Addendum SSA-3371

Addendum to Supporting Statement

Pain Report-Child

SSA-3371-BK

OMB No. 0960-0540

Terms of Clearance

Approved consistent with SSA acknowledgement that upon expiration the agency

will demonstrate progress on electronic implementation (distribution and receipt) of this instrument.

SSA’s goal is to provide the public with an electronic alternative for completing and submitting forms and applications. The electronic intake of information can occur only if there are electronic equivalences for receiving and processing the information. The expenditure of Systems resources required to develop, build, and implement electronic processes must compete with other priority initiatives for very limited funds.

SSA has not scheduled this form for electronic submission due to low volume usage and higher priority forms taking precedence. We will be implementing an electronic form as soon as is feasible.

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  The current language, which dates back to the last reprint of the form, is now outdated.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

14318001 1