Addendum to Supporting Statement

Addendum to Supporting Statement

Statement of Household Expenses and Contributions SSA-8011-F3

20 CFR 401.45

OMB No. 0960-0456

TERMS OF CLEARANCE

1. SSA shall clarify “Write ‘0’ under amount if your household has not spent any month for one of the expenses” to instruct the respondent to w rite 0 for that particular expense.

2. SSA shall clarify that for questions 3 and 4 in part III that the “if yes” question is to be answered only for a “yes” answer to question 3 or 4, respectively.

SSA has met the Terms of Clearance

1. SSA added “Write 0” under amount if your household has not spent any month for one of the expenses” to instruct the respondent to w rite 0 for that particular expense.

2. SSA added clarity to questions 3 and 4 in part III that the “if yes” question is to be answered only for a “yes” answer to question 3 or 4, respectively.

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  The current language, which dates back to the last reprint of the form, is now outdated.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