Addendum to the Supporting Statement 0960-0292

Addendum - 0292.docx

Claimant's Recent Medical Treatment

Addendum to the Supporting Statement 0960-0292

OMB: 0960-0292

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Addendum to the Supporting Statement for Form HA-4631

Claimant's Recent Medical Treatment

20 CFR 404.1512 and 416.912

OMB No. 0960-0292


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 Created2021-01-21

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