Addendum to the Supporting Statement for 0960-0024

Addendum to the Supporting Statement for Form SSA-787

Physician’s/Medical Officer’s Statement of Patient’s Capability to Manage Benefits

20 CFR 404.2015 and 416.615

OMB No. 0960-0024

Revision to the Collection Instrument

Form SSA-787 will be revised so that the form will openly state that SSA will not pay for medical evidence in a capability determination. This change is being implemented because many medical facilities subsequently bill SSA for providing this evidence. Stating that the Agency will not pay for this information should minimize any confusion about the matter.

Current language (first page of the form, under the heading “YOUR HELP IS NEEDED”):

“Please Note: This determination affects how benefits are paid and has no bearing on disability determinations. Thank you for your help.”

Proposed revision in bold:

“Please Note: This determination affects how benefits are paid and has no bearing on disability determinations. SSA will NOT pay for this information. Thank you for your help.”