Addendum to the Supporting Statement for
Form SSA-769-U4
Request for Change in Time/Place of Disability Hearing
20 CFR 404.914 (c) (2) and 20 CFR 416.1414 (c) (2)
OMB No. 0960-0348
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 The current language, which dates back to the last reprint of the form, is now outdated.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 form.
| File Type | application/msword |
| Author | 889123 |
| Last Modified By | 889123 |
| File Modified | 2013-02-15 |
| File Created | 2013-02-15 |