Addendum to Supporting Statement - 0689

Addendum to Supporting Statement for Form SSA-704

Certification of Contents of Document(s) or Record(s)

20 CFR 404.707, 404.715, 404.716, 404.720, 404.721, 404.723,

404.725, 404.727, 404.728, 404.730, 404.731, 404.732, 404.733,

404.735, 404.1370, 404.1371, 408.202 and 408.216

OMB No. 0960-0689

Minor Revisions to the Collection Instrument

SSA is making the following revisions:

• Change # 1: We are revising the language on the label “Birthday Age Shown” on Page 1, Section A.

Old Language: Birthday Age Shown

New Language: Birthday Age as Shown on Evidence

Justification #1: We are updating to clarify that Birthday Age on the evidence could differ than Age.

• Change #2: We are revising the language on the label “Nature of Evidence” on page 1, Sections A, B, C and D,

Old Language: Nature of Evidence

New Language: Type of Evidence

Justification #2: We are updating the label to provide clarity.

• Change #3: Page 1, Section A, we are updating the box “Other” (Relationship to Applicant”) in two places for this section and in one place in Section C.

Old Language: “Other” (Relationship to Applicant”)

New Language: Other (Please enter Relationship of Custodian to the Applicant)

Justification #3: We are updating the description for “Other” to provide clarity when the document is in neither the custody of the applicant nor record custodian.

• Change #4: Page 1, Section B, we are replacing terms “husband” and “wife” with gender neutral terms.

Old Language: “husband” and “wife”

New Language: “spouse”

Justification #4: This will align with the gender-neutral terms used on our other SSA forms.

• Change #5: Page 1, Section C, updating the label “Death.”

Old Language: Death

New Language: Death Certificate

Justification #5: We are updating the label to clarify that the evidence was in the form of a death certificate.

• Change #6: Page 1, Section E, “Explanation of Record” Question # 2, we are reformatting the boxes and removing the box labelled ballpoint pen.

Justification #6: We are revising to align the boxes with the labels, and we are removing the box for ballpoint pen since we already have a box labelled “Ink.”

• Change # 7: Page 2, Section G, Official Title section, we need to update the job titles as shown in the chart below.

Official Title	New Title/ Comments
Senior Claims Specialist	Claims Technical Expert
Claims Representative	Claims Specialist
Field Representative	Remove
Service Representative	Customer Service Representative
Data Review Technician	Remove
Quality Assurance Specialist	Quality Assurance Technician
State Record Custodian	Remove

Justification #7: We are updating the job titles to reflect the titles currently in use.

• Change #8: We are revising the Privacy Act Statement on this form.

Justification #8: 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.