Request for Workers’ Compensation/Public Disability Benefit Information
20 CFR 404.408(e)
OMB No. 0960-0098
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 The current language, which dates back to the last reprint of the form, is now outdated.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 this form.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Supporting Statement For Form HA-539, Notice Regarding Substitution of Party Upon Death of Claimant |
| Author | 689830 |
| File Modified | 0000-00-00 |
| File Created | 2021-09-05 |