Addendum to the Supporting Statement for 0960-0671

Addendum - 0671.docx

Acknowledgement of Receipt (Notice of Hearing)

Addendum to the Supporting Statement for 0960-0671

OMB: 0960-0671

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Addendum to the Supporting Statement for

Form HA-504, Acknowledgement of Receipt (Notice of Hearing)

Form HA-L83, Acknowledgement of Receipt (Notice of Hearing) Cover Letter

Form HA-55, Objection to Appearing by Video Teleconferencing

Form HA-510 and HA-510-OP1, Waiver of Written Notice of Hearing

20 CFR 404.936, 404.938, 404.950, 416.1436, 416.1438, 416.1450

OMB No. 0960-0671


Minor Revisions to the Collection Instrument


SSA is making the following revisions:


  • Change #1: We are revising the Privacy Act Statement on these forms.


Justification #1: 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 #2: We are revising the PRA statement on these forms (except for the HA-504, and HA-501-OP1).


Justification #2: 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  The current language, which dates back to the last reprint of the form, is now outdated.


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleAddendum to the Supporting Statement for Form SSA-3462
Author177717
File Modified0000-00-00
File Created2021-02-02

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