Addendum 0105

Addendum to the Supporting Statement for

Form SSA-1372-BK and SSA-1372-BK-FC

Advance Notice of Termination of Child’s Benefits and

Student’s Statement Regarding School Attendance

20 CFR 404.350-404.352, 404.367-404.368

Minor Revisions to the Collection Instrument

SSA is making the following revisions to SSA-1372-BK-FC:

• Change #1: We are adding the word nearest before “Federal Benefits Unit” in the second bullet.

Justification #1: We are adding the word “nearest” to the language in the second bullet to better identify which Federal Benefits Unit to contact and to be consistent with the foreign contact referral language used in other resources.

• Change #2: We are adding “and Country” to the last line of the address labels in item 1(b) on page 2 of the form.

Justification #2: We are adding the country to the label of the last address line because a foreign address should include the country.

• Change #3: We are revising the language in item 8 on page 3, to comply with the current prisoner/fugitive felony policy requirements.

Justification #3: We are revising the language, because the Social Security Act was amended in 04/2000 to change the requirements for prisoner suspension.

 

• Change #4: We are changing the label in the Signature block on page 4 from “SIGNS” to “SIGNATURE”.

Justification #4: We are changing the label to “SIGNATURE” to be consistent with the language used in the signature block of most forms.

• Change #5: We are revising the language in the last bullet under “IMPORTANT RESPONSIBILITIES” on page 7, to comply with the current prisoner/fugitive felony policy requirements.

Justification #5: We are revising the language, because the Social Security Act was amended in 04/2000 to change the requirements for prisoner suspension.

• Change #6: We are revising the Privacy Act Statement on this form.

Justification #6: 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 #7: We are revising the PRA statement on this form.

Justification #7: 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  The current language, which dates back to the last reprint of the form, is now outdated.