Justification for Non-Substantive Change to 0960-0017

Justification for the Change to Form SSA-753

Statement Regarding Marriage

20 CFR 404.726

OMB # 0960-0017

Justification for Non-Substantive Changes to Form SSA-753

We are making revisions to our Privacy Act Statement and our Perjury Statement for the SSA-753 in order to comply with new anti-fraud language that SSA is implementing.

SSA’s Office of the General Counsel for Program Law found instances on SSA’s public use forms in which the certification statements were missing language. To rectify this, we are making changes to the Perjury Statement in order to adopt a consistently-worded penalty statement for use on all applicable forms. The new statement reads as follows:

I declare under penalty of perjury that I have examined all the information on this form, and on any accompanying statements or forms, and it is true and correct to the best of my knowledge. I understand that anyone who knowingly gives a false or misleading statement about a material fact in this information, or causes someone else to do so, commits a crime and may be sent to prison, or may face other penalties, or both.

SSA will adopt the following abbreviated version for use on forms which can not accommodate the above version:

I declare under penalty of perjury that I have examined all the information on this form, and on any accompanying statements or forms, and it is true and correct to the best of my knowledge.

In reviewing this form, we also found our Privacy Act Statement to be inaccurate. Therefore, we are updating the Privacy Act Statement as well so that it contains all of the correct information.

The attached revised SSA-753 contains the revisions to the Perjury Statement, Privacy Act Statement and PRA. These changes will be implemented upon receipt of OMB approval.