Addendum to the Supporting Statement for 0960-0142

Addendum - 0142.doc

Statement of Death by Funeral Director

Addendum to the Supporting Statement for 0960-0142

OMB: 0960-0142

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Addendum to the Supporting Statement for Form SSA-721

Statement of Death by Funeral Director

20 CFR 404.715 and 404.720

OMB No. 0960-0142



Revisions to the Collection Instrument


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 The current language, which dates back to the last reprint of the form, is now outdated.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

File Typeapplication/msword
File TitleAddendum to the Supporting Statement for Form SSA-2528
AuthorNaomi Lebowitz
Last Modified By889123
File Modified2011-05-26
File Created2011-05-26

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