Federal Register / Vol. 86, No. 141 / Tuesday, July 27, 2021 / Notices 40221 

OMB Control Number: 3245–0018. 

Title: Disaster Home Loan 

Application. 

Description of Respondents: Disaster 

Survivors. 

Estimated Annual Responses: 34,273. 

Estimated Annual Hour Burden: 

42,841. 

Curtis Rich, 

Management Analyst. 

[FR Doc. 2021–15937 Filed 7–26–21; 8:45 am] 

BILLING CODE 8026–03–P 

SOCIAL SECURITY ADMINISTRATION 

[Docket No: SSA–2021–0022] 

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, 

and an 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, 

Comments: https://www.reginfo.gov/ 

public/do/PRAMain. Submit your 

comments online referencing Docket ID 

Number [SSA–2021–0022]. 

(SSA): Social Security 

Administration, OLCA, Attn: Reports 

Clearance Director, 3100 West High 

Rise, 6401 Security Blvd., Baltimore, 

MD 21235, Fax: 410–966–2830, Email 

address: OR.Reports.Clearance@ssa.gov. 

Or you may submit your comments 

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

public/do/PRAMain, referencing Docket 

ID Number [SSA–2021–0022]. 

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 September 27, 2021. 

Individuals can obtain copies of the 

collection instruments by writing to the 

above email address. 

1. Application for Parent’s Insurance 

Benefits—20 CFR 404.370, 404.371, 

404.373, 404.374 & 404.601–404.603— 

0960–0012. Section 202(h) of the Social 

Security Act (Act) establishes the 

conditions of eligibility a claimant must 

meet to receive monthly benefits as a 

parent of a deceased worker who was 

contributing at least one-half of the 

parent’s support at the time of the 

worker’s death or when the worker 

became disabled. SSA uses information 

from Form SSA–7–F6, Application for 

Parent’s Insurance Benefits, to 

determine if the claimant meets the 

eligibility and application criteria. The 

respondents are applicants filing for 

Parent’s Insurance Benefits. 

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–7–F6 (Paper) ....... 4 1 15 1 * $27.07 0 *** $27 

Interview (MCS) ........... 325 1 15 81 * 27.07 ** 21 *** 5,279 

Totals .................... 329 ........................ ........................ 82 ........................ ........................ *** 5,306 

* 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#00-0000). 

** We based this figure on averaging both the average FY 2021 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. 

2. Employment Relationship 

Questionnaire—20 CFR 404.1007— 

0960–0040. When SSA needs 

information to determine a worker’s 

employment status to maintain a 

worker’s earning records, the agency 

uses Form SSA–7160, Employment 

Relationship Questionnaire, to 

determine the existence of an employeremployee relationship. We use the 

information to develop the employment 

relationship; specifically, to determine 

whether a beneficiary is self-employed 

or an employee. The respondents are 

individuals, households, businesses, 

and state or local governments seeking 

to establish their status as employees, 

and their alleged employers. 

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–7160 .................... 45 1 25 19 * $22.14 ** 24 *** $820 

* We based this figure on the average U.S. worker’s hourly wages of $27.07 (https://www.bls.gov/oes/current/oes_nat.htm); the median hourly 

wage of $21.10 for public sector Information and Records Clerks (https://www.bls.gov/oes/current/oes434199.htm); and the median hourly wage 

of $18.25 for State and Local government Information and Records Clerks (https://www.bls.gov/oes/current/oes434199.htm), as reported by Bureau of Labor Statistics data. We used the average of these three wages to calculate the combined Average Theoretical Hourly Wage of $22.14. 

** We based this figure on the average FY 2021 wait times for field offices, based on SSA’s current management information data.


lotter on DSK11XQN23PROD with NOTICES1
40222 Federal Register / Vol. 86, No. 141 / Tuesday, July 27, 2021 / Notices 

*** 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. Statement of Self-Employment 

Income—20 CFR 404.101, 404.110, & 

404.1096(a)(d)—0960–0046. To qualify 

for insured status, and collect Social 

Security benefits, self-employed 

individuals must demonstrate they 

earned the minimum amount of selfemployment income (SEI) in a current 

year. SSA uses Form SSA–766, 

Statement of Self-Employment Income, 

to collect the information we need to 

determine if the individual earned at 

least the minimum amount of SEI 

needed for one or more quarters of 

coverage in the current year. Based on 

the information we obtain, we may 

credit additional quarters of coverage to 

give the individual insured status and 

expedite benefit payments. Respondents 

are self-employed individuals 

potentially eligible for Social Security 

benefits. 

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) * 

Total annual 

opportunity 

cost 

(dollars) ** 

≤SSA–766 ................................................ 910 1 5 76 * $27.07 ** $2,057 

* 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). 

** 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. Substitution of Party Upon Death of 

Claimant—20 CFR 404.957(c)(4) & 

416.1457(c)(4)—0960–0288. A judge 

may dismiss a request for a hearing on 

a pending claim of a deceased 

individual for Social Security benefits 

or Supplemental Security Income (SSI) 

payments. Individuals who believe the 

dismissal may adversely affect them 

may complete Form HA–539, Notice 

Regarding Substitution of Party Upon 

Death of Claimant, which allows them 

to request to become a substitute party 

for the deceased claimant. The judge 

and the hearing office support staff use 

the information from the HA–539 to: (1) 

Maintain a written record of request; (2) 

establish the relationship of the 

requester to the deceased claimant; (3) 

determine the substituted individual’s 

wishes regarding an oral hearing or 

decision on the record; and (4) admit 

the data into the claimant’s official 

record as an exhibit. The respondents 

are individuals requesting to be 

substitute parties for a deceased 

claimant. 

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) * 

Total annual 

opportunity 

cost 

(dollars) ** 

HA–539 .................................................... 4,000 1 5 333 * $10.95 ** $3,646 

* We based this figure on the average DI payments based on SSA’s current FY 2021 data (https://www.ssa.gov/legislation/2021FactSheet.pdf). 

** 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. Claimant Statement about Loan of 

Food or Shelter; Statement about Food 

or Shelter Provided to Another—20 CFR 

416.1130–416.1148—0960–0529. SSA 

bases an SSI claimant’s or recipient’s 

eligibility on need, as measured by the 

amount of income an individual 

receives. Per our calculations, income 

includes other people providing in-kind 

support and maintenance in the form of 

food and shelter to SSI applicants or 

recipients. SSA uses Forms SSA–5062, 

Claimant Statement about Loan of Food 

or Shelter, and SSA–L5063, Statement 

about Food or Shelter Provided to 

Another, to obtain statements about 

food or shelter provided to SSI 

claimants or recipients. SSA uses this 

information to determine whether the 

food or shelter are bona fide loans or 

income for SSI purposes. This 

determination may affect claimants’ or 

recipients’ eligibility for SSI as well as 

the amounts of their SSI payments. The 

respondents are claimants and 

recipients for SSI payments, and 

individuals who provide loans of food 

or shelter to them. 

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–5062—Paper 

Version ..................... 29,026 1 10 4,838 * $19.01 ** 24 *** $312,676 

SSA–L5063—Paper 

Version ..................... 29,026 1 10 4,838 * 19.01 ** 24 *** 312,676 


lotter on DSK11XQN23PROD with NOTICES1
Federal Register / Vol. 86, No. 141 / Tuesday, July 27, 2021 / Notices 40223 

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–5062—SSI Claims 

System ...................... 29,026 1 10 4,838 * 19.01 ** 24 *** 312,676 

SSA–L5063—SSI 

Claims System ......... 29,026 1 10 4,838 * 19.01 ** 24 *** 312,676 

Totals .................... 116,104 ........................ ........................ 19,352 ........................ ........................ *** 1,250,704 

* We based this figure on averaging both the average DI payments based on SSA’s current FY 2021 data (https://www.ssa.gov/legislation/ 

2021FactSheet.pdf), and 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 2021 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. 

6. Application for Circuit Court Law— 

20 CFR 404.985 & 416.1485—0960– 

0581. Individuals claiming that an 

acquiescence ruling (AR) would change 

SSA’s prior determination or decision 

must submit a written readjudication 

request with specific information. SSA 

reviews the information in the requests 

to determine if the issues stated in the 

AR pertain to the claimant’s case, and 

if the claimant is entitled to 

readjudication. If readjudication is 

appropriate, SSA considers the issues 

the AR covers. Any new determination 

or decision is subject to administrative 

or judicial review as specified in the 

regulations, and the claimants must 

provide information to request 

readjudication. The respondents are 

claimants for Social Security benefits 

and SSI payments, who request a 

readjudication of their claim based on 

an AR notice. 

Type of Request: Extension 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) ** 

AR-based Readjudication Requests ........ 10,000 1 17 2,833 * $10.95 ** $31,021 

* We based this figure on the average DI payments based on SSA’s current FY 2021 data (https://www.ssa.gov/legislation/2021FactSheet.pdf). 

** 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. Social Security Administration 

Health IT Partner Program 

Assessment—Participating Facilities 

and Available Content Form—20 CFR 

404.1614 & 416.1014—0960–0798. The 

Health Information Technology for 

Economic and Clinical Health (HITECH) 

Act promotes the adoption and 

meaningful use of health information 

technology (IT), particularly in the 

context of working with government 

agencies. Similarly, section 3004 of the 

Public Health Service Act requires 

health care providers or health 

insurance issuers with government 

contracts to implement, acquire, or 

upgrade their health IT systems and 

products to meet adopted standards and 

implementation specifications. To 

support expansion of SSA’s health IT 

initiative as defined under HITECH, 

SSA developed Form SSA–680, the 

Health IT Partner Program 

Assessment—Participating Facilities 

and Available Content Form. The SSA– 

680 allows healthcare providers to 

provide the information SSA needs to 

determine their ability to exchange 

health information with the agency 

electronically. We evaluate potential 

partners (i.e., healthcare providers and 

organizations) on: (1) The accessibility 

of health information they possess; and 

(2) the content value of their electronic 

health records’ systems for our 

disability adjudication processes. SSA 

reviews the completeness of 

organizations’ SSA–680 responses as 

one part of our careful analysis of their 

readiness to enter into a health IT 

partnership with us. The respondents 

are healthcare providers and 

organizations exchanging information 

with the agency. 

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) * 

Total annual 

opportunity 

cost 

(dollars) ** 

SSA–680 .................................................. 30 1 300 150 * $41.30 ** $6,195 

* We based this figures on average Healthcare Practitioners and Technical Occupations, as reported by Bureau of Labor Statistics data. 

(https://www.bls.gov/oes/current/oes_nat.htm#00-0000). 

** 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. 


lotter on DSK11XQN23PROD with NOTICES1
40224 Federal Register / Vol. 86, No. 141 / Tuesday, July 27, 2021 / Notices 

8. Authorization for the Social 

Security Administration to Obtain 

Personal Information—20 CFR 404.704, 

404.820 404.823, 404.1926, 416.203, & 

418.3001—0960–0801. SSA uses Form 

SSA–8510, Authorization for the Social 

Security Administration to Obtain 

Personal Information, to contact a 

public or private custodian of records 

on behalf of an applicant or recipient of 

an SSA program to request evidence 

information or proofs, which may 

support a benefit application or 

payment continuation. SSA also uses 

this form to obtain evidence or proofs to 

determine the claimant’s payment 

amount. We ask for information such as 

the following: 

• Age requirements (e.g., birth 

certificate, court documents) 

• Insured status (e.g., earnings, 

employer verification) 

• Marriage or divorce 

• Pension offsets 

• Wages verification 

• Annuities 

• Dividends, royalties, or other 

similar payments 

• Property information 

• Benefit verification from a State 

agency or third party 

• Immigration status (rare instances) 

• Income verification from public 

agencies or private individuals 

• Unemployment benefits 

• Insurance policies 

• Alimony or Child Support 

payments. 

If the custodian of the records 

requires a signed authorization from the 

individual(s) whose information SSA 

requests, SSA may provide the 

custodian with a copy of the SSA–8510. 

Once the respondent completes the 

SSA–8510, either using the paper form 

or using the Personal Information 

Authorization Intranet version, SSA 

uses the form as the authorization to 

obtain personal information regarding 

the respondent from third parties until 

the authorizing person (respondent) 

withdraws their claim or revokes the 

permission of its use. The collection is 

voluntary; however, failure to verify the 

individuals’ eligibility can prevent SSA 

from making an accurate and timely 

decision for their benefits. The 

respondents are individuals who may 

file for, or currently receive, Social 

Security benefits, SSI payments, or 

Medicare Part D subsidies. 

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) *** 

Paper SSA-8510 for 

general evidence purposes ........................ 8,226 1 5 686 * $19.01 ** 24 *** $75,584 

Personal Information 

Authorization Intranet 

Screens for general 

evidence purposes 

(SSI Claims System) 192,235 1 5 16,020 * 19.01 ** 24 *** 1,766,295 

Totals .................... 200,461 ........................ ........................ 16,706 ........................ ........................ *** 1,841,879 

* We based this figure on averaging both the average DI payments based on SSA’s current FY 2021 data (https://www.ssa.gov/legislation/ 

2021FactSheet.pdf), and 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 2021 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: July 21, 2021. 

Naomi Sipple, 

Reports Clearance Officer, Social Security 

Administration. 

[FR Doc. 2021–15898 Filed 7–26–21; 8:45 am] 

BILLING CODE 4191–02–P 

DEPARTMENT OF STATE 

[Public Notice: 11472] 

Notice of Determinations; Culturally 

Significant Objects Being Imported for 

Exhibition—Determinations: ‘‘Niki de 

Saint Phalle in the 1960s’’ Exhibition 

SUMMARY: Notice is hereby given of the 

following determinations: I hereby 

determine that certain objects being 

imported from abroad pursuant to 

agreements with their foreign owners or 

custodians for temporary display in the 

exhibition ‘‘Niki de Saint Phalle in the 

1960s’’ at The Menil Collection, 

Houston, Texas, the Museum of 

Contemporary Art San Diego, La Jolla, 

California, and at possible additional 

exhibitions or venues yet to be 

determined, are of cultural significance, 

and, further, that their 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: Chi 

D. Tran, Program Administrator, 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, 

and Delegation of Authority No. 236–3 

of August 28, 2000. 

Matthew R. Lussenhop, 

Acting Assistant Secretary, Bureau of 

Educational and Cultural Affairs, Department 

of State. 

[FR Doc. 2021–15959 Filed 7–26–21; 8:45 am] 

BILLING CODE 4710–05–P 


lotter on DSK11XQN23PROD with NOTICES1