Addendum to Supporting Statement 0105

Addendum 0105.doc

Advanced Notice of Termination of Child's Benefits, and Student's Statement Regarding School Attendance

Addendum to Supporting Statement 0105

OMB: 0960-0105

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Addendum to the Supporting Statement for

Form SSA-1372-BK and SSA-1372-BK-FC

Advance Notice of Termination of Child’s Benefits and

Student’s Statement Regarding School Attendance

20 CFR 404.350-404.352, 404.367-404.368




Minor Revisions to the Collection Instrument


SSA is making the following revisions:


  • Change #1: We are revising the PRA statement on this form.


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  The current language, which dates back to the last reprint of the form, is now outdated.


  • Change #2: We are revising 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 form.

File Typeapplication/msword
File TitleAddendum to the Supporting Statement for Form SSA-3462
Author177717
Last Modified ByMandley, Tasha
File Modified2017-04-18
File Created2017-04-18

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