Addendum - 0474

Addendum - 0474.docx

Child-Care Dropout Questionnaire

Addendum - 0474

OMB: 0960-0474

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Addendum to Supporting Statement for Form SSA-4162

Child-Care Dropout Questionnaire

20 CFR 404.211(e)(4)

OMB No. 0960-0474



Minor Revisions to the Collection Instrument


SSA is making the following revision:


  • Change #1: We are revising the Privacy Act Statement on this form.


Justification #1: 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.

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