Addendum to Supporting Statement

Addendum for Application for Child’s Insurance Benefits

20 CFR 404-350 – 404.368 and 404.603, CFR 416.350

OMB No. 0960-0010

SSA is making the following revisions:

Change 1: We are changing the statement on page 1, under the form title

• Old Language:

I apply on behalf of the child or children listed in item 3 below for all insurance benefits for which they may be eligible under Title II (Federal Old-Age, Survivors and Disability Insurance) of the Social Security Act, as presently amended. (If you are applying on your own behalf, answer the questions on this form with respect to yourself.

• New Language:

With this application, you are applying on behalf of the child or children listed in item 3 below for all insurance benefits for which they may be eligible under Title II (Federal Old-Age, Survivors, and Disability Insurance) of the Social Security Act as presently amended. If you are applying on your own behalf, answer the questions on this form with respect to yourself.

Justification 1: We made this change to make the first paragraph and second paragraph in this statement the same tone.

Change 2: We removed the statement on page 4, immediately following item 16, and removed questions 17 and 18.

Justification 2: We removed fugitive felon questions from all title II applications because of the Ready Retirement Initiative. The questions could not be answered by a claimant on an Internet application correctly without further development by the field office once the beneficiary electronically file the Internet application. This additional development defeated the goal of filing applications electronically via the internet.

Change 3: We renumbered items 19 through 29.

Justification 3: We renumbered these items because of the deletion of items 17 and 18.

Change 4: We revised the direct deposit question on page 6, and added a block to enroll in Direct Express.

• Old Language:

FOR OFFICIAL USE ONLY	DIRECT DEPOSIT PAYMENT ADDRESS (FINANCIAL INSTITUTION)
	Routing Transit Number	C/S Number	Depositor Account Number	No Account
				Direct Deposit Refused

• New Language:

DIRECT DEPOSIT PAYMENT ADDRESS (FINANCIAL INSTITUTION)
Routing Transit Number	Account Number	Checking Savings	Enroll in Direct Express
			Direct Deposit Refused

Justification 4: We revised the question, because of the Department of Treasury’s mandate to issue benefit payments electronically, this question is required in the Modernized Claims Systems (MCS). Revising this question avoids having to recontact the applicant.

Change 5: We are revising the language on page 8, Changes To Be Reported And How To Report, fifth bullet in left column.

• Old Language:

(Name of Child) (is) (is not) self-employed. rendering substantial services in a trade or business.

• New Language:

(Name of Child) (is) (is not) self-employed and rendering substantial services in a trade or business.

Justification 5: We revised the language to correct topographical errors.

Change 6 We revised the language on page 8, “Changes To Be Reported And How To Report”, seventh bullet in left column

• Old Language:

The child age 13 or older has an unsatisfied warrant for their arrest for a crime or attempted crime that is a felony (or in jurisdictions that do not define crime as felonies, a crime that is punishable by death or imprisonment for a term exceeding 1 year

• New Language:

The child age 13 or older has an unsatisfied warrant for more than 30 days for his or her arrest, or a crime or attempted crime that is a felony of flight to avoid prosecution or confinement, escape from custody and flight-escape. In most jurisdictions that do not classify crimes as felonies, a crime that is punishable by death or imprisonment for a term exceeding one year.

Justification 6: We revised the language, because of the Martinez Settlement. The Martinez Settlement is a nation-wide class action settlement that caused SSA to no longer suspend benefits for an outstanding felony warrant unless the warrant was issued for a crime or attempted crime of flight to avoid prosecution or confinement, escape from custody and flight-escape.

Change 7: We revised the language on page 8, Changes To Be Reported And How To Report, first bullet in right column.

• Old Language:

The child age 13 or older has an unsatisfied warrant for a violation of probation or parole under Federal or State law.

• New Language:

The child age 13 or older has for more than 30 continuous days committed a violation of probation or parole under Federal or State law.

Justification 7: This change is necessary due to the Clark Court Order (dated 3/19/10) requiring that we no longer suspend benefits based on an outstanding probation or parole violation warrant.

Change 8: We revised the language on page 8, Changes To Be Reported And How To Report, fourth bullet in right column.

• Old Language:

The child is confined to jail, prison, penal institution or correctional facility for conviction of a crime or confined to a public institution by court order in connection with a crime.

• New Language:

The child is confined for more than 30 continuous days to a jail, prison, penal institution or correctional facility for conviction of a crime or confined to a public institution by a court order in connection with a crime.

Justification 8: This change is necessary in order for the reporting responsibility to conform to the non-payment requirements of the Social Security Act in section 202(x)(1).

Revision to the Collection Instrument (SSA-4-INST)

Change 1: We are revising the language on page 1, “Changes To Be Reported And How To Report”, first sentence in the first bullet in left column.

• Old Language:

You or any child changes mailing address for checks or residence.

• New Language:

You or any child changes the mailing address for checks or residence.

Justification 1: We revised this statement to make it easier to read.

Change 2: We are vising the language on page 1, “Changes To Be Reported And How To Report”, fifth bullet in left column.

• Old Language:

(Name of Child) (is) (is not) self-employed rendering substantial services in a trade or business.

• New Language:

(Name of Child) (is) (is not) self-employed and rendering substantial services in a trade or business.

Justification 2: We revised the language to correct topographical errors.

Change 3: We revised the language on page 8, Changes To Be Reported And How To Report, seventh bullet in left column.

• Old Language:

The child age 13 or older has an unsatisfied warrant for their arrest for a crime or attempted crime that is a felony (or in jurisdictions that do not define crime as felonies, a crime that is punishable by death or imprisonment for a term exceeding 1 year.

• New Language:

The child age 13 or older has an unsatisfied warrant for more than 30 days for his or her arrest, or a crime or attempted crime that is a felony of flight to avoid prosecution or confinement, escape from custody and flight-escape. In most jurisdictions that do not classify crimes as felonies, a crime that is punishable by death or imprisonment for a term exceeding one year.

Justification 3: We changed this reporting responsibility because of the Martinez Settlement. The Martinez Settlement is a nation-wide class action settlement that caused us to no longer suspend benefits for an outstanding felony warrant unless the warrant was issued for a crime or attempted crime of flight to avoid prosecution or confinement, escape from custody and flight-escape.

Change 4: We are revising the language on page 8, Changes To Be Reported And How To Report, eighth bullet in left column.

• Old Language:

The child age 13 or older has an unsatisfied warrant for a violation of probation or parole under Federal or State law.

• New Language:

The child age 13 or older has for more than 30 continuous days committed a violation of probation or parole under Federal or State law.

Justification 4: This change is necessary due to the Clark Court Order (dated 3/19/10) requiring that we no longer suspend benefits based on an outstanding probation or parole violation warrant.

Change 5: We are revising the language on page 1, Changes To Be Reported And How To Report, first bullet in right column.

• Old Language:

The child is confined to jail, prison, penal institution or correctional facility for conviction of a crime or confined to a public institution by court order in connection with a crime.

• New Language:

The child is confined for more than 30 continuous days to a jail, prison, penal institution or correctional facility for conviction of a crime or confined to a public institution by a court order in connection with a crime.

Justification 5: This change is necessary in order for the reporting responsibility to conform to the non-payment requirements of the Social Security Act in section 202(x)(1).

Change 6: We are revising the language on page 2, Notice About Documents, first sentence.

• Old Language:

We recommend that you keep all documents you submitted to us.

• New Language:

We recommend that you keep copies of all documents you submitted to us.

Justification 6: We revised to make it easier to read.

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.