Addendum to the Supporting Statement

Addendum to the Supporting Statement

Form SSA-199

Vocational Rehabilitation Provider Claim

OMB No. 0960-0310

Revisions to the Collection Instrument

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  The current language, which dates back to the last reprint of the form, is now outdated.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

We will start using the new version of the collection instrument immediately after OMB approval. (We will continue to accept old copies until they run out.)

Change 1: We would like to replace the third line of the ‘To:’ address line on Form SSA-199 with VRA Operations Team instead of Division of Employment Support and Program Acquisitions.

Justification: SSA renamed the Division of Employment Support and Program Acquisitions.

Change 2: Immediately preceding box #1 of the form, we want to insert the following line: Check One __Initial Claim __Reconsideration __Resubmittal __Supplemental

Justification: We already require respondents to provide SSA with this information, but currently they have to remember to add it themselves somewhere on the current form. By providing an actual check box pre-printed on the form, we are less likely to receive claims from respondents who inadvertently omit this information. This will save SSA valuable time in processing State VR agency claims, because we follow a different procedure depending upon what type of claim we receive.

Change 3: At the very end of the collection instrument, we wish to place our website address: www.socialsecurity.gov/work.

Justification: This website is beneficial to our respondents because it contains information that can assist them in helping our beneficiaries with disabilities return to work.