Addendum to Supporting Statement

Addendum to supporting statement SSA 773.doc

Waiver of Right to Appear--Disability Hearing

Addendum to Supporting Statement

OMB: 0960-0534

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Addendum to the Supporting Statement for Form SSA-773-U4

Waiver of Right to Appear – Disability Hearing

20 CFR 404.913-.914, 404.916(b)(5), 416.1413-.1414, 416.1416(b)(5)

OMB No. 0960-0534



Minor Revisions to the Collection Instrument


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  The current language, which dates back to the last reprint of the form, is now outdated.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


File Typeapplication/msword
File TitleAddendum to the Supporting Statement for Form SSA-3462
Author177717
Last Modified By889123
File Modified2012-03-20
File Created2012-03-20

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