Revision to the Collection Instrument
SSA is making the following revision:
We plan to make the following change to SSA-3380 within the first year after approval. We will use the prior paper revision until stock is exhausted.
Change 1: We are adding a penalty warning near the beginning of form SSA-3380. The warning statement reads:
Anyone who makes or causes to be made a false statement or representation of material fact for use in determining a payment under the Social Security Act, or knowingly conceals or fails to disclose an event with an intent to affect an initial or continued right to payment, commits a crime punishable under Federal law by fine, imprisonment, or both, and may be subject to administrative sanctions.
Justification 1: We are adding the statement for fraud deterrence and legal enforcement purposes.
| File Type | application/msword |
| File Modified | 2015-06-02 |
| File Created | 2015-06-02 |