Federal Register / Vol. 86, No. 168 / Thursday, September 2, 2021 / Notices 49403 

54 15 U.S.C. 78s(b)(3)(C). 

55 17 CFR 200.30–3(a)(57) and (58). 

any other comments they may wish to 

submit about the proposed rule change. 

Interested persons are invited to 

submit written data, views, and 

arguments concerning the proposed rule 

change, including whether the proposal 

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 email to rule-comments@

sec.gov. Please include File No. SR– 

PEARL–2021–32 on the subject line. 

Paper Comments 

• Send paper comments in triplicate 

to Secretary, Securities and Exchange 

Commission, 100 F Street NE, 

Washington, DC 20549–1090. 

All submissions should refer to File 

Number SR–PEARL–2021–32. This file 

number should be included on the 

subject line if email 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 website (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 website viewing and 

printing in the Commission’s Public 

Reference Room, 100 F Street NE, 

Washington, DC 20549, on official 

business days between the hours of 

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

filing also will be available for 

inspection and copying at the principal 

office of the Exchange. All comments 

received will be posted without change. 

Persons submitting comments are 

cautioned that we do not redact or edit 

personal identifying information from 

comment submissions. You should 

submit only information that you wish 

to make available publicly. All 

submissions should refer to File 

Number SR–PEARL–2021–32 and 

should be submitted on or before 

September 23, 2021. Rebuttal comments 

should be submitted by October 7, 2021. 

VI. Conclusion 

It is therefore ordered, pursuant to 

Section 19(b)(3)(C) of the Act,54 that File 

Number SR–PEARL–2021–32 be and 

hereby is, temporarily suspended. In 

addition, the Commission is instituting 

proceedings to determine whether the 

proposed rule change should be 

approved or disapproved. 

For the Commission, by the Division of 

Trading and Markets, pursuant to delegated 

authority.55

Vanessa A. Countryman, 

Secretary. 

[FR Doc. 2021–18948 Filed 9–1–21; 8:45 am] 

BILLING CODE 8011–01–P 

SOCIAL SECURITY ADMINISTRATION 

[Docket No: SSA–2021–0034] 

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 an 

extension and revisions of OMBapproved 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–2021–0034]. 

(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–2021–0034]. 

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 November 1, 2021. 

Individuals can obtain copies of the 

collection instrument by writing to the 

above email address. 

Registration for Appointed 

Representative Services and Direct 

Payment—0960–0732. SSA uses Form 

SSA–1699 to register appointed 

representatives of claimants before SSA 

who: 

• Want to register for direct payment 

of fees; 

• Registered for direct payment of 

fees prior to 10/31/09, but need to 

update their information; 

• Registered as appointed 

representatives on or after 10/31/09, but 

need to update their information; or 

• Received a notice from SSA 

instructing them to complete this form. 

By registering these individuals, SSA: 

(1) Authenticates and authorizes them 

to do business with us; (2) allows them 

to access our records for the claimants 

they represent; (3) facilitates direct 

payment of authorized fees to appointed 

representatives; and, (4) collects the 

information we need to meet Internal 

Revenue Service (IRS) requirements to 

issue specific IRS forms if we pay an 

appointed representative in excess of a 

specific amount ($600). The 

respondents are appointed 

representatives who want to use Form 

SSA–1699 for any of the purposes cited 

in this Notice. 

Type of Request: Revision of an OMBapproved information collection. 


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49404 Federal Register / Vol. 86, No. 168 / Thursday, September 2, 2021 / 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) * 

Total annual 

opportunity cost 

(dollars) ** 

SSA–1699 ......................................................................... 10,382 1 20 3,461 * $71.59 ** $247,773 

* We based this figure on average Lawyers hourly wages, as reported by Bureau of Labor Statistics data (www.bls.gov/oes/current/oes231011.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. 

II. SSA submitted the information 

collections below to OMB for clearance. 

Your comments regarding these 

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 

October 4, 2021. Individuals can obtain 

copies of these OMB clearance packages 

by writing to OR.Reports.Clearance@

ssa.gov. 

1. Request for Withdrawal of 

Application—20 CFR 404.640—0960– 

0015. Form SSA–521, Request for 

Withdrawal of Application, allows 

claimants to specify which application 

they want to withdraw and the reason 

for the withdrawal. Form SSA–521 is 

our preferred instrument for a 

withdrawal request; however, any 

written request for withdrawal signed 

by the claimant or a proper applicant on 

the claimant’s behalf will suffice. 

Individuals who wish to withdraw their 

applications for benefits complete Form 

SSA–521, or sign the completed form 

for each request to withdraw. SSA uses 

the information from Form SSA–521 to 

process the request for withdrawal. The 

respondents are applicants for 

Retirement, Survivors, Disability, and 

Health 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) * 

Total annual 

opportunity cost 

(dollars) ** 

Respondents applying for or receiving Retirement, Survivors, or Health Insurance benefits .............................. 60,753 1 5 5,063 * $10.95 ** $55,440 

Respondents applying for or receiving Disability benefits 14,374 1 5 1,198 * 10.95 ** 13,118 

Totals ......................................................................... 75,127 ........................ ........................ 6,261 ........................ ** 68,558 

* 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. 

2. Statement of Employer—20 CFR 

404.801–404.803—0960–0030. When 

workers report they were paid wages but 

cannot provide proof of those earnings, 

and the wages do not appear in SSA’s 

records of earnings, SSA uses Form 

SSA–7011–F4, Statement of Employer, 

to document the alleged wages. 

Specifically, the agency uses the form to 

resolve discrepancies in the individual’s 

Social Security earnings record and to 

process claims for Social Security 

benefits. We only send Form SSA– 

7011–F4 to employers if we are unable 

able to locate the earnings information 

within our own records. The 

respondents are employers who can 

verify wage allegations made by wage 

earners. 

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–7011–F4 ........................................................................... 500 1 30 250 * $27.07 ** $6,768 

* 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. 

3. Request for Workers’ 

Compensation/Public Disability Benefit 

Information—20 CFR 404.408(e)—0960– 

0098. Individuals who received both 

Social Security disability payments and 

Worker’s Compensation/Public 

Disability Benefits (WC/PDB) must 

notify SSA about their WC/PDB, so that 

the agency can reduce the claimants’ 

Social Security disability payments 

accordingly. Recipients may submit 

evidence of their WC/PDB, such as a 

copy of their award notice or benefit 

check, or have their WC/PDB provider 

complete Form SSA–1709 to document 

their WC/PDB to SSA. The respondents 

are Federal, State, and local agencies, 

insurance carriers, and public or private 

self-insured companies administering 

WC/PDB benefits to disability 

recipients. 

Type of Request: Revision of an OMBapproved information collection. 


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Federal Register / Vol. 86, No. 168 / Thursday, September 2, 2021 / Notices 49405 

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–1709 ......................................................................... 120,000 1 15 30,000 * $26.65 ** $799,500 

* We based this figure by averaging both the average Federal, State, and Local Government hourly wages (https://www.bls.gov/oes/current/naics3_999000.htm), 

and the average Insurance Claims and Policy Processing Clerks hourly wages, as reported by Bureau of Labor Statistics data (https://www.bls.gov/oes/current/ 

oes439041.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. 

4. A Statement of Care and 

Responsibility for Beneficiary—20 CFR 

404.2020, 404.2025, 408.620, 408.625, 

416.620, and 416.625—0960–0109. SSA 

uses the information from Form SSA– 

788, Statement of Care and 

Responsibility for Beneficiary, to verify 

payee applicants’ statements of concern, 

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 obtains information 

from the custodian for evaluation 

against information the applicant 

provides. 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. 

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–788 ........................................................................... 134,000 1 10 22,333 * $27.07 ** $604,554 

* We based this figure on average U.S. citizen’s hourly salary, as reported by Bureau of Labor Statistics data (https://www.bls.gov/oes/current/oes_nat.htm#00- 

00000). 

** 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. Third Party Liability Information 

Statement—42 CFR 433.136–433.139— 

0960–0323. To reduce Medicaid costs, 

Medicaid state agencies identify third 

party insurers liable for medical care or 

services for Medicaid beneficiaries. 

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 Supplemental Security Income (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–U2, Third Party 

Liability Information Statement, 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. 

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–8019–U2 (Paper) ......................... 200 1 6 20 * $19.01 ........................ *** $380 

SSI Claims System (Intranet) ............... 35,257 1 6 3,526 * 19.01 ** 21 *** 301,613 

Totals ............................................. 35,457 ........................ ........................ 3,546 ........................ ........................ *** 301,993 

* 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 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. 

6. Certificate of Election for Reduced 

Spouse’s Benefits—20 CFR 404.421— 

0960–0398. SSA cannot pay reduced 

Social Security benefits to an already 

entitled spouse unless the spouse elects 

to receive reduced benefits and is (1) at 

least age 62, but under full retirement 

age; and (2) no longer caring for a child. 

In this situation, spouses who decide to 

elect reduced benefits must file Form 

SSA–25, Certificate of Election for 

Reduced Spouse’s Benefits. SSA uses 

the information to pay qualified spouses 

who elect to receive reduced benefits. 

Respondents are entitled spouses 

seeking reduced Social Security 

benefits. 


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I I I I I I 
49406 Federal Register / Vol. 86, No. 168 / Thursday, September 2, 2021 / Notices 

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–25 ............................................................................. 30,000 1 13 6,500 * $27.07 ** $175,955 

* We based this figure on average U.S. citizen’s hourly salary, as reported by Bureau of Labor Statistics data (https://www.bls.gov/oes/current/oes_nat.htm#00- 

00000) 

** 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. Coverage of Employees of State and 

Local Governments—20 CFR part 404, 

subpart M—0960–0425. The regulations 

at 20 CFR part 404, subpart M prescribe 

the rules for States to submit reports of 

deposits and recordkeeping to SSA. SSA 

requires States (and interstate 

instrumentalities) to provide wage and 

deposit contribution information for 

pre-1987 tax years. Since not all States 

have completely satisfied their pending 

wage report and contribution liability 

with SSA for pre-1987 tax years, SSA 

needs these regulations until we collect 

all pending items with the States, and 

to allow for collection of this 

information in the future, if necessary. 

The respondents are State and local 

governments or interstate 

instrumentalities. 

Type of Request: Extension of an 

OMB-approved information collection. 

Regulation section Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Total annual 

burden 

(hours) 

Average 

theoretical 

hourly cost 

amount 

(dollars) * 

Total annual 

opportunity 

cost 

(dollars) ** 

404. 1204 (a) & (b) ................................................................... 52 1 30 26 * $28.74 ** $747 

404.1215 ................................................................................... 52 1 60 52 * 28.74 ** 1,494 

404. 1216 (a) & (b) ................................................................... 52 1 60 52 * 28.74 ** 1,494 

Totals ................................................................................. 156 ........................ ........................ 130 ........................ ** 3,735 

* We based this figure on an average of both the State Government hourly wages (https://www.bls.gov/oes/current/naics4_999200.htm), and the average Local 

Government hourly wages, as reported by Bureau of Labor Statistics data (https://www.bls.gov/oes/current/naics4_999300.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. 

8. Permanent Residence in the United 

States Under Color of Law (PRUCOL)— 

20 CFR 416.1615 and 416.1618—0960– 

0451. Under 20 CFR 416.1415 and 

416.1618, SSA requires claimants or 

recipients to submit evidence of their 

alien status when they apply for SSI 

payments, and periodically thereafter as 

part of the eligibility determination 

process for SSI. When SSA cannot 

verify evidence of alien status through 

the regular claimant interview process, 

SSA verifies the validity of the evidence 

of PRUCOL for grandfathered 

nonqualified aliens with the Department 

of Homeland Security (DHS) using the 

DHS Systemic Alien Verification for 

Entitlements (SAVE) program. SSA 

determines if the individual qualifies for 

PRUCOL status based on the SAVE 

program response. SSA does not 

maintain any forms or applications for 

respondents to use, rather, the 

regulations listed in 20 CFR 416.1615 

and 416.1618 specify the information 

respondents need to submit to SSA to 

show evidence of PRUCOL. Without 

this information, SSA is unable to 

determine whether the PRUCOL 

individual is eligible for SSI payments. 

Respondents are qualified and 

unqualified aliens who apply for SSI 

payments under PRUCOL. 

Type of Request: Extension of an 

OMB-approved information collection. 

Modality of completion Number of 

responses 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

Average 

theoretical 

hourly cost 

amount 

(dollars) * 

Total annual 

opportunity 

cost 

(dollars) ** 

Personal Interview ..................................................................... 1,049 1 5 87 * $27.07 ** $2,355 

* 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. 

9. Request for Deceased Individual’s 

Social Security Record—20 CFR 

402.130—0960–0665. The Freedom of 

Information Act (FOIA), at 5 U.S.C. 

552(a)(3) of the U.S. Code, provides 

instructions for members of the public 

to request records from Federal 

Agencies. When a member of the public 

requests an individual’s Social Security 

record under FOIA, SSA needs the 

name and address of the requestor as 

well as a description of the requested 

record to process the request. SSA uses 

the information the respondent provides 

on Form SSA–711, Request for Deceased 

Individual’s Social Security Record, or 

via an internet request through SSA’s 

electronic Freedom of Information Act 

(eFOIA) website, to: (1) Verify the wage 

earner is deceased; and (2) access the 

correct Social Security record. 


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Federal Register / Vol. 86, No. 168 / Thursday, September 2, 2021 / Notices 49407 

Respondents are members of the public 

requesting deceased individuals’ Social 

Security records. 

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) *** 

Internet Request through eFOIA ........... 49,800 1 7 5,810 * $27.07 ........................ *** $157,277 

SSA–711 (paper) .................................. 200 1 7 23 * 27.07 ** 24 *** 2,788 

Total ............................................... 50,000 ........................ ........................ 5,833 ........................ ........................ *** 160,065 

* 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 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. 

10. Representative Payment—20 CFR 

404.2011, 404.2025, 416.611, and 

416.625—0960–0679. The regulations at 

20 CFR 404.2011 and 416.611 allow 

SSA to make payments to recipients’ 

representative payees if it may cause 

substantial harm for the beneficiaries to 

receive their payments directly. The 

regulations allow beneficiaries to 

dispute a finding that substantial harm 

exists by providing SSA with evidence 

to reevaluate the determination. In 

addition, sections 20 CFR 404.2025 and 

416.625 describe the information 

representative payees must provide SSA 

about their continuing relationship and 

responsibility for the recipients, and 

explain how they use the recipients’ 

payments to verify payee performance. 

The respondents are Title II and Title 

XVI recipients, and their representative 

payees. 

Type of Request: Revision of an OMBapproved information collection. 

Regulation section 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) ** 

404.2011(a)(1); 416.611(a)(1) ................................................... 260 1 15 65 * $19.01 ** $1,236 

404.2025; 416.625 .................................................................... 3,090 1 6 309 * 19.01 ** 5,874 

Totals ................................................................................. 3,350 ........................ ........................ 374 ........................ ** 7,110 

* 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). 

** 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. 

11. Function Report—Adult—20 CFR 

404.1512 & 416.912—0960–0681. 

Individuals receiving or applying for 

Social Security disability insurance 

(SSDI) or SSI must provide medical 

evidence and other proof SSA requires 

to prove their disability. SSA staff, and, 

on SSA’s behalf, State Disability 

Determination Services’ (DDS) 

employees, collect the information via 

paper Form SSA–3373, or through an 

in-person or telephone interview for 

cases where we need information about 

a claimant’s activities and abilities to 

evaluate the claimant’s disability. We 

use the information to document how 

claimants’ disabilities affect their ability 

to function, and to determine eligibility, 

or continued eligibility, for SSI and 

SSDI claims. The respondents are adult 

Title II and Title XVI claimants, or 

current recipients undergoing 

redeterminations of 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–3373 ......................................... 1,734,635 1 61 1,763,546 * $10.95 ** 21 *** $25,958,815 

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

** 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. 

12. Request for Business Entity 

Taxpayer Information—0960–0731. SSA 

requires law firms or other business 

entities to complete Form SSA–1694, 

Request for Business Entity Taxpayer 

Information, if they wish to serve as 

appointed representatives and receive 

direct payment of fees from SSA. SSA 

uses the information to issue a Form 

1099–MISC. SSA also uses the 

information to allow business entities to 

designate individuals to serve as entity 

administrators authorized to perform 

certain administrative duties on their 

behalf, such as providing bank account 


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49408 Federal Register / Vol. 86, No. 168 / Thursday, September 2, 2021 / Notices 

information, maintaining entity 

information, and updating individual 

affiliations. Respondents are law firms 

or other business entities with attorneys 

or other qualified individuals as 

partners or employees who represent 

claimants before SSA. 

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–1694 (Paper) .................................................................... 366 1 20 122 * $61.03 ** $7,446 

BSO online submission ............................................................. 103 1 20 34 * 61.03 ** 2,075 

Totals ................................................................................. 469 ........................ ........................ 156 ........................ ** 9,521 

* We based this figure on the average legal occupation’s hourly salary, as reported by Bureau of Labor Statistics data (https://www.bls.gov/oes/current/oes_nat.htm#

00-00000). 

** 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. 

13. Financial Disclosure for Civil 

Monetary Penalty (CMP) Debt—20 CFR 

498—0960–0776. When SSA imposes a 

CMP on individuals for various 

fraudulent conduct related to SSAadministrated programs, those 

individuals may request to pay the CMP 

through benefit withholding, or an 

installment agreement. To negotiate a 

monthly payment amount, fair to both 

the individual and the agency, SSA 

needs financial information from the 

individual. SSA uses Form SSA–640, to 

obtain the information necessary to 

determine a monthly installment 

repayment rate for individuals owing a 

CMP. The respondents are recipients of 

Social Security benefits and nonentitled individuals who must repay a 

CMP to the agency and choose to do so 

using an installment plan. 

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–640 ....................................................... 10 1 120 20 * $19.01 ** 24 *** $456 

* 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: August 30, 2021. 

Naomi Sipple, 

Reports Clearance Officer, Social Security 

Administration. 

[FR Doc. 2021–18988 Filed 9–1–21; 8:45 am] 

BILLING CODE 4191–02–P 

DEPARTMENT OF STATE 

[Public Notice: 11528] 

United States Passports Invalid for 

Travel to, in, or Through the 

Democratic People’s Republic of Korea 

(DPRK) 

AGENCY: Department of State. 

ACTION: Notice of extension of passport 

travel restriction. 

SUMMARY: On September 1, 2017, all 

U.S. passports were declared invalid for 

travel to, in, or through the Democratic 

People’s Republic of Korea (DPRK), 

unless specially validated for such 

travel. The restriction was extended for 

one year in 2018, 2019, and 2020. This 

notice extends the restriction until 

August 31, 2022, unless extended or 

revoked by the Secretary of State. 

DATES: The extension of the travel 

restriction is in effect on September 2, 

2021. 

FOR FURTHER INFORMATION CONTACT: 

Lawrence Kovaciny, Bureau of Consular 

Affairs, Passport Services, Office of 

Adjudication, 202–485–8800. 

SUPPLEMENTARY INFORMATION: On 

September 1, 2017, pursuant to the 

authority of 22 U.S.C. 211a and 

Executive Order 11295 (31 FR 10603), 

and in accordance with 22 CFR 

51.63(a)(3), all U.S. passports were 

declared invalid for travel to, in, or 

through the DPRK unless specially 

validated for such travel. The restriction 

was renewed on September 1, 2018, 

September 1, 2019, and again for 

another year effective September 1, 

2020. 

The Department of State has 

determined there continues to be 

serious risk to U.S. citizens and 

nationals of arrest and long-term 

detention constituting imminent danger 

to their physical safety, as defined in 22 

CFR 51.63(a)(3). Accordingly, all U.S. 

passports shall remain invalid for travel 

to, in, or through the DPRK unless 

specially validated for such travel under 

the authority of the Secretary of State. 

This extension to the restriction of 

travel to the DPRK shall be effective 

upon publication of this notice in the 

Federal Register and shall expire on 

August 31, 2022, unless extended or 

revoked by the Secretary of State. 

Dated: August 30, 2021. 

Brian P. McKeon, 

Deputy Secretary of State for Management 

and Resources. 

[FR Doc. 2021–19140 Filed 9–1–21; 8:45 am] 

BILLING CODE 4710–13–P 

SURFACE TRANSPORTATION BOARD 

[Docket No. FD 36536] 

Tulsa Base Railroad, L.L.C.—Lease 

and Operation Exemption—Base, Inc. 

Tulsa Base Railroad, L.L.C. (TBR), a 

noncarrier, has filed a verified notice of 

exemption under 49 CFR 1150.31 to 

acquire by lease and to operate 745 feet 

of track that extends south of the pointof-switch with BNSF Railway Company 


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