Federal Register / Vol. 73, No. 181 / Wednesday, September 17, 2008 / Notices 53919 

Authority: 15 U.S.C. 636(a)(24); 13 CFR 

120.3. 

Eric R. Zarnikow, 

Associate Administrator, Office of Capital 

Access. 

[FR Doc. E8–21716 Filed 9–16–08; 8:45 am] 

BILLING CODE 8025–01–P 

SMALL BUSINESS ADMINISTRATION 

Revocation of License of Small 

Business Investment Company 

Pursuant to the authority granted to 

the United States Small Business 

Administration by the Final Order of the 

United States District Court of 

Maryland, Baltimore Division, dated 

June 17, 2008, the United States Small 

Business Administration hereby revokes 

the license of Anthem Capital, L.P., a 

Delaware limited partnership, to 

function as a small business investment 

company under the Small Business 

Investment Company License No. 0373– 

0200 issued to Anthem Capital, L.P. on 

September 26, 1994 and said license is 

hereby declared null and void as of June 

31, 2008. 

United States Small Business 

Administration. 

Dated: September 8, 2008. 

A. Joseph Shepard, 

Associate Administrator for Investment. 

[FR Doc. E8–21715 Filed 9–16–08; 8:45 am] 

BILLING CODE 8025–01–P 

SOCIAL SECURITY ADMINISTRATION 

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 (Pub. L.) 104–13, the 

Paperwork Reduction Act of 1995, 

effective October 1, 1995. This notice 

includes revisions to OMB-approved 

information collections and extensions 

(no change) of existing 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 the 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 the SSA Reports Clearance Officer 

to the addresses or fax numbers listed 

below. 

(OMB), Office of Management and 

Budget, Attn: Desk Officer for SSA, 

Fax: 202–395–6974, e-mail address: 

OIRA_Submission@omb.eop.gov. 

(SSA), Social Security Administration, 

DCBFM,Attn: Reports Clearance 

Officer,1333 Annex Building,6401 

Security Blvd.,Baltimore, MD 

21235,Fax: 410–965–6400, e-mail 

address: OPLM.RCO@ssa.gov. 

I. The information collections listed 

below are pending at SSA. SSA will 

submit them to OMB within 60 days 

from the date of this notice. Therefore, 

your comments would be most helpful 

if you submit them to SSA within 60 

days from the date of this publication. 

Individuals can obtain copies of the 

collection instruments by calling the 

SSA Reports Clearance Officer at 410– 

965–0454 or by writing to the e-mail 

address listed above. 

1. Supplement to Claim of Person 

Outside the United States—20 CFR 

404.460, 404.463, 422.505(b), 42 CFR 

407.27(c)—0960–0051. SSA uses the 

information collected from Form SSA– 

21 to determine continuing entitlement 

to Social Security benefits and the 

proper benefit amounts of alien 

beneficiaries living outside the United 

States. SSA also uses the information to 

determine whether benefits are subject 

to withholding tax. The respondents are 

individuals entitled to Social Security 

benefits who are, will be, or have been 

residing outside the United States. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 35,000. 

Frequency of Response: 1. 

Average Burden per Response: 10 

minutes. 

Estimated Annual Burden: 5,833 

hours. 

2. Coverage of Employees of State and 

Local Governments—20 CFR 404, 

Subpart M—0960–0425. The Code of 

Federal Regulations at 20 CFR 404 

prescribe the rules for states submitting 

reports of deposits and related 

recordkeeping to SSA. States (and 

interstate instrumentalities) are required 

to provide wage and deposit-related 

contribution information for pre-1987 

periods. The respondents are state and 

local governments or interstate 

instrumentalities. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 52. 

Frequency of Response: 1. 

Average Burden per Response: 1 hour. 

Estimated Annual Burden: 52 hours. 

3. Medical Report on Adult with 

Allegation of Human Immunodeficiency 

Virus Infection; Medical Report on Child 

with Allegation of Human 

Immunodeficiency Virus Infection—20 

CFR 416.993–416.994—0960–0500. SSA 

uses Forms SSA–4814–F5 and SSA– 

4815–F6 to collect information 

necessary to determine if an individual 

with Human Immunodeficiency Virus 

(HIV) infection, who is applying for 

Supplemental Security Income (SSI) 

disability benefits, meets the 

requirements for presumptive disability 

payments. The respondents are the 

medical sources of the applicants for 

SSI disability payments. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 59,100. 

Frequency of Response: 1. 

Average Burden per Response: 10 

minutes. 

Estimated Annual Burden: 9,850 

hours. 

4. Application To Collect a Fee for 

Payee Services—20 CFR 404.2040(a), 

416.640(a) 416.1103(f)—0960–0719. 

SSA uses Form SSA–445 to collect 

information to make a determination 

whether to authorize or deny 

permission to collect fees for payee 

services. The respondents are private 

sector businesses or state and local 

government offices applying to become 

a fee-for-service organizational 

representative payee. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 100. 

Frequency of Response: 1. 

Average Burden per Response: 10 

minutes. 

Estimated Annual Burden: 17 hours. 

5. Request To Be Selected as a 

Payee—20 CFR 404.2010–404.2055, 

416.601–416.665—0960–0014. An 

individual applying to be a 

representative payee for a Social 

Security or SSI recipient completes 

Form SSA–11–BK. SSA designed the 

form to aid the investigation of a payee 

applicant. SSA uses the information to 

establish the applicant’s relationship to 

the beneficiary, his/her justification and 

his/her concern for the beneficiary, as 

well as the manner in which the 

applicant will use the benefits. The 

respondents are representative payee 

applicants for Titles II, VIII, XVI. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 1,500,000. 

Estimated Annual Burden: 248,335 

hours. 


pwalker on PROD1PC71 with NOTICES
53920 Federal Register / Vol. 73, No. 181 / Wednesday, September 17, 2008 / Notices 

Collection method Number of 

respondents 

Frequency of 

response 

Average 

burden per 

response 

Total annual 

burden 

Individuals/Households (90%): 

Representative Payee System (RPS) ...................................................... 135,000 1 10.5 23,625 

RPS/Signature Proxy ................................................................................ 765,000 1 9.5 121,125 

Paper Version ....................................................................................... 450,000 1 10.5 78,750 

Totals ................................................................................................. 1,350,000 ........................ ........................ 223,500 

Private Sector (9%): 

RPS .......................................................................................................... 13,500 1 10.5 2,363 

RPS/Signature Proxy ................................................................................ 76.500 1 9.5 12,113 

Paper Version ........................................................................................... 45,000 1 10.5 7,875 

Totals ................................................................................................. 135,000 ........................ ........................ 22,351 

State/Local/Tribal Government (1%): 

RPS .......................................................................................................... 1,500 1 10.5 263 

RPS/Signature Proxy ................................................................................ 8,500 1 9.5 1,346 

Paper Version ........................................................................................... 5,000 1 10.5 875 

Totals ................................................................................................. 15,000 ........................ ........................ 2,484 

Grand Total: ............................................................................... 1,500,000 ........................ ........................ 248,335 

6. Modified Benefit Formula 

Questionnaire—Foreign Pension—0960– 

0561. SSA uses the information 

collected on Form SSA–308 to 

determine exactly how much (if any) of 

a foreign pension may be used to reduce 

the amount of Title II Social Security 

retirement or disability benefits under 

the modified benefit formula. The 

respondents are applicants for Title II 

Social Security retirement or disability 

benefits who have foreign pensions. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 50,000. 

Frequency of Response: 1. 

Average Burden per Response: 10 

minutes. 

Estimated Annual Burden: 8,333 

hours. 

7. Claimant’s Work Background—20 

CFR 404.1565(b), 20 CFR 416.965(b)— 

0960–0300. SSA uses the information 

from form HA–4633 when an individual 

has requested a hearing before an 

administrative law judge (ALJ) on the 

issue of whether or not he or she is 

disabled. The completed HA–4633 

provides an updated summary of the 

individual’s relevant work history, 

information the ALJ requires in 

assessing a claimant’s disability within 

the meaning of the Social Security Act. 

The respondents are members of the 

public who have filed for disability 

benefits under Title II and/or Title XVI 

and have requested a hearing before an 

ALJ. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 151,000. 

Frequency of Response: 1. 

Average Burden per Response: 15 

minutes. 

Estimated Annual Burden: 37,750 

hours. 

II. SSA has submitted the information 

collections listed below. Your 

comments on the information 

collections will be most useful if OMB 

and SSA receive them within 30 days 

from the date of this publication. You 

can request a copy of the information 

collections by e-mail, 

OPLM.RCO@ssa.gov, fax 410–965–6400, 

or by calling the SSA Reports Clearance 

Officer at 410–965–0454. 

1. Statement Regarding Date of Birth 

and Citizenship—20 CFR 404.716— 

0960–0016. Form SSA–702 collects 

information needed when preferred or 

other evidence is not available to prove 

age or citizenship for an individual 

applying for Social Security benefits. 

SSA uses the information to establish 

age as a factor of entitlement to Social 

Security benefits or U.S. citizenship as 

a payment factor. Respondents are 

individuals with knowledge about the 

date of birth and/or citizenship of 

applicants for one or more Social 

Security benefits who need to establish 

their dates of birth as a factor of 

entitlement or U.S. citizenship as a 

factor of payment. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 1,200. 

Frequency of Response: 1. 

Average Burden per Response: 10 

minutes. 

Estimated Annual Burden: 200 hours. 

2. Application for Benefits under a 

U.S. International Social Security 

Agreement—20 CFR 404.1925—0960– 

0448. SSA uses information from Form 

SSA–2490–BK to determine entitlement 

to Social Security benefits from the 

United States or from a country that has 

entered into a Social Security agreement 

with the United States. The respondents 

are individuals who are applying for old 

age, survivors or disability benefits from 

the United States or from a Totalization 

agreement country. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 26,700. 

Frequency of Response: 1. 

Average Burden per Response: 30 

minutes. 

Estimated Average Burden: 13,350 

hours. 

3. Plan for Achieving Self-Support— 

20 CFR 416.110(e), 416.1180–1182, 

416.1225–1227—0960–0559. SSA 

collects the information on Form SSA– 

545 when an SSI applicant/recipient 

desires to use available income and 

resources to obtain education and/or 

training in order to become selfsupportive. SSA uses the information to 

evaluate the recipient’s plan for 

achieving self-support to determine 

whether to approve the plan under the 

provisions of the SSI program. The 

respondents are SSI applicants/ 

recipients who are blind or disabled and 

want to develop a plan to go to work. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 7,000. 

Frequency of Response: 1. 

Average Burden per Response: 2 

hours. 

Estimated Annual Burden: 14,000 

hours. 

4. Authorization to Disclose 

Information to Social Security 

Administration—20 CFR 404.1512 & 20 

CFR 416.912—0960–0623. SSA must 

obtain sufficient medical evidence to 

make eligibility determinations for 

Social Security disability benefits and 


pwalker on PROD1PC71 with NOTICES
Federal Register / Vol. 73, No. 181 / Wednesday, September 17, 2008 / Notices 53921 

SSI payments. For SSA to obtain 

medical evidence, an applicant must 

authorize his or her medical source(s) to 

release the information to SSA. The 

applicant may use Form SSA–827 to 

provide consent for the release of 

information. Generally, the State 

Disability Determination Service 

completes the form(s) based on 

information provided by the applicant, 

and sends the form(s) to the designated 

medical source(s). The respondents are 

applicants for Title II benefits and Title 

XVI payments. 

Type of Request: Revision of a 

currently approved information 

collection. 

READING, SIGNING, AND DATING THE 1ST SSA–827 (10 MINUTES) 

Total respondents 

Number of 

reports 

by each 

respondent 

Total annual 

responses 

Estimated 

number of 

minutes per 

response 

Total burden 

hours 

3,853,928 ......................................................................................................... 1 3,853,928 10 642,321 

SIGNING AND DATING THREE ADDITIONAL SSA–827S

Total respondents 

Number of 

reports 

by each 

respondent 

Total annual 

responses 

Estimated 

number of 

minutes per 

response 

Total burden 

hours 

3,853,928 ......................................................................................................... 3 11,561,784 1 192,696 

READING THE EXPLANATION OF THE SSA–827 ON THE INTERNET

Total respondents 

Number of 

reports by 

each 

respondent 

Total annual 

responses 

Estimated 

number of 

minutes per 

response 

Total burden 

hours 

586,232 ............................................................................................................ 1 586,232 3 29,312 

Collectively: 

Number of Respondents: 3,853,928. 

Frequency of Response (Average per 

case): 4. 

Average Burden per Response: 13 

minutes to complete all 4 forms. 

Average Burden to Read Internet 

Instructions: 3 minutes. 

Estimated Annual Burden for Reading 

Internet Explanation: 29,312. 

Estimated Annual Burden to read 

instructions and complete the form: 

864,329 hours. 

5. Review of the Disability Hearing 

Officer’s Reconsidered Determinations 

Before It Is Issued—20 CFR 404.913– 

404.918, 404.1512–404.1515, 404.1589, 

416.912–416.915, 416.989, 416.1413– 

416.1418, 404.918(d) and 416.1418(d)— 

0960–0709. When SSA approves a claim 

for Social Security disability benefits or 

SSI payments, it periodically conducts a 

continuing disability review (CDR) 

during which the agency reviews the 

claimant’s status to see if his/her 

condition has improved to the point 

where the claimant is capable of 

working. If SSA notifies a claimant that 

the agency will cease paying benefits, 

the claimant may appeal that 

determination. The first appeal gives the 

claimant the opportunity for a full 

evidentiary hearing before a disability 

hearing officer (DHO). A federal 

component reviews a small sample of 

the DHO’s determinations. It is rare for 

the reviewing component to reverse a 

DHO determination favorable to the 

claimant. Before SSA can produce the 

unfavorable determination, the claimant 

has 10 days to provide a written 

statement explaining why SSA should 

not stop payments. That written 

statement is the information collected in 

this process. Respondents are CDR 

claimants whose benefits are going to 

cease. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 8. 

Frequency of Response: 1. 

Average Burden per Response: 60 

minutes. 

Estimated Annual Burden: 8 hours. 

6. Farm Arrangement Questionnaire— 

20 CFR 404.1082(c)—0960–0064. When 

self-employed workers submit earnings 

data to SSA, they cannot count rental 

income from a farm unless they 

demonstrate ‘‘material participation’’ in 

the farm’s operation. A material 

participation arrangement means the 

farm owners who are seeking to have 

earnings counted by SSA must perform 

a combination of physical duties, 

management decisions, and capital 

investment in the farm they are renting 

out. In such cases, SSA uses form SSA– 

7157, the Farm Arrangement 

Questionnaire, to document material 

participation. The respondents are 

workers who are renting farmland to 

other people and who are involved in 

the operation of the farm and want to 

claim countable income from their work 

there. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 38,000. 

Frequency of Response: 1. 

Average Burden per Response: 30 

minutes. 

Estimated Annual Burden: 19,000 

hours. 

7. Disability Update Report—20 CFR 

404.1589–.1595, 416.988–.996—0960– 

0511. SSA periodically reviews current 

disability cases to determine if the 

recipients should continue to receive 

disability payments. In cases where 

these reviews indicate beneficiaries 

might have experienced a medical 

improvement, SSA must investigate 

further. The agency uses form SSA–455/ 

SSA–455–OCR–SM, the Disability 

Update Report, for this purpose. 

Specifically, SSA uses the information it 

gathers on this form to determine if (1) 

there is enough evidence to warrant 

referring the beneficiary for a full 

medical CDR (2) the beneficiary’s 

impairment has not changed enough to 

warrant a CDR; or (3) there are 

unresolved work-related issues for the 

beneficiary. The respondents are Title II 


pwalker on PROD1PC71 with NOTICES
53922 Federal Register / Vol. 73, No. 181 / Wednesday, September 17, 2008 / Notices 

and Title XVI disability payment 

recipients. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 880,000. 

Frequency of Response: 1. 

Average Burden per Response: 15 

minutes. 

Estimated Annual Burden: 220,000 

hours. 

Dated: September 10, 2008. 

Elizabeth A. Davidson, 

Reports Clearance Officer, Social Security 

Administration. 

[FR Doc. E8–21591 Filed 9–16–08; 8:45 am] 

BILLING CODE 4191–02–P 

SOCIAL SECURITY ADMINISTRATION 

[Docket No. SSA 2008–0046] 

Privacy Act of 1974, as Amended; 

Computer Matching Program; (SSA/ 

Centers for Medicare and Medicaid 

(CMS) Match Number 1076) 

AGENCY: Social Security Administration 

(SSA). 

ACTION: Notice of the renewal of an 

existing computer matching program 

which is scheduled to expire on October 

15, 2008. 

SUMMARY: In accordance with the 

provisions of the Privacy Act, as 

amended, this notice announces the 

renewal of an existing computer 

matching program that SSA is currently 

conducting with CMS. 

DATES: SSA will file a report of the 

subject matching program with the 

Committee on Homeland Security and 

Governmental Affairs of the Senate; the 

Committee on Oversight and 

Government Reform of the House of 

Representatives; and the Office of 

Information and Regulatory Affairs, 

Office of Management and Budget 

(OMB). The renewal of the matching 

program will be effective as indicated 

below. 

ADDRESSES: Interested parties may 

comment on this notice by either telefax 

to (410) 965–0201 or writing to the 

Deputy Commissioner for Budget, 

Finance and Management, 800 Altmeyer 

Building, 6401 Security Boulevard, 

Baltimore, MD 21235–6401. All 

comments received will be available for 

public inspection at this address. 

FOR FURTHER INFORMATION CONTACT: The 

Deputy Commissioner for Budget, 

Finance and Management as shown 

above. 

SUPPLEMENTARY INFORMATION: 

A. General 

The Computer Matching and Privacy 

Protection Act of 1988 (Pub. L. 100– 

503), amended the Privacy Act (5 U.S.C. 

552a) by describing the conditions 

under which computer matching 

involving the Federal government could 

be performed and adding certain 

protections for individuals applying for, 

and receiving, Federal benefits. Section 

7201 of the Omnibus Budget 

Reconciliation Act of 1990 (Pub. L. 101– 

508) further amended the Privacy Act 

regarding protections for such 

individuals. 

The Privacy Act, as amended, 

regulates the use of computer matching 

by Federal agencies when records in a 

system of records are matched with 

other Federal, State or local government 

records. It requires Federal agencies 

involved in computer matching 

programs to: 

(1) Negotiate written agreements with 

the other agency or agencies 

participating in the matching programs; 

(2) Obtain the approval of the 

matching agreement by the Data 

Integrity Boards (DIB) of the 

participating Federal agencies; 

(3) Publish notice of the computer 

matching program in the Federal 

Register; 

(4) Furnish detailed reports about 

matching programs to Congress and 

OMB; 

(5) Notify applicants and beneficiaries 

that their records are subject to 

matching; and 

(6) Verify match findings before 

reducing, suspending, terminating or 

denying an individual’s benefits or 

payments. 

B. SSA Computer Matches Subject to 

the Privacy Act 

We have taken action to ensure that 

all of SSA’s computer matching 

programs comply with the requirements 

of the Privacy Act, as amended. 

Dated: August 27, 2008. 

Mary Glenn-Croft, 

Deputy Commissioner for Budget, Finance 

and Management. 

Notice of Computer Matching Program, 

Social Security Administration (SSA) With 

the Centers for Medicare and Medicaid 

(CMS) 

A. PARTICIPATING AGENCIES

SSA and CMS. 

B. PURPOSE OF THE MATCHING PROGRAM

The purpose of this agreement is to 

establish the conditions, terms and 

safeguards under which CMS agrees to 

the ongoing disclosure of certain skilled 

nursing facility admission data by CMS 

to SSA. CMS will disclose the data 

through a computer matching operation 

for SSA’s use in identifying 

Supplemental Security Income (SSI) 

recipients who did not report their 

admission to a facility as required under 

applicable provisions of the Social 

Security Act (the Act). Such admission 

would subject the amount of SSI which 

an individual could receive for any 

month throughout which the individual 

is in such a facility to a reduced benefit 

rate. The SSI program provides 

payments to aged, blind and disabled 

recipients with income and resources 

below levels established by law and 

regulations. 

SSA will use other benefit 

information for the Title VIII, Special 

Veterans’ Benefits (SVB) determinations 

of entitlement and benefit amount. 

Other benefit information is defined as 

any recurring payment received as an 

annuity, pension, retirement or 

disability benefit. The match will be 

used to identify those SVB beneficiaries 

who are no longer residing outside the 

United States. 

C. AUTHORITY FOR CONDUCTING THE MATCHING

PROGRAM

This Matching Agreement between 

SSA and CMS is executed pursuant to 

the Privacy Act of 1974 (5 U.S.C. 552a), 

as amended (Pub. L. 100–503, the 

Computer Matching and Privacy 

Protection Act (CMPPA) of 1988), the 

Office of Management and Budget 

(OMB) Circular A–130, titled 

‘‘Management of Federal Information 

Resources’’ at 61 FR 6428–6435 

(February 20, 1996), and OMB 

guidelines pertaining to computer 

matching at 54 FR 25818 (June 19, 

1989). 

Legal authority for the SSI portion of 

the matching program described above 

is contained in sections 1611(e)(1)(A) 

and (B) and 1631(f) of the Act (42 U.S.C. 

1382(e)(1)(A) and (B) and 1383(f)); see 

also 20 CFR 416.211. 

Legal authority for the SVB portion of 

the matching program is contained in 

sections 801 and 806(a) and (b) of the 

Act (42 U.S.C. 1001 and 1006(a) and 

(b)). 

D. CATEGORIES OF RECORDS AND INDIVIDUALS

COVERED BY THE MATCHING PROGRAM

SSA will provide CMS with a finder 

file on a monthly basis extracted from 

SSA’s Supplemental Security Income 

Record and Special Veterans Benefits 

(SSR/SVB), SSA/ODSSIS 60–0103, with 

identifying information with respect to 

recipients of SSI benefits. CMS will 

match the SSA finder file against the 

system of records for individuals on the 

Long-Term Care Minimum Data Set 


pwalker on PROD1PC71 with NOTICES