15808 Federal Register / Vol. 74, No. 65 / Tuesday, April 7, 2009 / Notices 

19 17 CFR 200.30–3(a)(12). 

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 e-mail to rulecomments@sec.gov. Please include File 

Number SR–FINRA–2009–013 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–FINRA–2009–013. This file 

number should be included on the 

subject line if e-mail 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 inspection and copying 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. 

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 the File 

Number SR–FINRA–2009–013 and 

should be submitted on or before April 

28, 2009. 

For the Commission, by the Division of 

Trading and Markets, pursuant to delegated 

authority.19

Florence E. Harmon, 

Deputy Secretary. 

[FR Doc. E9–7773 Filed 4–6–09; 8:45 am] 

BILLING CODE 8010–01–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 (Pub. L.) 104–13, the 

Paperwork Reduction Act of 1995, 

effective October 1, 1995. This notice 

includes revisions and extensions of 

OMB-approved Information Collections 

and a new 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. To be sure we consider your 

comments, we must receive them no 

later than June 8, 2009. 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. Statement of Claimant or Other 

Person—20 CFR 404.702 & 416.570— 

0960–0045 

SSA uses the SSA–795 to obtain 

information from claimants or other 

persons having knowledge of facts in 

connection with claims for 

Supplemental Security Income (SSI) or 

Social Security benefits when there is 

no standard form to collect the needed 

information. SSA then uses the 

information to process claims for 

benefits or for ongoing issues related to 

the above programs. The respondents 

are applicants/recipients of SSI or 

Social Security benefits, or others who 

are in a position to provide information 

pertinent to the claim(s). 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 305,500. 

Frequency of Response: 1. 

Average Burden per Response: 15 

minutes. 

Estimated Annual Burden: 76,375 

hours. 

2. Statement of Employer—20 CFR 

404.801–404.803—0960–0030 

SSA uses Form SSA–7011–F4 to 

substantiate allegations of wages paid to 

workers when those wages do not 

appear in SSA’s records of earnings and 

the worker does not have proof of those 

earnings. SSA uses the information 

received on this form to process claims 

for Social Security benefits and to 

resolve discrepancies in the individual’s 

Social Security earnings record. We 

only send Form SSA–7011–F4 to 

employers if we deem it necessary; in 

many situations, we are able to locate 

the earnings information within our 

records without having to contact the 

employer. The respondents are 

employers who can verify wage 

allegations made by wage earners. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 925,000. 

Frequency of Response: 1. 

Average Burden per Response: 20 

minutes. 

Estimated Annual Burden: 308,333 

hours. 

3. Statement of Self-Employment 

Income—20 CFR 404.101, 404.110, 

404.1096(a)–(d)—0960–0046 

SSA collects the information on Form 

SSA–766 to expedite the payment of 

benefits to an individual who is selfemployed and who is establishing 

insured status. The form elicits the 

information necessary to determine if 

the individual will have the minimum 

amount of self-employment income for 

quarters of coverage. Respondents are 

Federal Register / Vol. 74, No. 65 / Tuesday, April 7, 2009 / Notices 15809 

self-employed individuals who may be 

eligible for Social Security benefits. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 2,500. 

Frequency of Response: 1. 

Average Burden per Response: 5 

minutes. 

Estimated Annual Burden: 208 hours. 

4. Certification by Religious Group—20 

CFR 404.1075—0960–0093 

SSA uses Form SSA–1458 to 

determine whether a religious group 

meets the qualifications set out in 

Section 1402(g) of the Internal Revenue 

Code, which exempts members of 

certain religious groups and sects from 

payment of Self-Employment 

Contribution Act taxes. The respondents 

are spokespersons for religious groups 

or sects. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 180. 

Frequency of Response: 1. 

Average Burden per Response: 15 

minutes. 

Estimated Annual Burden: 45 hours. 

5. Claim for Amounts Due in the Case 

of a Deceased Beneficiary—20 CFR 

404.503(b)—0960–0101 

A completed SSA–1724 ensures 

proper payment of an underpayment 

due a deceased beneficiary. It is 

required when there is insufficient 

information in the file to identify the 

person(s) entitled to the underpayment, 

or the person’s address. Generally, SSA 

collects the information when a 

surviving widow(er) is not already 

entitled to a monthly benefit on the 

same earnings record, or is not filing for 

a lump-sum death payment as a livingwith spouse. The respondents are 

applicants for underpayments owed to 

deceased beneficiaries. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 450,000. 

Frequency of Response: 1. 

Average Burden per Response: 10 

minutes. 

Estimated Annual Burden: 75,000 

hours. 

6. Instructions for Completion of 

Federal Assistance Application—0960– 

0184 

SSA uses information from Form 

SSA–BK–96 in selecting grant proposals 

for funding based on their technical 

merits. This information assists the 

agency in evaluating the soundness of 

the design of the proposed activities, the 

possibility of obtaining productive 

results, the adequacy of resources to 

conduct the activities, and the 

relationship to other similar activities of 

the respondents. The respondents are 

State and local governments, statedesignated protection and advocacy 

groups, colleges and universities, and 

profit and nonprofit private 

organizations. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 400. 

Frequency of Response: 2. 

Average Burden per Response: 14 

hours. 

Estimated Annual Burden: 11,200 

hours. 

7. Request for Deceased Individual’s 

Social Security Record—20 CFR 

402.130—0960–0665 

SSA uses the Form SSA–711 to 

process requests from the public for a 

microprint of the SS–5, Application for 

Social Security Card, for a deceased 

individual. Respondents are members of 

the public who are requesting deceased 

individuals’ Social Security records. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 50,000. 

Frequency of Response: 1. 

Average Burden per Response: 7 

minutes. 

Estimated Annual Burden: 5,833 

hours. 

8. Electronic Records Express—0960– 

0753 

Electronic Records Express (ERE) is a 

Web-based SSA program that allows 

medical providers to submit disability 

claimant data electronically to SSA. 

Both medical providers and other third 

parties with connections to disability 

applicants/recipients can use this 

system. This information collection 

request (ICR) includes the registration 

process for becoming a certified ERE 

user. We are expanding this ICR to 

include increased functionality for ERE 

by giving medical providers the ability 

to submit invoices electronically. The 

respondents are medical providers who 

evaluate or treat disability claimants/ 

recipients and are ERE users. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 17,689. 

Frequency of Response: 1. 

Average Burden per Response: 10 

minutes. 

Estimated Annual Burden: 2,948 

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 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 7, 2009. You can 

obtain a copy of the OMB clearance 

packages by calling the SSA Reports 

Officer at 410–965–3758 or by writing to 

the above listed address. 

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 SSI or Social Security 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 where 

the beneficiaries reside. 

Note: This is a correction notice. SSA 

published this information collection as an 

extension on January 15, 2009 at 74 FR 2642. 

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. 

Number of Respondents: 24,000. 

Frequency of Response: 1. 

Average Burden per Response: 15 

minutes. 

Estimated Annual Burden: 6,000 

hours. 

2. QuickStart Automated Enrollment 

System—31 CFR 210—0960–0564 

Financial institutions (FI) 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. The Department of 

Treasury’s Green Book, which is 

available online, includes information 

needed to enroll under QuickStart. The 

Green Book provides the data elements 

the recipient completes to enroll in 

direct deposit. Since the FI submits the 

DD/EFT information electronically, it is 

not using a SSA-prescribed form for 

sending information to Government 

agencies. SSA collects this information 

to facilitate electronic payments of 

funds. The respondents are Social 

Security and 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. 

15810 Federal Register / Vol. 74, No. 65 / Tuesday, April 7, 2009 / Notices 

3. Certification of Low Birth Weight— 

20 CFR 416.931, 416.926a(m), and 

416.924—0960–0720 

Hospitals and claimants use Form 

SSA–3380 to provide medical 

information to local field offices (FO) 

and the Disability Determination 

Services (DDS) on behalf of infants with 

low birth weight. FOs use the form as 

a protective filing statement and the 

medical information to make 

presumptive disability findings, which 

allow expedited payment to eligible 

claimants. DDSs use the medical 

information to determine disability and 

continuing disability. The respondents 

are hospitals that have information 

identifying low birth weight babies and 

their medical conditions. 

Note: This is a correction notice. SSA 

published this information collection as an 

extension on January 15, 2009 at 74 FR 2643. 

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. 

Number of Respondents: 24,000. 

Frequency of Response: 1. 

Average Burden per Response: 15 

minutes. 

Estimated Annual Burden: 6,000 

hours. 

4. Letter to Employer Requesting 

Information about Wages Earned by 

Beneficiary—20 CFR 416.703 & 

404.801—0960–0034 

When SSA has incomplete or 

questionable wage data, SSA uses Form 

SSA–L725 to verify a beneficiary’s 

wages. SSA uses the information on the 

SSA–L725 to calculate the correct 

benefits payable and to maintain an 

accurate record of earnings for the 

beneficiary. Respondents are small 

business employers. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 150,000. 

Frequency of Response: 1. 

Average Burden per Response: 40 

minutes. 

Estimated Annual Burden: 100,000 

hours. 

5. Statement of Care and Responsibility 

for Beneficiary—20 CFR 404.2020, 

404.2025, 408.620, 408.625, 416.620, 

416.625—0960–0109 

SSA uses information from Form 

SSA–788 to verify statements of concern 

made by payee applicants and to 

identify other potential payees. SSA is 

concerned with selecting the most 

qualified representative payee who will 

use Social Security benefits in the 

beneficiary’s best interest. SSA 

considers factors such as the payee 

applicant’s capacity to perform payee 

duties, awareness of the beneficiary’s 

situation and needs, demonstration of 

past and current concern for the 

beneficiary’s well-being. If the payee 

applicant does not have custody of the 

beneficiary, SSA will obtain information 

from the custodian to evaluate against 

information provided by the applicant. 

Respondents are individuals who have 

custody of the beneficiary in cases 

where someone else has filed to be the 

beneficiary’s representative payee. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 130,000. 

Frequency of Response: 1. 

Average Burden per Response: 10 

minutes. 

Estimated Annual Burden: 21,667 

hours. 

6. Third Party Liability Information 

Statement—42 CFR 433.136–433.139— 

0960–0323 

Medicaid state agencies must identify 

third party insurers liable for medical 

care or services for Medicaid 

beneficiaries; this reduces Medicaid 

costs. 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. 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. 

Under these agreements, SSA obtains 

third party liability information using 

Form SSA–8019 and provides that 

information to the Medicaid state 

agencies. 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. The respondents are SSI 

claimants and recipients. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 62,834. 

Frequency of Response: 1. 

Average Burden per Response: 5 

minutes. 

Estimated Annual Burden: 5,236 

hours. 

7. Application for Special Age 72-orOver Monthly Payments—20 CFR 

404.380–404.384—0960–0096 

Form SSA–19–F6 collects the 

information needed to determine 

whether a claimant can qualify for 

Special Age 72 payments. SSA will 

evaluate eligibility requirements using 

the data collected on this form. The 

respondents are individuals who 

reached age 72 before 1972. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 10. 

Frequency of Response: 1. 

Average Burden per Response: 10 

minutes. 

Estimated Annual Burden: 2 hours. 

Dated: March 30, 2009. 

John Biles, 

Reports Clearance Officer, Center for Reports 

Clearance, Social Security Administration. 

[FR Doc. E9–7453 Filed 4–6–09; 8:45 am] 

BILLING CODE 4191–02–P 

DEPARTMENT OF STATE 

[Public Notice 6568] 

Bureau of Educational and Cultural 

Affairs (ECA) Request for Grant 

Proposals: Youth Leadership 

Programs: Sub-Saharan Africa 

Announcement Type: New grant. 

Funding Opportunity Number: ECA/ 

PE/C/PY–09–42. 

Catalog of Federal Domestic 

Assistance Number: 00.000. 

Application Deadline: May 21, 2009. 

Executive Summary: The Office of 

Citizen Exchanges, Youth Programs 

Division, of the Bureau of Educational 

and Cultural Affairs announces an open 

competition for two Youth Leadership 

Program grants for countries of SubSaharan Africa, one for 40 participants 

from four Anglophone countries 

(Nigeria, Tanzania, Kenya and South 

Africa), and one for 60 participants from 

six Francophone countries (Burkina 

Faso, Chad, Cote D’Ivoire, Mali, 

Mauritania, and Niger). [Note: Target 

countries may be subject to change.] 

Public and private non-profit 

organizations meeting the provisions 

described in Internal Revenue Code 

section 26 USC 501(c)(3) may submit 

proposals to conduct a minimum of two 

U.S.-based three-week exchange projects 

for combinations of two Anglophone 

countries, or a minimum of three U.S.- 

based three-week exchange projects for 

combinations of two Francophone 

countries. The project activities will 

focus on civic education, leadership, 

diversity, and community activism, 

which will prepare participants to 

conduct follow up activities at home 

that serve a community need.