Addendum to Supporting Statement 0019

Addendum to the Supporting Statement for Form SSA-781

Certificate of Responsibility for Welfare and Care of Child Not in Applicant’s Custody

20 CFR 404.330, 404.339-404.341 and 404.348-404.349

OMB No. 0960-0019

Minor Revisions to the Collection Instrument

SSA is making the following revisions:

• Change #1: We are revising the Privacy Act Statement on this form.

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 form.

• Change #2: We are changing the upper case letters in the sentence to lower case letters on number 1.

  • Old Language: How Long From today will the child be away from you?

  • New Language: How long from today will the child be away from you?

Justification #2: We are making the change to correct grammar.