Addendum to the Supporting Statement for Form SSA-5072
Request for Medical Treatment in an SSA Employee Health Facility:
Patient Self-Administered or Staff-Administered Care
OMB No. 0960-0772
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 The current language, which dates back to the last reprint of the form, is now outdated.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.
| File Type | application/msword |
| File Title | Addendum to the Supporting Statement for Form SSA-3462 |
| Author | 177717 |
| Last Modified By | Mandley, Tasha |
| File Modified | 2017-03-28 |
| File Created | 2017-03-28 |