Addendum to the Supporting Statement 0960-0470

Addendum to the Supporting Statement for

Form SSA-L4163 Employer Questionnaire

20 CFR 404.408a

OMB No. 0960-0470

Minor Revisions to the Collection Instrument

Change: We are removing the word Signature and replacing with “Name of Individual Completing Form” on Form SSA-L4163.

Justification: No signature is required on this form. The form is completed by the pension- paying agency. There is no regulatory requirement for a signature.

We will start using the new version upon OMB approval. We can continue to use the old version until we run out of copies and then switch to the new version.

Change: We are removing the Privacy Act Statement from the collection instrument.

Justification:

We are removing the Privacy Act Statement from the collection instrument at the recommendation of Social Security Administration’s (SSA) Office of General Counsel (OGC). Per OGC, since SSA is not using this collection instrument to collect personal information directly from individuals, a Privacy Act Statement is not required.

Change: Updating Paperwork Reduction (PRA) Act Statement.

Justification:

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  The current language, which dates back to the last reprint of the form, is now outdated.