Addendum - 0110

Addendum - 0110.docx

State Mental Institution Policy Review

Addendum - 0110

OMB: 0960-0110

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Addendum to Supporting Statement for Form SSA-9584-BK

State Mental Institution Policy Review Booklet

20 CFR 404.2035, 404.2065, 416.635 and 416.665

OMB No. 0960-0110


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  The current language, which dates back to the last reprint of the form, is now outdated.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 this form.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorMandley, Tasha
File Modified0000-00-00
File Created2021-01-14

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