Addendum to Supporting Statement for 0960-0050

Addendum for Form SSA-7163

Questionnaire About Employment or Self-Employment Outside the United States

20 CFR 404.401(b)(l), 404.415 and 404.417

OMB Number 0960-0050

Revision to the Collection Instrument

• Change #1: SSA intends to provide Form SSA-7163 in a fillable PDF file on our website, in place of the non-fillable PDF version we currently provide. We propose to make all form entries fillable.

Justification #1: This change will allow the respondents to continue to print and complete the form by hand, or, alternatively, complete the form using a computing device, such as a personal computer or handheld (mobile) device, print, and submit the form to SSA for processing.

After OMB approves the addition of the new fillable version of the form, SSA will phase out the standard PDF versions from our Internet and Intranet websites and replace them with the fillable PDF file.

This action does not affect the public reporting burden.