Addendum to the Supporting Statement for 0960-0623

Addendum to the Supporting Statement for Form SSA-827

Authorization to Disclose Information to the Social Security Administration (SSA)

20 CFR Subpart P, 404.1512 and Subpart I, 416.912

OMB No. 0960-0623

Revision to the Collection Instrument

The fourth sub-item of item 1 in the “OF WHAT” section on the SSA-827 has two clauses. The first is, “Records which may indicate the presence of a communicable or venereal disease which may include, but are not limited to, diseases such as hepatitis, syphilis, gonorrhea and the human immunodeficiency virus, also known as Acquired Immune Deficiency Syndrome (AIDS),” This clause represents former Oklahoma State law language for medical release forms. The second clause is, “and tests for HIV.”

On November 1, 2007, the State of Oklahoma revised the language in its law to read, “Records which may indicate the presence of a communicable or non-communicable disease.” We are, therefore, revising the first clause in the fourth sub-item of item 1 in the “OF WHAT” section on the SSA-827 to reflect this revised language. We asked legal counsel for all States, the District of Columbia, and the U.S. Territories whether substituting the revised Oklahoma State law language on the SSA-827 in place of the former Oklahoma State law language would cause any medical records disclosure problems in their jurisdiction. The Pennsylvania Assistant Attorney General requested we expand the language in the second clause to read, “and tests for or records of HIV/AIDS” to ensure full compliance with Pennsylvania State law, and we are complying with this request. Legal counsel for all other jurisdictions advised us that they have no problem with the revised Oklahoma State law language.

To facilitate obtaining records from workers’ compensation programs and insurance companies who pay disability benefits, we are specifically identifying these sources in the “FROM WHOM” section.

To eliminate any confusion about the intent of the double dashes in the sub-items of

item 1 in the “OF WHAT” section, we are changing the dashes to bullets. This will also make the formatting consistent with that used in the ‘FROM WHOM” and “EXPIRES WHEN” sections.

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