Addendum to Supporting Statement 0540

Addendum to the Supporting Statement for Form SSA-3371-BK

Pain Report – Child

20 CFR 404.1512 and 416.912

OMB No. 0960-0540

Minor Revisions to the Collection Instrument

SSA is making the following revisions:

• Change #1: We are revising the PRA statement on this form.

Justification #1: 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  The current language, which dates back to the last reprint of the form, is now outdated.

• Change #2: We are revising the Privacy Act Statement on this form.

Justification #2: 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 form.

We are attaching the revised Privacy Act Statement and PRA to the ICR in ROCIS.