Addendum to the Supporting Statement 0960-0779

Addendum to Supporting Statement for Form SSA-3105

Important Information About Your Appeal, Waiver Rights,

and Repayment Options

20 CFR 404.502-.521

OMB No. 0960-0779

Minor Revisions to the Collection Instrument

SSA is making the following revisions:

• Change #1: We are revising the PRA statement to reflect our current boilerplate language. 

Justification #1: The current language, which dates back to the last reprint of the form, is now outdated.

• Change #2: SSA is updating the Privacy Act Statement on this form.

Justification #2: 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.

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