Addendum to the Supporting Statement for the SSA-104

Addendum to Supporting Statement

Claimant Travel Reimbursement Request

20 CFR 404.999a- 404.999d

OMB No. 0960-0752 SSA-104

Terms of Clearance

This ICR is approved on the understanding that respondents do not have to supply

the same information twice (once to state agencies and then again to SSA OMVE), even though the supporting statement suggests otherwise. Rather, at the point in time that this information is being collected, it is either collected by the state DDS (because they are processing the case) or it is collected by OMVE (because we are processing the case), not by both.

SSA has met the terms of clearance. Respondents do not have to supply the same information twice (once to state agencies and then again to SSA OMVE). Rather, at the point in time that this information is being collected, it is either collected by the state DDS (because they are processing the case) or it is collected by OMVE (because we are processing the case), not by both. Whoever has jurisdiction of the case sends the forms, the DDS or OMVE. Only one can have the case at any given level. This collection is voluntary for respondents.

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  The current language, which dates back to the last reprint of the form, is now outdated.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