Addendum to Supporting Statement for 0960-0602

Addendum for Supporting Statement for Form SSA-581

Authorization to Obtain Earnings Data

From the Social Security Administration

OMB No. 0960-0602

Revision to the Collection Instrument

• Change #1: Removed Division of Business Service from the Mail Completed Form to section.

Justification #1: In the last two years, the department responsible for receiving the SSA-581 form changed three times. We no longer want to designate the department handling the forms to avoid changing the form again

• Change #2: Revising the language “RA PENF 09 8XXX” from the Requesting Organization section to SSA Job No. 8### Index 01.

Justification #2: The RA PENF 8XXX is another way of saying the SSA issued Job No. Changing this language on the form will provide the public with clarity when calling SSA to inquire the status of a request.

• Change #3: Revising the language from “Periods” to “Years(s)” in the Periods Requested section.

Justification #3: SSA no longer provides the wages by specific periods requested. Removing the language periods from this process and replacing it with years, as SSA no longer allows the public to request wages by the quarterly periods. Changing the language will provide the public with clarity so that they understand that they are requesting years.

• Change #4: Removed all four of the month section from the “Periods Requested” section.

Justification #4: SSA no longer provides the wages by specific periods requested. SSA no longer allows the public to request wages by the quarterly periods. Changing the language will provide the public with clarity so that they understand that they are requesting years.

• Change #5: Added the MM-DD-YYYY to the bottom of the “Signature Date” field.

Justification #5: The public continues to complete the form improperly without putting the two-digit month and two-digit day in the appropriate fields; this causes SSA to reject the form. Making this change will assist the public in properly completing the forms and reduce the number of rejects.

• Change #6: Revised the language in the ‘Relationship’ field from Natural or adoptive parent to Spouse.

Justification #6: Majority of the forms SSA-581 are completed by the spouse. Revising this language makes the form easier for the public to complete.

• Change #7: Revised the language in the ‘Relationship’ field from Guardian to Representative.

Justification #7: Revising this language clarifies the language for the public.

• Change #8: Added the language “SSA must receive this form within 60 days from the date signed by the Number Holder (or Authorized Representative).” in the “Requesting Organization’s Information.”

Justification #8: SSA must reject many forms not submitted within 60 days of the Number Holder (or Authorized Representative) signature. Placing this language on the form will remind the requestors of the urgency of submitting the forms a soon as possible.

• Change #9: SSA is revising the Privacy Act (PA) Statement for this form.

• Justification #9: SSA’s OGC is conducting a systematic review of the PA Statements on agency forms, and created a new PA Statement for this one.

Upon OMB’s approval, we plan to destroy the stock of the old version so we can begin using the new version of the form immediately.