Addendum to the Supporting Statement for Form SSA-4640
Authorization for the Social Security Administration to
Obtain Account Records from a Financial Institution and
Request for Records (Medicare)
20 CFR 418.3420
OMB No. 0960-0729
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 The current language, which dates back to the last reprint of the form, is now outdated.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.
| File Type | application/msword |
| File Title | Addendum to the Supporting Statement for Form SSA-3462 |
| Author | 177717 |
| Last Modified By | 889123 |
| File Modified | 2012-05-22 |
| File Created | 2012-04-18 |