Addendum for SSA-788

Addendum 0109.doc

Statement of Care and Responsibility for Beneficiary

Addendum for SSA-788

OMB: 0960-0109

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Addendum to Supporting Statement for Form SSA-788,

Statement of Care and Responsibility for Beneficiary

20 CFR 404.2020, 404.2025, 408.620, 408.625, 416.620, 416.625

OMB No. 0960-0109

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  The current language, which dates back to the last reprint of the form, is now outdated.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

File Typeapplication/msword
File TitleAddendum to the Supporting Statement for Form SSA-3462
Author177717
Last Modified By889123
File Modified2015-06-23
File Created2015-06-23

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