Addendum to the Supporting Statement for 0960-0020

Addendum to Supporting Statement for Form SSA-783

Statement Regarding Contributions

20 CFR 404.360 - 404.366 and 404.736

OMB No. 0960-0020

Revisions to the Information Collection

SSA is making the following revisions:

• Change #1: We are revising the item for the name of the person completing the form as follows:

From:

PRINT NAME YOUR FULL NAME (FIRST NAME, MIDDLE INITIAL, LAST NAME)

To:

PRINT YOUR FULL NAME (FIRST NAME, MIDDLE INITIAL, LAST NAME).

Justification #1: We are revising this item to remove the repetitive use of the word “NAME.”

• Change #2: We are revising question 1(c) as follows:

From:

If any contributions ended before the wage earner’s or self-employed person’s death or, if living, before application was filed, give name of contributor and why he stopped.

To:

If any contributions ended before the wage earner’s or self-employed person’s death or, if living, before application was filed, give name of contributor and why contributions stopped.

Justification #2: We are removing the word “he” and replacing it with gender‑neutral language.

• Change #3: We are revising the Privacy Act Statement on this form.

Justification #3: 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 #4: We are revising the PRA statement on this form.

Justification #4: 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  The current language, which dates back to the last reprint of the form, is now outdated.

These revisions do not affect the burden for this information collection request. We will make these revisions upon OMB’s approval.