Addendum - 0481

Addendum - 0481 (Final).docx

Statement of Funds You Provided to Another, Statement of Funds You Received

Addendum - 0481

OMB: 0960-0481

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Addendum to the Supporting Statement for Forms SSA-2854 & SSA-2855

Statement of Funds You Provided to Another and Statement of Funds You Received

20 CFR 416.1103(f)

OMB No. 0960-0481


Minor Revisions to the Collection Instruments


SSA is making the following revisions:


  • Change #1: We are revising the PRA statements on these forms.


Justification #1: We are revising the PRA statements to reflect our current boilerplate language.  The current language, which dates back to the last reprint of the forms, is now outdated.


  • Change #2: We are revising the Privacy Act Statements on these forms.


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 Statements on these forms.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleAddendum to the Supporting Statement for Form SSA-3462
Author177717
File Modified0000-00-00
File Created2021-04-16

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