Addendum to Supporting Statement

Addendum 0635.doc

Function Report - Adult Third Party

Addendum to Supporting Statement

OMB: 0960-0635

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Addendum to Supporting Statement for Function Report – Adult Third Party

20 CFR 404.1512 and 20 CFR 416.912

Form SSA-3380-BK

OMB No. 0960-0635


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  The current language, which dates back to the last reprint of the form, is now outdated.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 Typeapplication/msword
File TitleAddendum to the Supporting Statement for Form SSA-3462
Author177717
Last Modified By889123
File Modified2012-07-12
File Created2012-07-12

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