Addendum to Supporting Statement 0578

Addendum 0578.doc

Work History Report

Addendum to Supporting Statement 0578

OMB: 0960-0578

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Supporting Statement for Form SSA-3369-BK

Work History Report

CFR 404.1512, 416.912, 404.1560, 404.1565, 416.960 and 416.965

OMB No. 0960-0578



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  The current language, which dates back to the last reprint of the form, is now outdated.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 Modified2017-05-03
File Created2017-05-03

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