Addendum to Supporting Statement 0960-0739

Addendum 0960-0739.doc

Certificate of Incapacity

Addendum to Supporting Statement 0960-0739

OMB: 0960-0739

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Addendum to the Supporting Statement for Form SSA-604

Certificate of Incapacity

5 CFR 890.302(d)


OMB No. 0960-0739



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  The current language, which dates back to the last reprint of the form, is now outdated.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

File Typeapplication/msword
File TitleAddendum to the Supporting Statement for Form SSA-3462
Author177717
Last Modified By889123
File Modified2013-01-17
File Created2013-01-17

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