6568 Federal Register / Vol. 81, No. 25 / Monday, February 8, 2016 / Notices 

17 17 CFR 200.30–3(a)(12). 

provisions of 5 U.S.C. 552, will be 

available for Web site 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 such 

filing also will be available for 

inspection and copying at the principal 

office of the Exchange. All comments 

received will be posted without change; 

the Commission does not edit personal 

identifying information from 

submissions. You should submit only 

information that you wish to make 

available publicly. All submissions 

should refer to File Number SR– 

NYSEMKT–2016–16, and should be 

submitted on or before February 29, 

2016. 

For the Commission, by the Division of 

Trading and Markets, pursuant to delegated 

authority.17

Robert W. Errett, 

Deputy Secretary. 

[FR Doc. 2016–02330 Filed 2–5–16; 8:45 am] 

BILLING CODE 8011–01–P 

SOCIAL SECURITY ADMINISTRATION 

[Docket No: SSA–2016–0002] 

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 

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, Fax: 

202–395–6974, Email address: OIRA_

Submission@omb.eop.gov. 

(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 www.regulations.gov, 

referencing Docket ID Number [SSA– 

2016–0002]. 

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 April 8, 2016. 

Individuals can obtain copies of the 

collection instruments by writing to the 

above email address. 

1. Statement for Determining 

Continuing Eligibility, Supplemental 

Security Income Payment(s)—20 CFR 

416.204—0960–0416. SSA conducts 

disability redeterminatons to determine 

if Supplemental Security Income (SSI) 

recipients (1) met and continue to meet 

all statutory and regulatory 

requirements for SSI eligibility and (2) 

are receiving the correct SSI payment 

amount. SSA makes these 

redeterminations through periodic use 

of Form SSA–8203BK. SSA conducts 

this legally mandated information 

collection in field offices via personal 

contact (face-to-face or telephone 

interview) using the automated 

Modernized SSI Claim System 

(MSSICS). The respondents are SSI 

recipients or their representative payees. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of completion Number of 

responses 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

MSSICS ........................................................................................................... 801,789 1 20 267,263 

MSSICS/Signature Proxy ................................................................................ 666,431 1 19 211,036 

Paper ............................................................................................................... 135,357 1 20 45,119 

Totals ........................................................................................................ 1,603,577 ........................ ........................ 523,418 

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 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. 


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Modality of completion Number of 

responses 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–2574 Paper version ................................................................................ 50,000 1 7 5,833 

Intranet version (MSSICS) ............................................................................... 150,000 1 7 17,500 

Totals ........................................................................................................ 200,000 ........................ ........................ 23,333 

3. Plan for Achieving Self-Support 

(PASS)—20 CFR 416.110(e), 416.1180– 

416.1182, 416.1225–416.1227—0960– 

0559. The SSI program encourages 

recipients to return to work. One of the 

program objectives is to provide 

incentives and opportunities that help 

recipients toward employment. The 

PASS provision allows individuals to 

use available income or resources (such 

as business equipment, education, or 

specialized training) to enter or re-enter 

the workforce and become selfsupporting. In turn, SSA does not count 

the income or resources recipients use 

to fund a PASS when determining an 

individual’s SSI eligibility or payment 

amount. An SSI recipient who wants to 

use available income and resources to 

obtain education or training to become 

self-supporting completes Form SSA– 

545. SSA uses the information from the 

SSA–545 to evaluate the recipient’s 

PASS, and to determine eligibility 

under the provisions of the SSI program. 

The respondents are SSI recipients who 

want to develop a return-to-work plan. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of completion Number of 

responses 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–545 .......................................................................................................... 7,000 1 120 14,000 

4. 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. 

Modality of completion Number of 

responses 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–1699 ........................................................................................................ 16,000 1 20 5,333 

II. SSA submitted the information 

collections below to OMB for clearance. 

Your comments regarding the 

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 

March 9, 2016. Individuals can obtain 

copies of the OMB clearance packages 

by writing to OR.Reports.Clearance@

ssa.gov. 

1. Certificate of Responsibility for 

Welfare and Care of Child Not in 

Applicant’s Custody—20 CFR 404.330, 

404.339–404.341 and 404.348– 

404.349—0960–0019. Under the 

provisions of the Social Security Act 

(Act), non-custodial parents who are 

filing for spouse, mother, or father 

Social Security benefits based on having 

the child of a number holder or worker 

in their care, must meet the in-care 

requirements the Act discusses. The incare provision requires claimants to 

have an entitled child under age 16 or 

disabled in their care. SSA uses Form 

SSA–781, Certificate of Responsibility 

for Welfare and Care of Child in 

Applicant’s Custody, to determine if 

claimants meet the requirement. The 

respondents are applicants for spouse, 

mother’s or father’s Social Security 

benefits. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of completion Number of 

responses 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–781 .......................................................................................................... 14,000 1 10 2,333 


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6570 Federal Register / Vol. 81, No. 25 / Monday, February 8, 2016 / Notices 

2. Authorization for the Social 

Security Administration to Obtain 

Account Records from a Financial 

Institution—20 CFR 416.200 and 

416.203—0960–0293. SSA collects and 

verifies financial information from 

individuals applying for Title II and 

Title XVI waiver determinations, as well 

as those who apply for, or currently 

receive (in the case of redetermination) 

Supplemental Security Income (SSI) 

payments. We require the financial 

information from these applicants to: (1) 

Determine the eligibility of the 

applicant or recipient for Supplemental 

Security Income (SSI) benefits; or (2) 

determine if a request to waive a Social 

Security overpayment defeats the 

purpose of the Social Security Act. If the 

Title II and Title XVI waiver applicants, 

or the SSI claimants provide 

incomplete, unavailable, or seemingly 

altered records, SSA contacts their 

financial institutions to verify the 

existence, ownership, and value of 

accounts owned. Financial institutions 

need individuals to sign Form SSA– 

4641–F4, or work with SSA staff to 

complete one of SSA’s electronic 

applications, e4641 or the Access to 

Financial Institutions (AFI) screens, to 

authorize the individual’s financial 

institution to disclose records to SSA. 

The respondents are Title II and Title 

XVI recipients applying for waivers, or 

SSI applicants, recipients, and their 

deemors to determine SSI eligibility. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of completion Number of 

responses 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–4641 (paper) ........................................................................................... 252,500 1 6 25,250 

e4641 and AFI (electronic) .............................................................................. 15,747,500 1 2 524,917 

Totals ........................................................................................................ 16,000,000 ........................ ........................ 550,167 

3. Request for Change in Time/Place 

of Disability Hearing—20 CFR 

404.914(c)(2) and 416.1414(c)(2)—0960– 

0348. At the request of the claimants or 

their representative, SSA schedules 

evidentiary hearings at the 

reconsideration level for claimants of 

Title II benefits or Title XVI payments 

when we deny their claims for 

disability. When claimants or their 

representatives find they are unable to 

attend the scheduled hearing, they 

complete Form SSA–769 to request a 

change in time or place of the hearing. 

SSA uses the information as a basis for 

granting or denying requests for changes 

and for rescheduling disability hearings. 

Respondents are claimants or their 

representatives who wish to request a 

change in the time or place of their 

hearing. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of 

completion 

Number of 

responses 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–769–U4 ................................................................................................... 7,483 1 8 998 

4. Notice Regarding Substitution of 

Party Upon Death of Claimant— 

Reconsideration of Disability 

Cessation—20 CFR 404.907–404.921 

and 416.1407–416.1421—0960–0351. 

When a claimant dies before we make 

a determination on that person’s request 

for reconsideration of a disability 

cessation, SSA seeks a qualified 

substitute party to pursue the appeal. If 

SSA locates a qualified substitute party, 

the agency uses Form SSA–770 to 

collect information about whether to 

pursue or withdraw the reconsideration 

request. We use this information as the 

basis for the decision to continue or 

discontinue with the appeals process. 

Respondents are substitute applicants 

who are pursuing a reconsideration 

request for a deceased claimant. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of completion Number of 

responses 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–770 .......................................................................................................... 1,200 1 5 100 

5. Privacy and Disclosure of Official 

Records and Information; Availability of 

Information and Records to the Public— 

20 CFR 401.40(b)&(c), 401.55(b), 

401.100(a), 402.130, 402.185—0960– 

0566. SSA established methods for the 

public to: (1) Access their SSA records; 

(2) allow SSA to disclose records; (3) 

correct or amend their SSA records; (4) 

consent to release of their records; (5) 

request records under the Freedom of 

Information Act (FOIA); (6) request SSA 

waive or reduce fees normally charges 

for release of FOIA; and (7) request 

access to an extract of their SSN record. 

SSA often collects the necessary 

information for these requests through a 

written letter, with the exception of the 

consent for release of records, for which 

we use Form SSA–3288. The 

respondents are individuals requesting 

access to, correction of, or disclosure of 

SSA records. 

Type of Request: Revision of an OMBapproved information collection. 


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Federal Register / Vol. 81, No. 25 / Monday, February 8, 2016 / Notices 6571 

Modality of completion Number of 

responses 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

Access to Records ........................................................................................... 10,000 1 11 1,833 

Designating a Representative for Disclosure of Records ............................... 3,000 1 2 6,000 

Amendment of Records ................................................................................... 100 1 10 17 

Consent of Release of Records ...................................................................... 3,000,000 1 3 150,000 

FOIA Requests for Records ............................................................................ 15,000 1 5 1,250 

Waiver/Reduction of Fees ............................................................................... 400 1 5 33 

Respondents who request access to an extract of their SSN record ............. 10 1 8.5 1 

Totals ........................................................................................................ 3,028,510 ........................ ........................ 159,134 

6. Beneficiary Interview and Auditor’s 

Observations Form—0960–0630. SSA’s 

Office of the Inspector General collects 

information from Form SSA–322, the 

Beneficiary Interview and Auditor’s 

Observation form, to interview 

beneficiaries or their payees to 

determine whether they are complying 

with their duties and responsibilities. 

The respondents are randomly selected 

SSI recipients and Social Security 

beneficiaries who have representative 

payees. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of completion Number of 

responses 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–322 .......................................................................................................... 1,000 1 15 250

7. International Direct Deposit—31 

CFR 210—0960–0686. SSA’s 

International Direct Deposit (IDD) 

Program allows beneficiaries living 

abroad to receive their payments via 

direct deposit to an account at a 

financial institution outside the United 

States. SSA uses Form SSA–1199- 

(Country) to enroll Title II beneficiaries 

residing abroad in IDD, and to obtain 

the direct deposit information for 

foreign accounts. Routing account 

number information varies slightly for 

each foreign country, so we use a 

variation of the Treasury Department’s 

Form SF–1199A for each country. The 

respondents are Social Security 

beneficiaries residing abroad who want 

SSA to deposit their Title II benefit 

payments directly to a foreign financial 

institution. 

Type of Request: Revision of an OMBapproved information collection. 

Modality of completion Number of 

responses 

Frequency of 

response 

Average 

burden per 

response 

(minutes) 

Estimated total 

annual burden 

(hours) 

SSA–1199–(Country) ....................................................................................... 12,500 1 5 1,041 

Dated: February 3, 2016. 

Naomi R. Sipple, 

Reports Clearance Officer, Social Security 

Administration. 

[FR Doc. 2016–02353 Filed 2–5–16; 8:45 am] 

BILLING CODE 4191–02–P 

DEPARTMENT OF STATE 

[Public Notice: 9437] 

60-Day Notice of Proposed Information 

Collection: Overseas Schools Grant 

Status Report 

ACTION: Notice of request for public 

comment. 

SUMMARY: The Department of State is 

seeking Office of Management and 

Budget (OMB) approval for the 

information collection described below. 

In accordance with the Paperwork 

Reduction Act of 1995, we are 

requesting comments on this collection 

from all interested individuals and 

organizations. The purpose of this 

notice is to allow 60 days for public 

comment preceding submission of the 

collection to OMB. 

DATES: The Department will accept 

comments from the public up to April 

8, 2016. 

ADDRESSES: 

You may submit comments by any of 

the following methods: 

• Web: Persons with access to the 

Internet may comment on this notice by 

going to www.Regulations.gov. You can 

search for the document by entering 

‘‘Docket Number: DOS–2015–0066’’ in 

the Search field. Then click the 

‘‘Comment Now’’ button and complete 

the comment form. 

• Email: millerkd2@state.gov. 

• Regular Mail: Send written 

comments to: Office of Overseas 

Schools, U.S. Department of State, 2201 

C Street NW., Washington, DC 20520. 

• Fax: 202–261–8224 

• Hand Delivery or Courier: same as 

mail address. 

You must include the DS form number, 

information collection title, and the 

OMB control number in any 

correspondence. 

FOR FURTHER INFORMATION CONTACT: 

Direct requests for additional 

information regarding the collection 

listed in this notice, including requests 

for copies of the proposed collection 

instrument and supporting documents, 

to Keith Miller, Department of State, 

Office of Overseas Schools, A/OPR/OS, 

Room H328, SA–1, Washington, DC 

20522–0132, who may be reached on 

202–261–8200 or at millerkd2@

state.gov. 

SUPPLEMENTARY INFORMATION: 


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