Addendum to Supporting Statement 0470

Addendum 0470.doc

Agency/Employer Government Pension Offset Questionnaire

Addendum to Supporting Statement 0470

OMB: 0960-0470

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Supporting Statement for Form SSA-L4163

Agency/Employer Government Pension Offset Questionnaire

20 CFR 404.408(a)

OMB No. 0960-0470



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 the Supporting Statement for Form SSA-3462
Author177717
Last Modified BySYSTEM
File Modified2019-08-01
File Created2019-08-01

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