Addendum to Supporting Statement for 0960-0540

Addendum - 0540.doc

Pain Report - Child

Addendum to Supporting Statement for 0960-0540

OMB: 0960-0540

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Addendum to the Supporting Statement for Form SSA-3371-BK

Pain Report – Child

20 CFR 404.1512 and 416.912

OMB No. 0960-0540



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 The current language, which dates back to the last reprint of the form, is now outdated.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 Statement on agency forms. As a result, SSA is adding a Privacy Act Statement to this form.


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File Modified2012-10-19
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