Addendum to the Supporting Statement - 0960-0662

Addendum to Supporting Statement for

Form HA-1151 Medical Statement of Ability

To Do Work-Related Activities (Physical) and

Form HA-1152 Medical Statement of Ability

To Do Work-Related Activities (Mental)

20 CFR 404.1512-404.1513, 416.912-416.913, 404.1517, and 416.917

OMB No. 0960-0662

Revisions to the Collection Instrument

SSA is making the following revisions to the collection instruments:

• Change #1: We are renaming the Forms HA-1151 and HA-1152, as we removed the word “Source” from the titles.

Justification #1: The final rule “Revisions to Rules Regarding Evaluation of Medical Evidence” eliminated the treating source rule and changed how we consider medical opinions. Since the final rule changed the terminology, we are updating the titles accordingly.

• Change #2: Removed “Office of Disability Adjudication and Review” from the title bar.

Justification #2: We reevaluated this form, and do not believe the individual office name is necessary, as the form is a Social Security Administration form, we do not need to indicate on the form which individual office will process the information.

• Change #3: We are revising the Privacy Act Statements on these forms.

Justification #3: 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  The current language, which dates back to the last reprint of the form, is now outdated.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 #4: We are revising the PRA statement on these forms.

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  The current language, which dates back to the last reprint of the form, is now outdated.

We will implement these revisions upon OMB’s approval. These revisions will not change the burden information for this information collection.