Document
Addendum-0646 (Final)
ICR 202607-0960-002 · OMB 0960-0646 · Object 171408800.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Addendum-0646 (Final) |
| Author | LP/RRC |
| Last Modified By | Writer |
| File Modified | 2026-07-30 |
| File Created | 2026-08-01 |
| Conversion State | complete |
Extracted Text
Addendum to the Supporting Statement for
Teacher Questionnaire, Form SSA-5665-BK
Request for Administrative Information, Form SSA-5666
20 CFR 404.1513, 416.913, and 416.924a(a)
OMB No. 0960-0646
Revisions to the Collection Instruments
Paper SSA-5665-BK and Form SSA-5666 (and Fillable PDF Version):
We are making the following revisions:
• Change: We are revising the Privacy Act Statements on these forms.
Justification: 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.
We will implement these revisions upon OMB’s approval. These revisions do 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 07/20/2023:
• Term: The agency made minor modifications to the supporting statement to clarify the description of the information collection and how it is submitted. The agency made a minor modification to the form to clarify when a respondent should leave a response blank.
SSA response: SSA complied with OMB’s request to clarify the description of the information collection and its submission process in the supporting statement, and to update the form to specify when respondents should leave a response blank, prior to OMB’s last approval. We have maintained these revisions in the submitted documentation.