Addendum to Supporting Statement

Addendum to Supporting Statement for Form SSA-1709

Request for Workers' Compensation/Public Disability Information

20 CFR 404.408(e)

OMB # 0960-0098

Minor Revisions to the Collection Instrument

SSA is making the following revisions:

We are revising the PRA statement to reflect our current boilerplate language.  The current language, which dates back to the last reprint of the form, is now outdated.

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 first page of the form.

Terms of Clearance

SSA agrees to update the burden for this collection (via OMB Form 83-C) to

account for the reduction due to increased use of the SASRO system over time.

The burden for this collection could not be updated via OMB Form 83-C, as SSA no longer uses this form. In addition, Nebraska is the only state that has access to the SASRO system to access workers’ compensation (WC) payment information. In order to obtain WC payment information, SSA submits request using the SSA-1709 via fax to the Nebraska field office for verification.