Addendum to Supporting Statement

Addendum for Form SSA-4-BK

Application for Child’s Insurance Benefits

20 CFR 404-350 – 404.368 and 404.603, CFR 414.350

OMB No. 0960-0010

Terms of Clearance

There are no terms of clearance.

Revisions to the Collection Instrument

Change 1: We are revising question three on page one of the SSA-4-BK.

Old Language:

The Worker's children (including natural children, adopted children, and stepchildren) or dependent grandchildren (including stepgrandchildren) may be eligible for benefits based on the earnings record of the Worker. For a living Worker, the information below applies to this month or to any of the past 12 months. For a deceased Worker, the information below applies to the date of death or for any period since the Worker's death. Also list any student who is between the ages of 18 and 23 if the student was both: 1) previously entitled to Social Security benefits on any Social Security record for August 1981, and 2) was also in full-time attendance at a post-secondary school for May 1982.

LIST BELOW ALL SUCH CHILDREN (IN ORDER OF BIRTH BEGINNING WITH THE OLDEST) who are now, or who were at the appropriate time (above), UNMARRIED and:

• UNDER AGE 18

• AGE 18 TO 19 (OR TO AGE 23 FOR MONTHS PRIOR TO AUGUST 1982) AND ATTENDING SECONDARY SCHOOL

• DISABLED OR HANDICAPPED (age 18 or over and disability began before age 22)

New Language:

The Worker's children (including natural children, adopted children, and stepchildren) or dependent grandchildren (including stepgrandchildren) may e eligible for benefits based on the earnings record of the Worker. For a living Worker, the information below applies to this month or to any of the past 12 months. For a deceased Worker, the information below applies to the date of death or for any period since the Worker's death.

LIST BELOW ALL SUCH CHILDREN (IN ORDER OF BIRTH BEGINNING WITH THE OLDEST) who are now, or who were at the appropriate time (above), UNMARRIED and:

• UNDER AGE 18

• AGE 18 TO 19 AND ATTENDING ELEMENTARY OR SECONDARY SCHOOL FULL-TIME

• DISABLED OR HANDICAPPED (age 18 or over and disability began before age 22)

Justification 1: Question three includes some outdated language. The dates used in that question describe an age group of people that are no longer students. We are deleting the language that uses those outdated dates and rewording the language to make it read more smoothly.

Change 2: We are adding a bullet item under the heading HOW TO REPORT on page nine of the SSA-4-BK and on page one of the SSA-4-INST.

Old Language:

HOW TO REPORT

You can make your reports by telephone, mail, or in person, whichever you prefer.

If you are awarded benefits and one or more of the above change(s) occur, you should report by:

• Calling us TOLL FREE at 1-800-772-1213;

• If you are deaf or hearing impaired, calling us TOLL FREE at TTY 1-800-325-0778; or

• Calling, visiting or writing your local Social Security office at the phone number and address above.

For general information about Social Security, visit our web site at www.socialsecurity.gov.

For those under full retirement age, the law requires that a report of earnings be filed with SSA within 3 month and 15 days after the end of any taxable year in which the child earns more than the annual exempt amount. You may contact SSA to file a report for the child. Otherwise, SSA will use the earnings reported by the child's employer(s) and the child's self-employment tax return (if applicable) as the report of earnings required by law, to adjust benefits under the earnings test. It is your responsibility to ensure that the information you give concerning the child's earnings is correct.

New Language:

HOW TO REPORT

You can make your reports by telephone, mail, or in person, whichever you prefer.

If you are awarded benefits and one or more of the above change(s) occur, you should report by:

• Visiting the section “What You Can Do Online” at our web site at ww.socialsecurity.gov;

• Calling us TOLL FREE at 1-800-772-1213;

• If you are deaf or hearing impaired, calling us TOLL FREE at TTY 1-800-325-0778; or

• Calling, visiting or writing your local Social Security office at the phone number and address above.

For general information about Social Security, visit our web site at www.socialsecurity.gov.

For those under full retirement age, the law requires that a report of earnings be filed with SSA within 3 month and 15 days after the end of any taxable year in which the child earns more than the annual exempt amount. You may contact SSA to file a report for the child. Otherwise, SSA will use the earnings reported by the child's employer(s) and the child's self-employment tax return (if applicable) as the report of earnings required by law, to adjust benefits under the earnings test. It is your responsibility to ensure that the information you give concerning the child's earnings is correct.

Justification 2: A bullet item was added to show that if awarded benefits, changes can be made under the “What Can You Do Online” section of our website. Our website address was also added to that item.

The new version of this document will be used immediately after OMB approval. The old version of this IC should be destroyed.

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