Addendum to Supporting Statement

0960-0098 Addendum.doc

Request for Workers' Compensation/Public Disability Benefit Information

Addendum to Supporting Statement

OMB: 0960-0098

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Addendum to the Supporting Statement for Form SSA-1709

Request for Workers’ Compensation/Public Disability Benefit Information

20 CFR 404.408(e)

OMB No. 0960-0098





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/msword
File TitleADDENDUM TO SUPPORTING STATEMENT
AuthorNaomi
Last Modified BySYSTEM
File Modified2018-04-24
File Created2018-04-24

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