[Federal Register Volume 81, Number 150 (Thursday, August 4, 2016)]
[Notices]
[Pages 51536-51537]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-18529]


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DEPARTMENT OF STATE

[Public Notice: 9661]


60-Day Notice of Proposed Information Collection: Statement of 
Claim Related to Pensions Provided by the Kingdom of Belgium

ACTION: Notice of request for public comment.

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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 
October 3, 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-2016-0055'' in the Search 
field. Then click the ``Comment Now'' button and complete the comment 
form.
     Email: [email protected].
     Regular Mail: Send written comments to: Office of the 
Assistant Legal Adviser for Management, ATTN: Belgium Claim Form, Room 
4325, 2201 C Street NW., Washington, DC 20520.
    You must include the DS form number (if applicable), 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 Alice Kottmyer, Office of the Legal Adviser 
for Management, who may be reached on 202-647-2318 or 
[email protected].

SUPPLEMENTARY INFORMATION: 
     Title of Information Collection: Statement of Claim 
Related to Pensions Provided by the Kingdom of Belgium.
     OMB Control Number: None.
     Type of Request: New Collection.
     Originating Office: Office of the Legal Adviser.
     Form Number: DS-7792.
     Respondents: Individuals who earned a pension from the 
Government of Belgium for work in one of its overseas territories.

[[Page 51537]]

     Estimated Number of Respondents: 20.
     Estimated Number of Responses: 20.
     Average Time per Response: 30 minutes.
     Total Estimated Burden Time: 10 hours.
     Frequency: Once per respondent.
     Obligation to Respond: Required to obtain a benefit.
    We are soliciting public comments to permit the Department to:
     Evaluate whether the proposed information collection is 
necessary for the proper functions of the Department.
     Evaluate the accuracy of our estimate of the time and cost 
burden for this proposed collection, including the validity of the 
methodology and assumptions used.
     Enhance the quality, utility, and clarity of the 
information to be collected.
     Minimize the reporting burden on those who are to respond, 
including the use of automated collection techniques or other forms of 
information technology.
    Please note that comments submitted in response to this Notice are 
public record. Before including any detailed personal information, you 
should be aware that your comments as submitted, including your 
personal information, will be available for public review.
    Abstract of proposed collection: This collection will implement the 
1982 Agreement Between the Government of the United States of America 
and the Kingdom of Belgium on Social Security, and related agreements. 
This information collection will facilitate compensation for eligible 
claimants in situations where the pension provided by the Government of 
Belgium needs to be supplemented.
    Methodology: The information will be collected on a form, the DS-
7792, Statement of Claim, which can be submitted by mail, email, or 
fax.

    Dated: July 29, 2016.
Lisa J. Grosh,
Assistant Legal Adviser, International Claims and Investment Disputes.
[FR Doc. 2016-18529 Filed 8-3-16; 8:45 am]
 BILLING CODE 4710-08-P