Addendum to the Supporting Statement for 0960-0662

Addendum to the Supporting Statement for Form HA-1151

Medical Source Statement of Ability

To Do Work-Related Activities (Physical) and

Form HA-1152 Medical Source Statement of Ability

To Do Work-Related Activities (Mental)

20 CFR 404.1512-404.1513, 416.912-416.913, 404.1517, 416.917

OMB No. 0960-0662

Revisions to the Collection Instrument

SSA is making several minor changes to both forms:

• We are changing “claimant” to “individual” in all instances on both forms

• We added “(s)” to all instances of “supervisor” on the HA-1152 [i.e. “supervisor(s)”]

We highlighted the revised text on the attached forms.

In addition, we are revising the PRA statement to reflect our current boilerplate language because our current language is outdated.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.