Addendum to the Supporting Statement - 0300

Addendum to Supporting Statement for Form HA-4633

Claimant’s Work Background

20 CFR 404.1512(a); 404.1520(a)(4); 404.1565(b)

and 20 CFR 416.912(a); 416.920(a)(4); 416.965(b)

OMB No. 0960-0300

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  The current language, which dates back to the last reprint of the form, is now outdated.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