Addendum to the Supporting Statement 0960-0696

Addendum to the Supporting Statement for

Form SSA-1020/i1020

Application for Extra Help with

Medicare Prescription Drug Plan Costs

OMB No. 0960-0696

Revisions to the Collection Instrument

SSA is making the following revisions to Form SSA-1020:

• Change #1: SSA updated the year shown on the bottom of each page.

Justification #1: We wanted to show accurate dates.

• Change #2: On the cover page, third paragraph, first sentence, we deleted the word “But.”

Justification #2: We updated existing language using plain language guidelines.

• Change #3: SSA updated the first and last pages with the updated return address to mail the completed form from Wilkes-Barre Data Operations Center to the Wilkes-Barre Direct Operations Center.

Justification #3: The agency updated the return address to correct location name.

• Change #4: SSA updated the year shown in question 13 (and the year shown in the question 13 example box).

Justification #4: We wanted to show accurate dates.

• Change #5: SSA placed the following field in bold font on page 6, “Your Signature.”

Justification #5: We emphasized the signature line to help reduce the number of unsigned form submissions.

• Change #6: We are revising the Privacy Act Statement on Form SSA-1020.
  
  Justification #6: 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 Form SSA-1020.

SSA is making the following revision to the i1020:

• Change #1: We are revising the Privacy Act Statement on the i1020.
  
  Justification #1: 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 i1020.

SSA will implement the changes above upon OMB approval.

These actions do not affect the public reporting burden.