Addendum to the Supporting Statement 0960-0681

Addendum - 0681.docx

Function Report - Adult

Addendum to the Supporting Statement 0960-0681

OMB: 0960-0681

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Addendum to the Supporting Statement for Form SSA-3373-BK

Function Report – Adult

20 CFR 404.1512 and 20 CFR 416.912

OMB No. 0960-0681



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.


  • Change #2: We are revising the PRA statement on this form.


Justification #2: 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  The current language, which dates back to the last reprint of the form, is now outdated.

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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