3092 Federal Register / Vol. 70, No.

12 / Wednesday, January 19, 2005 / Notices

Annual Responses: 486,000. SMALL BUSINESS ADMINISTRATION SUMMARY: In accordance with the
Annual Burden: 487,600. Paperwork Reduction Act of 1995, this
Listing of All the Small Business notice announces the U.S. Small
Jacqueline White, Administration Currently Approved Business Administration’s currently
Chief, Administrative Information Branch. Information Collections approved information collections.
[FR Doc. 05–989 Filed 1–18–05; 8:45 am] AGENCY: Small Business Administration. FOR FURTHER INFORMATION CONTACT:
BILLING CODE 8025–01–P Curtis B. Rich, Management Analyst,
ACTION: Notice.
202–205–7030, curtis.rich@sba.gov.

OMB Expiration
Title of collection Control No. date

Surety Bond Guarantee Assistance ............................................................................................................................ 3245–0007 3/31/2007

Size Status Declaration ............................................................................................................................................... 3245–0009 8/31/2007
Request from Borrowers (Financial Statements) ........................................................................................................ 3245–0012 5/31/2005
Disaster Business Loan Application ............................................................................................................................ 3245–0017 7/31/2007
Disaster Home Loan Application ................................................................................................................................. 3245–0018 9/30/2006
Pro-Net ......................................................................................................................................................................... 3245–0024 2/28/2007
SBIC Management Assessment Questionnaire & License Application; Exhibits to SBIC License App. and Mgmt.
Assessment Questionnaire ...................................................................................................................................... 3245–0062 4/30/2007
SBIC Financial Reports ............................................................................................................................................... 3245–0063 10/31/2007
U.S. Small Business Administration Application for Section 504 Loan ...................................................................... 3245–0071 4/30/2005
CDC Annual Report Guide .......................................................................................................................................... 3245–0074 8/31/2007
Training Program Evaluation ....................................................................................................................................... 3245–0075 3/31/2007
Notice to New SBA Borrowers .................................................................................................................................... 3245–0076 5/31/2007
Reports to SBA; Provisions of 13 CFR 120.472 ......................................................................................................... 3245–0077 9/30/2006
Portfolio Financing Report ........................................................................................................................................... 3245–0078 9/30/2007
Statement of Personal History ..................................................................................................................................... 3245–0080 12/31/2006
25-Model Corp. Resol. or GP Certif., 33-Model Letter to Selling Agent 34-Bank ID 1065 Appl. Lic, Assure. of
Compliance .............................................................................................................................................................. 3245–0081 7/31/2005
Disaster Home/Business Loan Inquiry Record ........................................................................................................... 3245–0084 9/30/2006
Nomination for the Small Business Prime Contractor & Nomination of the Small Business Subcontractor of the
Year Award .............................................................................................................................................................. 3245–0096 12/31/2005
Application for Small Business Size Determination .................................................................................................... 3245–0101 8/31/2006
Request for Information Concerning Portfolio Financing ............................................................................................ 3245–0109 9/30/2006
Borrower’s Progress Certification Form ...................................................................................................................... 3245–0110 9/30/2006
Financial Institution Confirmation Form ....................................................................................................................... 3245–0116 8/31/2006
Disclosure Statement, Leveraged Licenses and Disclosure Statement Non-Leveraged Licensees .......................... 3245–0118 11/30/2005
Governor’s Request for Disaster Declaration .............................................................................................................. 3245–0121 5/31/2006
Transaction Report on Loans Serviced by Lenders .................................................................................................... 3245–0131 5/31/2006
Lender Transcript of Account ...................................................................................................................................... 3245–0132 3/31/2005
Disaster Survey Worksheet ......................................................................................................................................... 3245–0136 3/31/2007
Federal Cash Transaction Report, Financial Status Report Program Income report, Narrative Program report ...... 3245–0169 3/31/2007
Stockholders Confirmation (Corporation) Ownership Confirmation (Partnership) ...................................................... 3245–0172 8/31/2007
Statement of Personal History ..................................................................................................................................... 3245–0178 9/30/2006
SBA Counseling Evaluation ......................................................................................................................................... 3245–0183 5/31/2005
Servicing Agent Agreement ......................................................................................................................................... 3245–0193 5/31/2005
Settlement Sheet ......................................................................................................................................................... 3245–0200 3/31/2005
7(a) Loan Closing Forms ............................................................................................................................................. 3245–0201 5/31/2005
8(a) Annual Update ..................................................................................................................................................... 3245–0205 10/31/2005
Secondary Market Assignment and Disclosure Form ................................................................................................. 3245–0212 12/31/2005
Small Business Administration; Application for Certificate of Competency ................................................................ 3245–0225 9/30/2007
Representatives Used and Compensation Paid for Services in Connection with obtaining Federal Contracts ........ 3245–0270 12/31/2005
Financing Eligibility Statement—Social Disadvantage ................................................................................................
Disadvantage/Economic Disadvantage 3245–0301 9/30/2007
8(a)/SDB Paper and Electronic Application ................................................................................................................ 3245–0313 8/31/2007
Voluntary Customer Surveys in accordance with E.O. 12862 .................................................................................... 3245–0314 6/30/2005
HUBZone internet Application Form ............................................................................................................................ 3245–0320 2/28/2006
Entrepreneurial Development Management Information System (EDMIS) Counseling Information Form & Man-
agement Training Report ......................................................................................................................................... 3245–0324 9/30/2006
Pre-Disaster Mitigation Small Business Loan Application .......................................................................................... 3245–0326 9/30/2006
New Market Venture Capital (NMVC) Program Application Funding and reporting ................................................... 3245–0332 9/30/2005
NMVC Program Application interview Question; SSBIC Applicant Tech. Proposal; Request for Approval of Man-
agement Services .................................................................................................................................................... 3245–0338 7/31/2005
Veterans Business Ownership Survey ........................................................................................................................ 3245–0340 4/30/2006
Costs of litigation to small business; executive Interview questionnaire .................................................................... 3245–0345 8/31/2006
PCLP Quarterly loan lose reserve report and PCLP Request .................................................................................... 3245–0346 2/28/2007
Small Business questionnaire (Use of Telecommunications) ..................................................................................... 3245–0347 8/31/2006
SBA Express Information Collection ........................................................................................................................... 3245–0348 2/28/2006
HUBzone Application Data Update ............................................................................................................................. 3245–0350 12/31/2005
Entrepreneurial Development Impact Survey .............................................................................................................. 3245–0351 12/31/2005
Microloan Program Electronic Reporting System (MPERS) ....................................................................................... 3245–0352 7/31/2007

VerDate jul<14>2003 15:11 Jan 18, 2005 Jkt 205001 PO 00000 Frm 00098 Fmt 4703 Sfmt 4703 E:\FR\FM\19JAN1.SGM 19JAN1
 Federal Register / Vol. 70, No. 12 / Wednesday, January 19, 2005 / Notices
Jacqueline White,
Chief, Administrative Information Branch.
[FR Doc. 05–990 Filed 1–18–05; 8:45 am]
BILLING CODE 8025–01–P
SOCIAL SECURITY ADMINISTRATION
Agency Information Collection
Activities: Proposed Request
The Social Security Administration
(SSA) publishes a list of information
collection packages that will require
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. The information collection
packages that may be included in this
notice are for new 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 on ways
to minimize burden on respondents,
including the use of automated
collection techniques or other forms of
information technology. Written
comments and recommendations
regarding the information collections
should be submitted to the SSA Reports
Clearance Officer. The information can
be mailed and/or faxed to the address
and fax number listed below: (SSA),
Social Security Administration,
DCFAM, Attn: Reports Clearance
Officer, 1338 Annex Building, 6401
Security Blvd., Baltimore, MD 21235.
Fax: 410–965–6400.
OPLM.RCO@ssa.gov.
The information collections listed
below are pending at SSA and will be
submitted to OMB within 60 days from
the date of this notice. Therefore, your
comments should be submitted to SSA
within 60 days from the date of this
publication. You can obtain copies of
the collection instruments by calling the
SSA Reports Clearance Officer at 410–
965–0454 or by writing to the address
listed above.
1. Application for Help with Medicare
Prescription Drug Plan Costs, SSA–
1020SC—0960–NEW. The Medicare
Prescription Drug, Improvement, and
Modernization Act of 2003 (Public Law
108–173; MMA) establishes a new
Medicare Part D program for voluntary
prescription drug coverage for premium,
deductible, and cost-sharing subsidies
for certain low-income individuals. The
MMA stipulates that subsidies must be
available for individuals who are
eligible for the program and who meet
eligibility criteria for help with
VerDate jul<14>2003 15:11 Jan 18, 2005 Jkt 205001
premium, deductible, and/or co-
payment costs.
Individuals who receive these
subsidies may ask SSA to redetermine
the amount of help they receive if they
experience a ‘‘subsidy-changing event,’’
including marriage, separation, divorce,
an annulment, or the death of a spouse.
Until late 2006, when redetermination
forms will become available, SSA will
use form SSA–1020–SC, the Application
for Help with Medicare Prescription
Drug Plan Costs, to make
redeterminations based on subsidy-
changing events. The respondents are
individuals whose application for help
toward the costs for this program has
been approved and are requesting a
redetermination of their subsidy based
on a subsidy-changing event.
Type of Request: New information
collection.
Number of Respondents: 76,000.
Frequency of Response: 1.
Average Burden Per Response: 35
minutes.
Estimated Annual Burden: 44,333
hours.
2. Application for Help with Medicare
Prescription Drug Plan Costs—0960–
NEW (Internet/Intranet Application
Screens). The Medicare Prescription
Drug, Improvement, and Modernization
Act of 2003 (Public Law 108–173;
MMA) establishes a new Medicare Part
D program for voluntary prescription
drug coverage for premium, deductible,
and cost-sharing subsidies for certain
low-income individuals. The MMA
stipulates that subsidies must be
available for individuals who are
eligible for the program and who meet
eligibility criteria for help with
premium, deductible, and/or co-
payment costs. Form SSA–1020, the
Application for Help with Medicare
Prescription Drug Plan Costs, collects
information about an applicant’s
resources and is used by SSA to
determine eligibility for this assistance.
We are proposing electronic versions
of the SSA–1020, which will collect the
information via the Intranet (the
information is provided by the
respondent during an interview at a
Social Security field office) or the
Internet (i1020) (if respondents
complete the Internet screens on their
own and submit them electronically).
The respondents are individuals who
are eligible for enrollment in the
Medicare Part D program and are
requesting assistance with the related
costs.
Type of Request: New information
collection.
Number of Respondents: 2,000,000.
Frequency of Response: 1.
PO 00000 Frm 00099 Fmt 4703 Sfmt 4703 E:\FR\FM\19JAN1.SGM
3093
Average Burden Per Response: 45
minutes.
Estimated Annual Burden: 1,500,000.
Dated: January 12, 2005.
Elizabeth A. Davidson,
Reports Clearance Officer, Social Security
Administration.
[FR Doc. 05–1022 Filed 1–18–05; 8:45 am]
BILLING CODE 4191–02–P
SOCIAL SECURITY ADMINISTRATION
Privacy Act of 1974 as Amended;
Computer Matching Program (SSA/
Department of Homeland Security
(DHS) Number 1010)
AGENCY: Social Security Administration
(SSA).
Notice of a modification to a
ACTION:
computer matching program.
SUMMARY: In accordance with the
provisions of the Privacy Act, as
amended, this notice announces a
modification of a computer matching
program that SSA conducts with DHS.
DATES: SSA will file a report of the
subject matching program with the
Committee on Governmental Affairs of
the Senate, the Committee on
Government Reform of the House of
Representatives and the Office of
Information and Regulatory Affairs,
Office of Management and Budget
(OMB). The matching program will be
effective as indicated below.
ADDRESSES: Interested parties may
comment on this notice either by telefax
to (410) 965–5961 or writing to the
Associate Commissioner for Income
Security Programs, 245 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
Associate Commissioner for Income
Security Programs as shown above.
SUPPLEMENTARY INFORMATION:
A. General
The Computer Matching and Privacy
Protection Act of 1988 (Public Law (P.
L.) 100–503), amended the Privacy Act
(5 U.S.C. § 552a) by describing the
manner in which computer matching
involving Federal agencies 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
19JAN1