of State, SA– 

44, 301 4th Street, SW., Room 700, 

Washington, DC 20547–0001. 

Dated: January 6, 2009. 

C. Miller Crouch, 

Principal Deputy Assistant Secretary for 

Educational and Cultural Affairs, Department 

of State. 

[FR Doc. E9–657 Filed 1–14–09; 8:45 am] 

BILLING CODE 4710–05–P 

DEPARTMENT OF STATE 

[Public Notice 6482] 

Culturally Significant Objects Imported 

for Exhibition Determinations: ‘‘The El 

Peru-Waka Archaeological Project’’ 

SUMMARY: 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 of October 19, 1999, as 

amended, and Delegation of Authority 

No. 257 of April 15, 2003 [68 FR 19875], 

I hereby determine that the objects to be 

included in the exhibition ‘‘The El PeruWaka Archaeological Project,’’ imported 

from abroad for temporary exhibition 

within the United States, are of cultural 

significance. The objects are imported 

pursuant to loan agreements with the 

foreign owners or custodians. I also 

determine that the exhibition or display 

of the exhibit objects at the Kimbell Art 

Museum, Fort Worth, TX, from on or 

about July 19, 2009, until on or about 

December 6, 2009, and at possible 

additional exhibitions or venues yet to 

be determined, is in the national 

interest. Public Notice of these 

Determinations is ordered to be 

published in the Federal Register. 

FOR FURTHER INFORMATION CONTACT: For 

further information, including a list of 

the exhibit objects, contact Carol B. 

Epstein, Attorney-Adviser, Office of the 

Legal Adviser, U.S. Department of State 

(telephone: 202/453–8048). The address 

is U.S. Department of State, SA–44, 301 

4th Street, SW., Room 700, Washington, 

DC 20547–0001. 

Dated: January 6, 2009. 

C. Miller Crouch, 

Principal Deputy Assistant Secretary for 

Educational and Cultural Affairs, Department 

of State. 

[FR Doc. E9–660 Filed 1–14–09; 8:45 am] 

BILLING CODE 4710–05–P 

DEPARTMENT OF STATE 

[Public Notice 6483] 

Culturally Significant Objects Imported 

for Exhibition Determinations: ‘‘Wine, 

Worship and Sacrifice: The Golden 

Graves of Ancient Vani’’ 

AGENCY: Department of State. 

ACTION: Notice, correction. 

SUMMARY: On October 11, 2007, notice 

was published on page 57987 of the 

Federal Register (volume 72, number 

196) of determinations made by the 

Department of State pertaining to the 

exhibition ‘‘Wine, Worship and 

Sacrifice: The Golden Graves of Ancient 

Vani.’’ On December 27, 2007, the 

referenced notice was corrected on page 

73415 of the Federal Register (volume 

72, number 247) as to two additional 

objects to be included in the exhibition. 

The referenced notice is again corrected 

here as to two 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 of October 19, 1999, as 

amended, and Delegation of Authority 

No. 257 of April 15, 2003 [68 FR 19875], 

I hereby determine that the objects to be 

included in the exhibition ‘‘Wine, 

Worship and Sacrifice: The Golden 

Graves of Ancient Vani,’’ imported from 

abroad for temporary exhibition within 

the United States, are of cultural 

significance. The objects are imported 

pursuant to loan agreements with the 

foreign owners or custodians. I also 


jlentini on PROD1PC65 with NOTICES