Addendum - 0576

Addendum - 0576 (Final).docx

Representative Payee Report of Benefits and Dedicated Account

Addendum - 0576

OMB: 0960-0576

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Addendum to the Supporting Statement for Form SSA-6233-BK

Representative Payee Report of Benefits and Dedicated Account

20 CFR 416.546, 416.635, 416.640, 416.665

OMB No. 0960-0576


Minor Revisions to the Collection Instruments


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  The current language, which dates back to the last reprint of the form, is now outdated.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 Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleSupporting Statement For Form HA-539, Notice Regarding Substitution of Party Upon Death of Claimant
Author689830
File Modified0000-00-00
File Created2021-11-29

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