Addendum to the Supporting Statement for 0960-0542

Addendum - 0542.docx

Function Report - Child (Birth to 1st Birthday, Age 1 to 3rd Birthday, Age 3 to 6th Birthday, Age 6 to 12th Birthday, Age 12 to 18th Birthday)

Addendum to the Supporting Statement for 0960-0542

OMB: 0960-0542

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Addendum to the Supporting Statement for Function Reports - Child

Forms SSA-3375, SSA-3376, SSA-3377, SSA-3378, and SSA-3379

20 CFR 416.912 and 416.924a(a)(2)

OMB No. 0960-0542



Minor Revisions to the Collection Instrument


SSA is making the following revisions:


  • Change #1: We are revising the Privacy Act Statement on this form.


Justification #1: 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 form.



Future Plans: We intend to make all of the forms in this information collection request fillable. We will submit a Change Request to OMB when we are ready to do so.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleAddendum to the Supporting Statement for Form SSA-3462
Author177717
File Modified0000-00-00
File Created2021-01-23

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