Addendum to the Supporting Statement 0960-0779

Addendum to Supporting Statement for

Form SSA-3105

Important Information About Your Appeal, Waiver Rights,

and Repayment Options

20 CFR 404.502-.521

OMB No. 0960-0779

Terms of Clearance

This collection should be reported as a violation in OMB’s annual ICB report.

SSA Response

SSA reported this collection as a violation (collection in use without an OMB number) in SSA’s April 22, 2011 reply to OMB’s fiscal year 2011 Data Call for the 2011 Information Collection Budget (Mr. Cass Sunstein’s February 23, 2011 memo “Minimizing Paperwork and Reporting Burdens; Data Call for the 2011 Information Collection Budget”).

Minor Revisions to the Collection Instrument

SSA is making the following revisions:

SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms and other information collection instruments. As a result, SSA is updating the Privacy Act Statement on electronic application.

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