Addendum to Supporting Statement

Addendum 0477.docx

Modified Benefit Formula Questionnaire-Employer

Addendum to Supporting Statement

OMB: 0960-0477

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Addendum to Supporting Statement for Form SSA-58

Modified Benefit Formula Questionnaire-Employer

20 CFR 404.1512-404.1515, 416.912-416.915

OMB No. 0960-0477


Minor Revisions to the Collection Instrument


SSA is making the following revisions:


  • Change #1: We are revising the PRA statement on this form.


Justification #1: 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  The current language, which dates back to the last reprint of the form, is now outdated.


  • Change #2: We are revising the Privacy Act Statement on this form.


Justification #2: 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. Please see the revised PRA and Privacy Act Statements in ROCIS.


  • Change #3: We are making the form electronically fillable.


Justification #3: We are making the form electronically fillable to meet current agency design and accessibility requirements.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleAddendum to the Supporting Statement for Form SSA-3462
Author177717
File Modified0000-00-00
File Created2021-01-14

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