SSA-3368 Addendum

Addendum to the Supporting Statement for Form SSA-3368

Disability Report-Adult

20 CFR 404.1512 and 416.912

0MB No. 0960-0579

Revision to the Collection Instrument

We made some changes for clarity throughout the document.

We revised questions D.,G., and I. in Section 2 as indicated in the markup of the paper form to more accurately elicit the information we need.

We expanded the wording of the question in Section 8 as indicated in the markup of the paper form to make the respondent more aware of the specific kinds of plans or programs we are asking about.

We restructured the information collected at the bottom of page 10 as indicated in the markup of the paper form to eliminate duplicate information collection if the respondent is either the disabled person or the person identified in Section I Item D. The duplicate information eliminated is the respondent’s address. If the respondent is the disabled person, we will have already collected his or her address on the benefit application form. If the respondent is the person identified in Section I Item D., we will have already collected his or her address in Item D. We need to collect address information here only if the respondent is neither the disabled person nor the person identified in Section I Item D. This information enables us to contact the respondent by mail if we are unsuccessful in doing so by telephone (or email). We want to collect the respondent’s telephone number to permit a more expeditious contact with him or her if we need to clarify information on the form or obtain missing information. We also want to collect relationship information to enable us to determine if the respondent is a proper party who can protect the disabled person’s application filing date.

All the other changes indicated in the markup of the paper form are non-substantive cosmetic or editorial in nature.

Comparable changes appear on both the Internet and EDCS screens.