Addendum - 0045

Addendum to the Supporting Statement for Form SSA-795

Statement of Claimant or Other Person

20 CFR 404.702, 20 CFR 416.570

OMB No. 0960-0045

Revisions to the Collection Instrument

SSA is making the following revisions:

• Change #1: We are revising the Person Statement screen within the SSI Claims System and moving it to the Consolidated Claims Experience (CCE) platform.

Justification #1: The current version of the SSA-795 screen within the SSI Claims Sysetm only allows the technicians to enter the information in the SSI Claims System screen, print it, and obtain a wet signature. The new screen and platform under the CCE, allows the technicians to enter the information to the screen and record how they obtained the signature: either wet signature (i.e., ink) or oral (i.e., attestation). See the screen package for detail screen description.

• Change #2: We updated 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 the form.