Addendum to the Supporting Statement for Form SSA-3462

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Addendum to the Supporting Statement for
Forms SSA-3192 and SSA-3193
Medical Permit Parking Application Forms
41 cfr 102-74.305
omb No. 0960-0624

Minor Revisions to the Collection Instrument

SSA is making the following revisions:

    • Change #1:  We removed the PO Box and updated the mailing address on both Forms SSA‑3192 and SSA-3193.

Justification #1:  We discontinued use of the PO Box address because we no longer had funds available to maintain it.

    • Change #2:  We removed Form SSA-3194 from our Information Collection.

Justification #2:  We removed Form SSA-3194 from our information collection because it is no longer needed; fewer than 10 respondents per year fail to recover within the expected duration provided by the physician, eliminating the need for renewal.

    • Change #3:  We are revising the Privacy Act Statement on this form.

Justification #3:  SSA’s Office of Law and Policy / Privacy & Disclosure Policy 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.

SSA will implement these revisions upon OMB’s approval.  These revisions will not affect the current burden for this information collection.

Terms of Clearance

OMB placed the following Terms of Clearance on this Information Collection when they last approved it on 7/20/23:

    • Term:  SSA modified this form to allow for full electronic signing, completion, and submission.

SSA response:  We created a fully electronic submission method, that also allows for eSignature (as discussed in #3 of the Supporting Statement).