Federal Register / Vol. 74, No. 109 / Tuesday, June 9, 2009 / Notices 27379 

30 17 CFR 200.30–3(a)(12). 

those that may be withheld from the 

public in accordance with the 

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

available for inspection and copying in 

the Commission’s Public Reference 

Room, on official business days between 

the hours of 10 a.m. and 3 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– 

NYSEAmex–2009–19 and should be 

submitted on or before June 30, 2009. 

For the Commission, by the Division of 

Trading and Markets, pursuant to delegated 

authority.30

Florence E. Harmon, 

Deputy Secretary. 

[FR Doc. E9–13394 Filed 6–8–09; 8:45 am] 

BILLING CODE 8010–01–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 and extensions of 

OMB-approved information collections 

and a new collection. 

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, e-mail, 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 shown 

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, 1332 Annex Building, 6401 

Security Blvd., Baltimore, MD 21235, 

Fax: 410–965–6400, E-mail address: 

OPLM.RCO@ssa.gov. 

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 August 10, 2009. Individuals 

can obtain copies of the collection 

instrument by calling the SSA Reports 

Clearance Officer at 410–965–3758 or by 

writing to the e-mail address we list 

above. 

1. Psychiatric Review Technique—20 

CFR 404.1520a, 416.920a—0960–0413. 

The SSA–2506–BK assists the Disability 

Determination Services (DDS) offices in 

evaluating mental impairments by 

helping to organize and present the 

mental findings in a clear, concise, and 

consistent manner; consider and 

evaluate all aspects of the mental 

impairment relevant to the individual’s 

ability to perform work-related mental 

functions; and identify additional 

evidence needed to determine 

impairment severity. 

The respondents are the State DDSs 

and Federal DDSs administering the 

Title II and Title XVI programs. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 54. 

Frequency of Response: 27,553. 

Average Burden per Response: 15 

minutes. 

Estimated Annual Burden: 371,966 

hours. 

2. Certificate of Election for Reduced 

Spouse’s Benefits—20 CFR 404.421— 

0960–0398. Reduced benefits are not 

payable to an already entitled spouse, at 

least age 62 but under full retirement 

age, who no longer has a child in care 

unless the spouse elects to receive 

reduced benefits. If a spouse decides to 

elect reduced benefits, they must 

complete Form SSA–25. SSA uses the 

information collected on Form SSA–25 

to pay a qualified spouse who elects to 

receive a reduced benefit. Respondents 

are entitled spouses seeking reduced 

benefits. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 30,000. 

Frequency of Response: 1. 

Average Burden per Response: 2 

minutes. 

Estimated Annual Burden: 1,000 

hours. 

II. SSA has submitted the information 

collections we list below to OMB for 

clearance. Your comments on the 

information collections would be most 

useful if OMB and SSA receive them 

within 30 days from the date of this 

publication. To be sure we consider 

your comments, we must receive them 

no later than July 9, 2009. You can 

obtain a copy of the OMB clearance 

packages by calling the SSA Reports 

Clearance Officer at 410–965–3758 or by 

writing to the above e-mail address. 

1. Statement of Employer—20 CFR 

404.801–404.803—0960–0030. SSA uses 

Form SSA–7011–F4 to substantiate 

allegations of wages paid to workers 

when those wages do not appear in 

SSA’s records of earnings and the 

worker does not have proof of those 

earnings. SSA uses the information from 

this form to process claims for Social 

Security benefits and to resolve 

discrepancies in the individual’s Social 

Security earnings record. We only send 

Form SSA–7011–F4 to employers if we 

deem it necessary. We make every effort 

to locate the earnings information 

within our records before we contact the 

employer. The respondents are 

employers who can verify wage 

allegations made by wage earners. 

Note: This is a correction notice. SSA 

published this information collection as an 

extension on April 07, 2009 at 74 FR 15808. 

Since we are revising the Privacy Act 

Statement, this is now a revision of an OMBapproved information collection. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 925,000. 

Frequency of Response: 1. 

Average Burden per Response: 20 

minutes. 

Estimated Annual Burden: 308,333 

hours. 

2. Statement of Claimant or Other 

Person—20 CFR 404.702 & 416.570— 

0960–0045. SSA uses the SSA–795 to 

obtain information from claimants or 

other persons having knowledge of facts 

in connection with claims for 

Supplemental Security Income (SSI) or 

Social Security benefits when there is 

no standard form to collect the needed 

information. SSA uses the information 

to process claims for benefits or for 

ongoing issues related to the above 

programs. The respondents are 

applicants/recipients of SSI or Social 

Security benefits, or others who are in 

a position to provide information 

pertinent to the claim(s). 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 305,500. 

Frequency of Response: 1. 

Average Burden per Response: 15 

minutes. 

Estimated Annual Burden: 76,375 

hours. 

3. Statement of Self-Employment 

Income—20 CFR 404.101, 404.110, 

27380 Federal Register / Vol. 74, No. 109 / Tuesday, June 9, 2009 / Notices 

404.1096(a)–(d)—0960–0046. SSA 

collects the information on Form SSA– 

766 to expedite the payment of benefits 

to an individual who is self-employed 

and who is establishing insured status. 

The form elicits the information 

necessary to determine if the individual 

will have the minimum amount of selfemployment income for quarters of 

coverage. Respondents are selfemployed individuals who may be 

eligible for Social Security benefits. 

Note: This is a correction notice. SSA 

published this information collection as an 

extension on April 7, 2009 at 74 FR 15808. 

Since we are revising the Privacy Act 

Statement, this is now a revision of an OMBapproved information collection. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 2,500. 

Frequency of Response: 1. 

Average Burden per Response: 5 

minutes. 

Estimated Annual Burden: 417 hours. 

4. Certification by Religious Group— 

20 CFR 404.1075—0960–0093. SSA uses 

information from Form SSA–1458 to 

determine whether a religious group 

meets the qualifications contained in 

Section 1402(g) of the Internal Revenue 

Code, which exempts members of 

certain religious groups and sects from 

payment of Self-Employment 

Contribution Act taxes. The respondents 

are spokespersons for religious groups 

or sects. 

Type of Request: Extension of an 

OMB-approved information collection. 

Number of Respondents: 180. 

Frequency of Response: 1. 

Average Burden per Response: 15 

minutes. 

Estimated Annual Burden: 45 hours. 

5. Instructions for Completion of 

Federal Assistance Application—0960– 

0184. SSA uses information from Form 

SSA–BK–96 to select grant proposals for 

funding based on their technical merits. 

This information assists the agency in 

evaluating the soundness of the design 

of the proposed activities, the 

possibilities of obtaining productive 

results, the adequacy of resources to 

conduct the activities and the 

relationship to other similar activities of 

the respondents. The respondents are 

State and local governments, Statedesignated protection and advocacy 

groups, colleges and universities and 

profit and nonprofit private 

organizations. 

Note: This is a correction notice. SSA 

published this information collection as an 

extension on April 7, 2009 at 74 FR 15808. 

Since we are revising the Privacy Act 

Statement, this is now a revision of an OMBapproved information collection. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 400. 

Frequency of Response: 2 hours. 

Average Burden per Response: 14 

hours. 

Estimated Annual Burden: 11,200 

hours. 

6. Representative Payee Report— 

Special Veterans Benefits—20 CFR 

408.665—0960–0621. Title VIII of the 

Social Security Act allows the payment 

of monthly benefits (referred to as 

Special Veterans Benefits) by the 

Commissioner of Social Security to 

qualified World War II veterans who 

reside outside the United States. An 

SSA-appointed representative payee 

may receive and manage the monthly 

payment for the beneficiary’s use and 

benefit. SSA uses the Form SSA–2001– 

F6 to determine if the payee has used 

the benefits properly and continues to 

demonstrate strong concern for the 

beneficiary. Respondents are persons or 

organizations who act on behalf of 

beneficiaries receiving Special Veterans 

Benefits. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 100. 

Frequency of Response: 1. 

Average Burden per Response: 10 

minutes. 

Estimated Annual Burden: 17 hours. 

7. Request for Deceased Individual’s 

Social Security Record—20 CFR 

402.130—0960–0665. SSA uses the 

Form SSA–711 to process requests from 

the public for a microprint of the SS– 

5, Application for Social Security Card, 

for a deceased individual. Respondents 

are members of the public who are 

requesting deceased individuals’ Social 

Security records. 

Note: This is a correction notice. SSA 

published this information collection as an 

extension on April 7, 2009 at 74 FR 15808. 

Since we are revising the Privacy Act 

Statement, this is now a revision of OMBapproved information. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 50,000. 

Frequency of Response: 1. 

Average Burden per Response: 7 

minutes. 

Estimated Annual Burden: 5,834 

hours. 

8. Request for Business Entity 

Taxpayer Information—0960–0731. SSA 

uses the SSA–1694 to collect 

information from law firms or other 

business entities that have partners or 

employees to facilitate direct payment 

of SSA-authorized fees for representing 

claimants before SSA. SSA will use this 

information to meet any requirement for 

issuance of a Form 1099–MISC. The 

respondent law firms or other business 

entities that represent claimants before 

SSA. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 2,000. 

Frequency of Response: 1. 

Average Burden per Response: 10 

minutes. 

Estimated Annual Burden: 333 hours. 

Type of Request: Revision of an OMBapproved information collection. 

9. Electronic Records Express—0960– 

0753. Electronic Records Express (ERE) 

is a Web-based SSA program that allows 

medical providers to electronically 

submit disability claimant data to SSA. 

Medical providers and other third 

parties with connections to disability 

applicants/recipients can use this 

system. This information collection 

request (ICR) includes the registration 

process for becoming a certified ERE 

user. We are expanding this ICR to 

include increased functionality by 

giving medical providers the ability to 

submit invoices electronically. The 

respondents are medical providers who 

evaluate or treat disability claimants/ 

recipients and other third parties. 

Type of Request: Revision of an OMBapproved information collection. 

Number of Respondents: 17,689. 

Frequency of Response: 1. 

Average Burden per Response: 10 

minutes. 

Estimated Annual Burden: 2,948 

hours. 

III. Correction Notices 

1. Function Report Adult—Third 

Party—20 CFR 404.1512 & 416.912— 

0960–0635. This is a correction notice: 

SSA inadvertently published duplicate 

notices for this collection at 74 FR 

23764 on 5/20/09 and again at 74 FR 

23916 on 5/21/09. The first publication 

was in error. Therefore, we request 

comments only for the second 

publication with a submission date no 

later than July 20, 2009. 

2. Function Report Adult—20 CFR 

404.1512 & 416.912—0960–0681. This is 

a correction notice: SSA inadvertently 

published duplicate notices for this 

collection at 74 FR 23764 on 5/20/09 

and again at 74 FR 23916 on 5/21/09. 

The first publication was in error. 

Therefore, we request comments only 

for the second publication with a 

submission date no later than July 20, 

2009. 

Dated: June 2, 2009. 

John Biles, 

Reports Clearance Officer, Center for Reports 

Clearance, Social Security Administration. 

[FR Doc. E9–13316 Filed 6–8–09; 8:45 am] 

BILLING CODE 4191–02–P