Addendum To Supporting Statement 0960-0292

Addendum to Supporting Statement for Form HA-4631,

Claimant’s Recent Medical Treatment

20 CFR 404.1512 and 416.912

OMB#0960-0292

Terms of Clearance

In reviewing its electronic forms process, SSA agrees to consider this form as a candidate for electronic submission. Upon resubmission of this form for OMB approval, SSA will either (1) make this form electronically available; or (2) provide OMB with a detailed explanation of why electronic submission was not feasible.

In compliance with the Terms of Clearance, SSA has made electronic submission of Form HA-4631 available for claimants who appoint a representative. The claimant’s representative can access the HA-4631 through the Electronic Records Express initiative. Appointment of a representative occurs in about 75-80% of claimant cases.

Electronic submission of Form HA-4631 is not currently available to unrepresented claimants. SSA is currently exploring the feasibility of electronic submission of Form HA-4631 for claimants who do not appoint a representative.

.Minor Revisions to the Collection Instrument

SSA is making the following revisions:

We are revising the PRA statement to reflect our current boilerplate language.  The current language, which dates back to the last reprint of the form, is now outdated.

SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the first page of the form.