Addendum to the Supporting Statement for 0960-0624

Addendum to the Supporting Statement for

Forms SSA-3192, SSA-3193, and SSA-3194

Medical Permit Parking Application Forms

41 cfr 101.20-104.2

omb No. 0960-0624

Minor Revisions to the Collection Instrument

We are making the following revisions to each of the forms:

SSA-3192

• Change #1: We are changing the office of the Director from Office of Protective Security Services to Office of Security Administration and Project Management.

• Adjusted office to read as: “directly forward…via a separate fax/facsimile to the Director, Office of Security Administration and Project Management at (410) 597-0455 or sealed envelope….”

Justification #1: The responsibility of Medical Parking official moved under the new organizational structure of the Office of Security Administration and Project Management.

• Change #2: We are changing the office of the Director from Office of Protective Security Services to Office of Security Administration and Project Management.

• Second Page of form, paragraph adjacent to heading Applicant’s Authorization and Certification; changing text to read: “…authorized SSA officials, including the Director, Office of Security Administration and Project Management….”

Justification #2: The responsibility of Medical Parking official moved under the new organizational structure of the Office of Security Administration and Project Management.

• Change #3: We are changing the office of the Director from Office of Protective Security Services to Office of Security Administration and Project Management.

• Second Page of form, under signature line: Changing addressee’s office from Office of Protective Security Services to Office Security Administration and Project Management.

Justification #3: The responsibility of Medical Parking official moved under the new organizational structure of the Office of Security Administration and Project Management.

SSA-3193

• Change #4: We are changing the office of the Director from Office of Protective Security Services to Office of Security Administration and Project Management.

• First Page of form, paragraph adjacent to heading Applicant’s Authorization to Release Medical Documentation; changing text to read: “…authorized SSA officials, including the Director, Office of Security Administration and Project Management….”

Justification #4: The responsibility of Medical Parking official moved under the new organizational structure of the Office of Security Administration and Project Management.

• Change #5: We are changing the office of the Director from Office of Protective Security Services to Office of Security Administration and Project Management.

• Second Page of form, under telephone/signature line: Changing addressee’s office from Office of Protective Security Services to Office of Security Administration and Project Management.

Justification #5: The responsibility of Medical Parking official moved under the new organizational structure of the Office of Security Administration and Project Management.

SSA-3194

• Change #6: We are changing the office of the Director from Office of Protective Security Services to Office of Security Administration and Project Management.

• First page, first paragraph changing the third sentence to read: “…the Director, Office of Security Administration and Project Management, by fax to (410) 597-0455 or bring to the servicing Parking and Credentialing Office.”

Justification #6: The responsibility of Medical Parking official moved under the new organizational structure of the Office of Security Administration and Project Management.

We will make these revisions to the forms upon OMB approval.

Future Plans: In response to public comments received from the EEOC, SSA plans to make changes to all of the forms very soon following OMB approval. Once we finalize the changes, we will submit a new information collection request (ICR) to revise these three forms. We expect to submit the new ICR within the next fiscal year; however, since we just received the comments in August 2017, we are not currently ready to make changes.