Addendum - 0576

Addendum - 0576.docx

Representative Payee Report of Benefits and Dedicated Account

Addendum - 0576

OMB: 0960-0576

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Addendum to Supporting Statement for Form SSA-6233

Representative Payee Report of Benefits and Dedicated Account

20 CFR 416.546, 416.635, 416.640, 416.665

OMB No. 0960-0576



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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