Federal Register / Vol. 87, No. 121 / Friday, June 24, 2022 / Notices 37899 

36 17 CFR 200.30–3(a)(12). 

information that you wish to make 

available publicly. All submissions 

should refer to File Number SR– 

CboeBZX–2022–034 and should be 

submitted on or before July 15, 2022. 

For the Commission, by the Division of 

Trading and Markets, pursuant to delegated 

authority.36

Jill M. Peterson, 

Assistant Secretary. 

[FR Doc. 2022–13476 Filed 6–23–22; 8:45 am] 

BILLING CODE 8011–01–P 

SOCIAL SECURITY ADMINISTRATION 

[Docket No: SSA–2022–0028] 

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 

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–2022–0028]. 

(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–2022–0028]. 

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 August 23, 2022. Individuals 

can obtain copies of the collection 

instruments by writing to the above 

email address. 

1. Supplemental Statement Regarding 

Farming Activities of Person Living 

Outside the United States—0960–0103. 

When a beneficiary or claimant reports 

farm work from outside the United 

States, SSA documents this work on 

Form SSA–7163A–F4. Specifically, SSA 

uses the form to determine if we should 

apply foreign work deductions to the 

recipient’s Title II benefits. We collect 

the information either annually or every 

other year, depending on the 

respondent’s country of residence. Once 

respondents complete the form, they 

mail it back to SSA. Respondents are 

Social Security recipients engaged in 

farming activities outside the United 

States. 

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–7163A–F4 ....................................... 19 1 60 19 * $11.70 ** $222 

* We based this figure on the average DI payments based on SSA’s current FY 2022 data (https://www.ssa.gov/legislation/2022factsheet.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. Information About Joint Checking/ 

Savings Account—20 CFR 416.1201 and 

416.1208—0960–0461. SSA considers a 

person’s resources when evaluating 

eligibility for Supplemental Security 

Income (SSI). Generally, we consider 

funds in checking and savings accounts 

as resources owned by the individuals 

whose names appear on the account. 

However, individuals applying for SSI 

may rebut this assumption of ownership 

in a joint account by submitting certain 

evidence to establish the funds do not 

belong to them. SSA uses Form SSA– 

2574 to collect information from SSI 

applicants and recipients who object to 

the assumption that they own all or part 

of the funds in a joint checking or 

savings account bearing their names. 

SSA collects information about the 

account from both the SSI applicant or 

recipient and the other account 

holder(s). After receiving the completed 

form, SSA determines if we should 

consider the account to be a resource for 

the SSI applicant and recipient. The 

respondents are applicants and 

recipients of SSI, and individuals who 

list themselves as joint owners of 

financial accounts with SSI applicants 

or 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–2574 (Paper) ........................................ 50,000 1 7 5,833 * $19.86 ........................ *** $115,843 

SSA–2574 (SSI Claim System) .................... 150,000 1 7 17,500 * 19.86 ** 21 *** 1,390,200 

Totals ..................................................... 200,000 ........................ ........................ 23,333 ........................ ........................ *** $1,506,043 

* We based this figure by averaging both the average DI payments based on SSA’s current FY 2022 data (https://www.ssa.gov/legislation/2022factsheet.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). 


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37900 Federal Register / Vol. 87, No. 121 / Friday, June 24, 2022 / Notices 

** We based this figure by averaging the average FY 2022 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. 

3. Real Property Current Market Value 

Estimate—0960–0471. SSA considers an 

individual’s resources when evaluating 

eligibility for SSI payments. The value 

of an individual’s resources, including 

non-home real property, is one of the 

eligibility requirements for SSI 

payments. SSA obtains current market 

value estimates of the claimant’s real 

property through Form SSA–L2794. We 

allow respondents to use readily 

available records to complete the form, 

or we can accept their best estimates. 

We use this form as part of initial 

applications and in post-entitlement 

situations. The respondents are small 

business operators in real estate; state 

and local government employees tasked 

with assessing real property values; and 

other individuals knowledgeable about 

local real estate values. 

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–L2794 .............................................. 300 1 20 100 * $23.45 ** $2,345 

* We based this figure on the median hourly salary of Real Estate Brokers and Sales Agents, 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. 

4. Employer Verification of Earnings 

After Death—20 CFR 404.821 and 

404.822—0960–0472. When SSA 

records show a wage earner is deceased, 

and we receive wage reports from an 

employer for the wage earner for a year 

subsequent to the year of death, SSA 

mails the employer Form SSA–L4112 

(Employer Verification of Earnings After 

Death). SSA uses the information Form 

SSA–L4112 provides to verify wage 

information previously received from 

the employer is correct for the employee 

and the year in question (the year 

subsequent to the year of death), to 

ensure we avoid wage fraud on the 

deceased’s account. The respondents are 

employers who report wages for 

employees who died. 

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–L4112 .............................................. 13,114 1 10 2,186 * $28.01 ** $61,230 

* 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). 

** 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. Child Care Dropout 

Questionnaire—20 CFR 404.211(e)(4)— 

0960–0474. If individuals applying for 

Title II disability benefits care for their 

own or their spouse’s children under 

age 3, and have no steady earnings 

during the time they care for those 

children, they may exclude that period 

of care from the disability computation 

period. We call this the child-care 

dropout exclusion. SSA uses the 

information from Form SSA–4162 to 

determine if an individual qualifies for 

this exclusion. Respondents are 

applicants for Title II disability 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 

(minutes) ** 

Total annual 

opportunity 

cost 

(dollars) *** 

SSA–4162 .................... 1,563 1 5 130 * $28.01 ** 24 *** $21,148 

* 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). 

** We based this figure on the average FY 2022 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. 


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Federal Register / Vol. 87, No. 121 / Friday, June 24, 2022 / Notices 37901 

6. Medical Report on Adult with 

Allegation of Human Immunodeficiency 

Virus Infection; Medical Report on Child 

with Allegation of Human 

Immunodeficiency Virus Infection—20 

CFR 416.933–416.934—0960–0500. 

Section 1631(e)(i) of the Social Security 

Act (Act) authorizes the Commissioner 

of SSA to gather information to make a 

determination about an applicant’s 

claim for SSI payments. Section 

1631(a)(4) of the Act provides that the 

Commissioner may pay SSI payments to 

an applicant for a period not exceeding 

six months prior to the determination of 

the individual’s disability, if the 

individual is presumptively disabled 

and is determined to be otherwise 

eligible for benefits; this procedure is 

called Presumptive Disability (PD). SSA 

uses Forms SSA–4814 and SSA–4815 to 

collect information necessary to 

determine if an individual with human 

immunodeficiency virus infection, who 

is applying for SSI disability benefits, 

meets the requirements for PD. The 

respondents are the medical sources of 

the applicants for SSI disability 

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 for 

teleservice 

centers 

(minutes) ** 

Total annual 

opportunity 

cost 

(dollars) *** 

SSA–4814 .................... 1,307 1 8 174 * $16.02 ** 19 *** $9,420 

SSA–4815 .................... 20 1 10 3 * 16.02 ** 19 *** 144 

Totals .................... 1,327 ........................ ........................ 177 ........................ ........................ *** 9,564 

* We based this figure on the average Healthcare Support Occupations, as reported by Bureau of Labor Statistics data (https://www.bls.gov/ 

oes/current/oes310000.htm). 

** We based this figure on the average FY 2022 wait times for 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. 

7. Certificate of Election for Reduced 

Widow(er)s and Surviving Divorced 

Spouse’s Benefits—20 CFR 404.335— 

0960–0759. Section 202(q) of the Act 

provides SSA the authority to reduce 

benefits under certain conditions when 

elected by a Title II beneficiary. 

However, reduced benefits are not 

payable to an already entitled spouse (or 

divorced spouse) who: 

• Is at least age 62 and under full 

retirement age in the month of the 

number holder’s death; and 

• Is receiving both reduced spouse’s 

(or divorced spouse’s) benefits and 

either retirement or disability benefits in 

the month before the month of the 

number holder’s death. 

To elect reduced widow(er) benefits, 

a recipient completes Form SSA–4111, 

and mails it back to SSA. SSA uses the 

information collected to pay a qualified 

dually entitled widow(er) (or surviving 

divorced spouse) who elects to receive 

a reduced widow(er) benefit. The 

respondents are qualified dually 

entitled widow(er)s (or surviving 

divorced spouse) who elect to receive a 

reduced widow(er) benefit. 

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–4111 ................................................ 30,000 1 2 1,000 * $28.01 ** $28,010 

* 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). 

** 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: June 20, 2022. 

Naomi Sipple, 

Reports Clearance Officer, Social Security 

Administration. 

[FR Doc. 2022–13489 Filed 6–23–22; 8:45 am] 

BILLING CODE 4191–02–P 

DEPARTMENT OF STATE 

[Public Notice 11767] 

Notice of Determinations; Culturally 

Significant Objects Being Imported for 

Exhibition—Determinations: ‘‘Black 

Orpheus: Jacob Lawrence & the Mbari 

Club’’ 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 ‘‘Black Orpheus: Jacob 

Lawrence & the Mbari Club’’ at the 

Chrysler Museum of Art, Norfolk, 

Virginia; the New Orleans Museum of 

Art, New Orleans, Louisiana; the Toledo 

Museum of Art, Toledo, Ohio; 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 


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