Addendum to the Supporting Statement for 0960-0722

Addendum - 0722.doc

Request for Evidence from Doctor or Hospital

Addendum to the Supporting Statement for 0960-0722

OMB: 0960-0722

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Addendum to the Supporting Statement for Request for Evidence from Doctor (HA-66) and Evidence from Hospital (HA-67)

20 CFR 404 Subpart P and 20 CFR 416 Subpart I

OMB No. 0960-0722



Revisions to the Collection Instrument


We are revising the PRA statements 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 The current language, which dates back to the last reprint of the form, is now outdated.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 Statements on these forms.

File Typeapplication/msword
File TitleAddendum to the Supporting Statement for Form SSA-2528
AuthorNaomi Lebowitz
Last Modified By889123
File Modified2011-03-10
File Created2011-03-10

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