Addendum for Certificate of Incapacity

Addendum for Certificate of Incapacity.doc

Certificate of Incapacity

OMB: 0960-0739

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Addendum for Supporting Statement for Form SSA-604

Certificate of Incapacity

5 CFR 890.302(d)

OMB No. 0960-0739




Terms of Clearance


SSA agrees to clarify is justification for why the expiration date for this OMB control number will not be printed on the forms (both in this and in future supporting statements.


SSA has met the above terms. The expiration date has been added to the form.


SSA agrees to add a question about how long the child’s condition is expected to last, given that one of the criteria for certifying a qualifying disability is that the disability will last for at least a year.


SSA has met the above terms. We added the how long is the child’s condition question to form SSA-604.


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  The current language, which dates back to the last reprint of the form, is now outdated.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



File Typeapplication/msword
File TitleAddendum for Certificate of Incapacity
AuthorMandley, Tasha
Last Modified ByMandley, Tasha
File Modified2009-12-10
File Created2009-12-10

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