Addendum to Supporting Statement

Addendum to the Supporting Statement for Form SSA-3830

Certification of Low Birth Weight for SSI Eligibility

20 CFR 416.931, 416.926a(m) (7) & (8) and 416.924

OMB # 0960-0720

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  The current language, which dates back to the last reprint of the form, is now outdated.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.

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