Federal Register / Vol. 86, No. 159 / Friday, August 20, 2021 / Notices 46897 

Percent 

Non-Profit Organizations without Credit Available Elsewhere ..................................... 2.000 

The number assigned to this disaster 

for physical damage is 17087 B and for 

economic injury is 17088 0. 

(Catalog of Federal Domestic Assistance 

Number 59008) 

James Rivera, 

Associate Administrator for Disaster 

Assistance. 

[FR Doc. 2021–17871 Filed 8–19–21; 8:45 am] 

BILLING CODE 8026–03–P 

SOCIAL SECURITY ADMINISTRATION 

[Docket No: SSA–2021–0024] 

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 revisions 

and extensions 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–2021–0024]. 

(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–2021–0024]. 

I. 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 October 19, 

2021. Individuals can obtain copies of 

the collection instruments by writing to 

the above email address. 

1. Request for Waiver of Overpayment 

Recovery and Request for Change in 

Overpayment Recovery Rate—20 CFR 

404.502, 404.506–404.512, 416.550– 

416.558, 416.570–416.571—0960–0037. 

When Social Security beneficiaries and 

Supplemental Security Income (SSI) 

recipients receive an overpayment, they 

must return the extra money. These 

beneficiaries and recipients can use 

Form SSA–632–BK, Request for Waiver 

of Overpayment Recovery, to request a 

waiver from repaying their 

overpayment. Beneficiaries and 

recipients can also use Form SSA–634, 

Request for Change in Overpayment 

Recovery Rate, to request a change to 

the monthly recovery rate of their 

overpayment. The respondents must 

provide financial information to help 

the agency determine how much the 

overpaid person can afford to repay 

each month. The respondents are 

individuals who are overpaid Social 

Security or SSI payments who are 

requesting: (1) A waiver of recovery of 

an overpayment, or (2) a lesser rate of 

withholding. 

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–632—Request for Waiver of 

Overpayment Recovery (If completing entire paper form, including 

the AFI authorization) ........................ 400,000 1 120 800,000 * $10.95 ** 21 *** $10,293,000 

SSA–634—Request for Change in 

Overpayment Recovery Rate (Completing paper form) ............................ 100,000 1 45 75,000 * 10.95 ** 21 *** 1,204,500 

Totals ............................................. 500,000 ........................ ........................ 875,000 ........................ ........................ *** 11,497,500 

* 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. 

2. Statement of Claimant or Other 

Person—20 CFR 404.702 and 416.570— 

0960–0045. SSA uses Form SSA–795, 

Statement of Claimant or Other Person, 

in special situations where there is no 

authorized form or questionnaire, yet 

we require a signed statement from the 

applicant, claimant, or other individuals 

who have knowledge of facts, in 

connection with claims for Social 

Security benefits or SSI. The 

information we request on the SSA–795 

is of sufficient importance that we need 

both a signed statement and a penalty 

clause. SSA uses this information to 

process, in addition to claims for 

benefits, issues about continuing 

eligibility; ongoing benefit amounts; use 

of funds by a representative payee; fraud 

investigation; and other program-related 

matters. The most common respondents 

are applicants for, or recipients of, 

Social Security or SSI. Respondents also 

include friends and relatives of the 

involved parties, coworkers, neighbors, 

or anyone else in a position to provide 

information pertinent to the issue(s). 

Type of Request: Revision of an OMBapproved information collection. 


khammond on DSKJM1Z7X2PROD with NOTICES
46898 Federal Register / Vol. 86, No. 159 / Friday, August 20, 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)* 

Average wait 

time in field 

office 

(minutes)** 

Total Annual 

Opportunity 

Cost 

(dollars)*** 

SSA–795 (paper version) .............................. 207,239 1 15 51,810 * $10.95 ** 24 *** $1,475,031 

SSA–795 (Person Statement) electronic 

version ....................................................... 24,583 1 15 6,146 * 27.07 ........................ *** 166,372 

Totals ..................................................... 231,822 ........................ ........................ 57,956 ........................ ........................ *** 1,641,403 

* We based these figures on the average DI payments based on SSA’s current FY 2021 data (https://www.ssa.gov/legislation/2021FactSheet.pdf) and on the average U.S. worker’s hourly wages, as reported by Bureau of Labor Statistics data (https://www.bls.gov/oes/current/oes_nat.htm#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. 

3. Claimant’s Medications—20 CFR 

404.1512 and 416.912—0960–0289. In 

cases where claimants request a hearing 

after denial of their disability claim for 

Social Security, SSA uses Form HA– 

4632, Claimant’s Medications, to request 

information from the claimant regarding 

the medications they use. This 

information helps the judge overseeing 

the case to fully investigate: (1) The 

claimant’s medical treatment and (2) the 

effects of the medications on the 

claimant’s medical impairments and 

functional capacity. The judge makes 

the completed form a part of the 

documentary evidence of record, 

placing it in the official record of the 

proceedings as an exhibit. The 

respondents are applicants (or their 

representatives) for Old Age Survivors 

and Disability Insurance (OASDI) 

benefits or SSI payments who request a 

hearing to contest an agency denial of 

their claim. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of completion Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated 

total annual 

burden 

(hours) 

Average 

theoretical 

hourly cost 

amount 

(dollars)* 

Average wait 

time in field 

office 

(minutes)** 

Total Annual 

Opportunity 

Cost 

(dollars)*** 

HA–46321—PDF/paper version .................... 53,200 1 15 13,300 * $10.95 ** 24 *** $378,651 

Electronic Records Express Submissions .... 136,800 1 15 34,200 * 27.07 ........................ *** 925,794 

Totals ..................................................... 190,000 ........................ ........................ 47,500 ........................ ........................ *** 1,304,445 

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

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

4. Disability Report-Adult—20 CFR 

404.1512 and 416.912—0960–0579. 

State Disability Determination Services 

(DDS) use Form SSA–3368, Disabilty 

Report—Adult, and its electronic 

versions, to determine if adult disability 

applicants’ impairments are severe and, 

if so, how the impairments affect the 

applicants’ ability to work. This 

determination informs whether the 

DDSs and SSA will find the applicant 

to be disabled and entitled to SSI 

payments. The respondents are 

applicants for Title II disability benefits 

or Title XVI SSI payments. 

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–3368 (Paper) ........................................ 6,045 1 90 9,068 * $10.95 ** 21 *** $122,465 

EDCS 3368 (Intranet) ................................... 1,263,104 1 90 1,894,656 * 10.95 ** 21 *** 25,587,325 

i3368 (Internet) .............................................. 989,361 1 90 1,484,042 * 10.95 ........................ *** 16,250,260 

Totals ..................................................... 2,258,510 ........................ ........................ 3,387,766 ........................ ........................ *** 41,960,050 

* 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. 

5. Request for internet Services and 

800# Automated Telephone Services 

Knowledge-Based Authentication 

(RISA–KBA)—20 CFR 401.45—0960– 

0596. The Request for internet Services 

and 800# Automated Telephone 

Services (RISA) Knowledge-Based 

Authentication (KBA) is one of the 

authentication methods SSA uses to 

allow individuals access to their 

personal information through our 

internet and Automated Telephone 

Services. SSA asks individuals and 

third parties who seek personal 

information from SSA records, or who 

register to participate in SSA’s online 

business services, to provide certain 

identifying information. As an extra 

measure of protection, SSA asks 

requestors who use the internet and 

telephone services to provide additional 


khammond on DSKJM1Z7X2PROD with NOTICES
Federal Register / Vol. 86, No. 159 / Friday, August 20, 2021 / Notices 46899 

identifying information unique to those 

individuals so SSA can authenticate 

their identities before releasing personal 

information. The respondents are 

current beneficiaries who are requesting 

personal information from SSA, and 

individuals and third parties who are 

registering for SSA’s online business 

services. 

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) ** 

Internet Requestors ................................. 2,921,795 1 3 146,090 * $27.07 ** $3,954,656 

Telephone Requestors ............................. 1,157,833 1 4 77,189 * 27.07 ** 2,089,506 

Totals ................................................ 4,079,628 ........................ ........................ 223,279 ........................ ** 6,044,162 

* 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). 

** 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. Testimony by Employees and the 

Production of Records and Information 

in Legal Proceedings—20 CFR 403.100– 

403.155—0960–0619. SSA’s regulations 

establish policies and procedures for an 

individual, organization, or government 

entity to request official agency 

information, records, or testimony of an 

agency employee in a legal proceeding 

when the agency is not a party. The 

request, which respondents submit in 

writing, must: (1) Fully set out the 

nature and relevance of the sought 

testimony; (2) explain why the 

information is not available by other 

means; (3) explain why it is in SSA’s 

interest to provide the testimony; and 

(4) provide the date, time, and place for 

the testimony. Respondents are 

individuals or entities who request 

testimony from SSA employees in 

connection with a legal proceeding. 

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) ** 

20 CFR 403.100–403.155 ....................... 100 1 60 100 * $27.07 ** $2,707 

* 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). 

** 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. Certification of Prisoner Identity 

Information—20 CFR 422.107—0960– 

0688. Inmates of Federal, State, or local 

prisons may need a Social Security card 

as verification of their Social Security 

number for school or work programs, or 

as proof of employment eligibility upon 

release from incarceration. Before SSA 

can issue a replacement Social Security 

card, applicants must show SSA proof 

of their identity. People who are in 

prison for an extended period typically 

do not have current identity documents. 

Therefore, under written agreement 

with the correctional institution, SSA 

allows prison officials to verify the 

identity of certain incarcerated U.S. 

citizens who need replacement Social 

Security cards. Prison officials provide 

SSA information from the official prison 

files, sent on correctional facility 

letterhead. SSA uses this information to 

establish the applicant’s identity in the 

replacement Social Security card 

process. The respondents are prison 

officials who certify the identity of 

prisoners applying for replacement 

Social Security cards. 

Type of Request: Extension of an 

OMB-approved Information Collection 

Modality of completion Number of 

respondents 

Frequency of 

response 

Number of 

responses 

Average 

burden per 

response 

(minutes) 

Estimated 

total annual 

burden 

(hours) 

Average 

theoretical 

hourly cost 

amount 

(dollars) * 

Total annual 

opportunity 

cost 

(dollars) ** 

Verification of Prisoner Identity Statements .. 1,000 200 200,000 3 10,000 * $28.80 ** $288,000 

* We based this figure on average Probation Officers and Correctional Treatment Specialists hourly salary, as reported by Bureau of Labor Statistics data (https://

www.bls.gov/oes/current/oes211092.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 

collection below to OMB for clearance. 

Your comments regarding this 

information collection 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 

September 20, 2021. Individuals can 

obtain copies of this OMB clearance 

package by writing to 

OR.Reports.Clearance@ssa.gov. 

Authorization for the Social Security 

Administration to Obtain Account 

Records from a Financial Institution 


khammond on DSKJM1Z7X2PROD with NOTICES

I I I I I I I 
46900 Federal Register / Vol. 86, No. 159 / Friday, August 20, 2021 / Notices 

and Request for Records (Medicare)—20 

CFR 418.3420—0960–0729. The 

Medicare Prescription Drug, 

Improvement, and Modernization Act of 

2003 (MMA) established the Medicare 

Part D program for voluntary 

prescription drug coverage of premium, 

deductible, and copayment costs for 

individuals with limited income and 

resources. The MMA mandates that the 

Government provide subsidies for those 

individuals who qualify for the 

program, and who meet eligibility 

criteria for help with premium, 

deductible, or co-payment costs. SSA 

uses the SSA–4640, Authorization for 

the Social Security Administration to 

Obtain Account Records from a 

Financial Institution and Request for 

Records (Medicare), to determine if 

subsidy applicants or recipients qualify, 

or continue to qualify, for the subsidy. 

SSA uses Form SSA–4640 to: (1) Obtain 

the individual’s consent to verify 

balances of financial institution (FI) 

accounts; and (2) obtain verification of 

such balances from the FI. Respondents 

are Medicare Part D program subsidy 

applicants or claimants, and their 

financial institutions. 

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) ** 

Medicare Part D Subsidy Applicants ....... 5,000 1 1 83 * $10.95 ** $909 

Financial Institutions ................................ 5,000 1 4 333 * 37.56 ** 12,507 

Totals ................................................ 10,000 ........................ ........................ 416 ........................ ** 13,416 

* We based these figures on the average DI payments based on SSA’s current FY 2021 data https://www.ssa.gov/legislation/ 

2021FactSheet.pdf), and the average Business and Financial operations occupations, as reported by Bureau of Labor Statistics data (https://

www.bls.gov/oes/current/oes130000.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. 

Dated: August 17, 2021. 

Naomi Sipple, 

Reports Clearance Officer, Social Security 

Administration. 

[FR Doc. 2021–17857 Filed 8–19–21; 8:45 am] 

BILLING CODE 4191–02–P 

DEPARTMENT OF STATE 

[Public Notice: 11505] 

Ninth Summit of the Americas Leaders 

Meeting 

We are delighted to inform that U.S. 

cities are invited to present proposals to 

host the concluding week of high-level 

events and meetings of the Ninth 

Summit of the Americas (Summit) 

process to occur during summer 2022. 

Over the course of approximately two to 

five days, the United States Government 

will organize official and informal 

events, bilateral meetings, and media 

events that Chiefs of State and Heads of 

Government and senior officials of 

participating governments from the 

Western Hemisphere will attend. 

As many as 10,000 participants, 

including support staff, security, media, 

and businesspersons may attend. Global 

media attention will focus on the 

leaders’ meeting at the Summit. The 

President of the United States and up to 

50 Chiefs of State, Heads of 

Government, and high-level participants 

from the governments of the Americas, 

regional and global international 

organizations, and other special guests 

are expected to attend. Each Summit 

delegation will likely be comprised of 

Cabinet Ministers, Senior Advisors, 

Security Officers, and members of the 

Foreign Media. The Summit’s associated 

high-level stakeholder forums and 

events, which may include but are not 

limited to the CEO Summit of the 

Americas, Civil Society Forum, Young 

Americas Forum, and commercial 

exhibitions, will attract prominent 

business executives, local government 

and civil society leaders, and youth 

entrepreneurs from around the world. 

With this many high-profile visitors, 

security will be a major consideration 

for the selection of the city and 

conference venues. The following 

meetings could be held during the 

Summit week: (1) Concluding Summit 

Implementation Review Group (SIRG) 

National Summit Coordinators 

Plenipotentiaries Meeting—2–3 days, 

approximately 200 delegates; (2) SIRG 

Ministerial Meeting—1 day, 

approximately 300 delegates; (3) CEO 

Summit—3 days, approximately 1,000 

to 5,000 attendees; (4) Civil Society 

Forum—2 days, approximately 1,000 to 

1,200 attendees; (5) Young Americas 

Forum—2 days, approximately 500 to 

700 attendees; (6) Summit inaugural 

ceremony and dinner—half day, 

restricted attendance 1,000 to 3,000 

delegates at the ceremony, and 

approximately two groups of 100 to 300 

attendees each at separate receptions/ 

dinners; (7) Summit Leaders Meeting— 

1 to 2 days, restricted in-room 

attendance up to 300 delegates; 

approximately 10,000 delegates in other 

venues. Additional stakeholder forums, 

events and meetings may take place 

throughout the week as well. The 

minimum requirements are as follows: 

An international airport with frequent 

and consistent connections to and from 

countries in the Western Hemisphere 

(further information about the Summit 

of the Americas can be found at the 

website for the Ninth Summit of the 

Americas: www.IXSummitAmericas.org, 

or the Summits of the Americas 

Secretariat’s website: www.summitamericas.org); an identified Fixed Based 

Operator (FBO) for private aircraft 

arrivals/departures and adequate 

parking space for 30 private aircraft; 

approximately 20,000 hotel room nights 

of international standard including 100 

suites for Heads of Government and 

cabinet-level Ministers; Conference 

facilities for multiple meetings; 

Political, business, and civic support; 

Local security capable of supporting 

delegates and VIPs. 

Preparation of Proposals 

Deadline is September 3, 2021. 

Proposals must be submitted by email as 

a single PDF from a verified state/ 

territory or municipal government email 

address to IX-SummitAmericas@

state.gov. Items supporting proposals, 

including additional attachments, 

videos, or professional video 

presentations of the city and/or 

convention space, should identify 

complete URLs in the PDF. Questions 

about the proposal and submission 

process can be directed to IXSummitAmericas@state.gov. Questions 


khammond on DSKJM1Z7X2PROD with NOTICES