Addendum to Supporting Statement

Addendum to the Supporting Statement 0059.doc

Work Activity Report--Employee

Addendum to Supporting Statement

OMB: 0960-0059

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Addendum to the Supporting Statement for Form SSA-821-BK,

Work Activity Report-Employee

20 CFR 404.1520(b), 404.1571-.1576, 404.1584-.1593 and 416.971-.976

OMB No. 0960-0059



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  The current language, which dates back to the last reprint of the form, is now outdated.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


We are attaching the revised PRA and Privacy Act Statement in ROCIS.

File Typeapplication/msword
File TitleAddendum to the Supporting Statement for Form SSA-3462
Author177717
Last Modified By889123
File Modified2015-07-30
File Created2014-06-16

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