Addendum to the Supporting Statement for 0960-0585

Addendum to the Supporting Statement for Form SSA-437

Discrimination Complaint Form

OMB No. 0960-0585

Terms of Clearance

This request is approved consistent with the revised supporting statement and instrument received in OIRA on 5/3/07, which note material changes to the instrument for clarification purposes. SSA will send the instrument to FMT to be standardized in format upon OMB approval prior to circulation.

SSA is seeking to renew OMB’s approval without changes to the existing information collection. When OMB last approved this information collection instrument on May 16, 2009, its approval was subject to the above Terms of Clearance.

The current instrument is consistent with the revised supporting statement and instrument received in OIRA on May 3, 2007. The current instrument made clarifying changes to the earlier version of the form and we have no interest in reversing those changes, nor are we adding any further substantive revisions at this time. As listed below, we are merely updating the Privacy Act and Paperwork Reduction Act statements.

Revisions to the Collection Instrument

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 this form.

1