Addendum to the Supoorting Statement for 0960-0247

Addendum - 0247.docx

Workers' Compensation/Public Disability Benefit Questionnaire

Addendum to the Supoorting Statement for 0960-0247

OMB: 0960-0247

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Addendum to the Supporting Statement for SSA-546

Workers' Compensation/Public Disability Benefit Questionnaire

20 CFR 404.408

OMB No. 0960-0247



Minor Revisions to the Collection Instrument


SSA is making the following revision:


  • Change #1: We are removing the paper and fillable PDF versions of Form SSA-546 from this information collection.


Justification #1: As we mentioned in #3 of the Supporting Statement, we no longer use the paper or fillable PDF versions of this form. All respondents use the Modernized Claims System version of the form as part of a personal interview with a field office employee.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleAddendum to the Supporting Statement for Form SSA-3462
Author177717
File Modified0000-00-00
File Created2021-01-22

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