Addendum to the Supporting Statement

Addendum to SUPPORTING STATEMENT FOR FORM HA-4632

CLAIMANT'S MEDICATIONS

20 CFR, 404.1512 and 416.912

OMB No. 0960-0289

Terms of Clearance:

SSA currently makes this form available in a PDF format that the public can view, download, and/or print from the SSA webb site. SSA plans to convert this form to an electronically fillable version as a key element in the ongoing Electronic Disability [e-Dib] initiative. Upon resubmission of this collection for OMB approval in 2009, OMB expects that SSA will have made substantial progress in making this form electronically available.

       

SSA is complying with the terms of clearance supplied by the previous OMB approval of Form

HA-4632. Form HA-4632 is currently available in a portable document format (PDF) on the

SSA website where claimants can print, fill out, and send or take the completed form to SSA for

processing. However, for claimants who appoint a representative, electronic submission of

Form HA-4632 is now available to the claimant’s representative through the Electronic Records

Express initiative. Appointment of a representative occurs in about 80 percent of

claimant cases.

Minor Revisions to the Collection Instrument

SSA is making the following revisions:

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  The current language, which dates back to the last reprint of the form, is now outdated.

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 first page of the form.