Addendum - 0779

Addendum - 0779 (Final).docx

Important Information About Your Appeal, Waiver Rights and Repayment Options

Addendum - 0779

OMB: 0960-0779

Document [docx]
Download: docx | pdf

Addendum to the Supporting Statement for Form SSA-3105

Important Information about Your Appeal, Waiver Rights, and Repayment Options

20 CFR 404.502a

OMB No. 0960-0779


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  The current language, which dates back to the last reprint of the form, is now outdated.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 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 Created2022-01-15

© 2024 OMB.report | Privacy Policy