Addendum - 0001

Addendum to the Supporting Statement for Form SSA-760

Certificate of Support

20 CFR 404.370, 404.408a, & 404.750

OMB No. 0960-0001

Minor Revisions to the Collection Instruments

SSA is making the following revisions:

• Change #1: We are revising “Enter His (Her) Social Security Number” to “Worker’s Social Security Number.”

Justification#1: We are making this change for consistency purposes.

• Change #2: After “Witnesses are only required if this application has been signed by mark (X) above. If signed by mark (X), two witnesses to the signing who know the applicant making the request must sign below, giving their full addresses.” we are adding “Also, print the applicant’s name in the Signature block.”

Justification #2: We are making this change for consistency purposes.

• Change #3: We are revising the PRA statement on this form.

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  The current language, which dates back to the last reprint of the form, is now outdated.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 Privacy Act Statement on this form.

Justification #4: 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.

SSA will implement these revisions upon OMB’s approval. There are no revisions to the burden for this information collection due to these changes.