Addendum to the Supporting Statement - 0300

Addendum - 0300.docx

Claimant's Work Background

Addendum to the Supporting Statement - 0300

OMB: 0960-0300

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Addendum to Supporting Statement for Form HA-4633

Claimant’s Work Background

20 CFR 404.1512(a); 404.1520(a)(4); 404.1565(b)

and 20 CFR 416.912(a); 416.920(a)(4); 416.965(b)

OMB No. 0960-0300



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.

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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