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Addendum to the Supporting Statement for Form SSA-3462
ICR 202608-0960-005 · OMB 0960-0759 · Object 171627100.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Addendum to the Supporting Statement for Form SSA-3462 |
| Author | 177717 |
| Last Modified By | Writer |
| File Modified | 2026-08-26 |
| File Created | 2026-08-28 |
| Conversion State | complete |
Extracted Text
Addendum to the Supporting Statement for Form SSA-4111
Certificate of Election for Reduced Widow(er)’s and
Surviving Divorced Spouse’s Benefits
20 CFR 404.335
OMB No. 0960-0759
Revisions to the Collection Instrument
• Change #1: 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 the form.
Terms of Clearance
OMB placed the following Terms of Clearance on this Information Collection when they last approved it on 8/31/23:
• Term: Prior to reapproval, the agency will revisit Supporting Statement A Question 2 to more thoroughly describe why and how the SSA-4111 is used.
SSA Response:
SSA provided additional information to Supporting Statement A Question 2 to more thoroughly describe why and how the SSA-4111 is used.