Addendum to Supporting Statement - 0693

Addendum to Supporting Statement for Form SSA-L106-F3 and SSA-L706

Letter to Custodian of School Records

Letter to Custodian of Birth Records

20 CFR 404.704, 404.716, 416.802 and 422.107

OMB No. 0960-0693

Minor Revisions to the Collection Instruments

SSA is making the following revisions to the SSA-L706:

• Change #1: Page 1, Part 1, add the term “Parent’s.”

Justification #1: We are adding the term “Parent’s” to the section for Mother’s and Father’s Full name. This term is for children who may have same-sex parents listed on their birth records. This aligns with the gender-neutral terms used on our other SSA forms.

• Change #2: Page 2, Part 5, we are adding the following sentence to Date of Birth block.

From: Date of Birth or Age

To: Date of Birth. If Date of Birth is not available, then Age.

Justification #2: We are adding this sentence to clarify this section and let respondents know that the date of birth is preferred but, if not available, then we can accept Age.

Change #3: Page 2, Part 5, we are adding the following sentence above the selection of boxes shown: “If age has been provided in the above block, indicate age as of which birthday.”

Justification #3: We are adding the sentence to clarify the instructions for selecting the boxes shown (Last, Next, Nearest, Not Given).

• Change #4: Page 2, Part 5, add the term “Parent’s” in place of “Mother’s” and “Father’s” Full Name.

Justification #4: We are adding the term “Parent’s” to the section for Mother’s and Father’s Full name. This takes into consideration children who may have same-sex parents listed on their birth records. This aligns with the gender-neutral terms used on our other SSA forms.

• Change #5: Page 3, Part 5, we are adding check boxes for the question regarding the Seal.

Justification #5: We are adding check boxes “Yes” and “No” when asked if there is a Seal.

Change #6: Page 3, Part 5, we are adding the sentence “If Yes, affix seal” after the “Yes” check box for a Seal.

Justification #6: We are adding this sentence to clarify that we would like to see the seal if one exists.

• Change #7: Page 3, Part 5, we are removing the Affix Seal space.

Justification #7: We are removing the block space for “Affix Seal” as we are asking respondents to affix the seal after the “if Yes, affix seal” question (see Change #6 above).

• Change #8: Page 3. We are revising the Privacy Act Statement on this form.

Justification #8: 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.

SSA is making the following revisions to the SSA-L106:

• Change #1: Page 1, Part 1, add an additional space for Parent’s names.

Justification #1: We are adding an additional fill in line for “Names of Parent(s), this will be helpful in the event that more than one parent’s name needs to be listed.

• Change #2: Page 3, Part 4, update the term “Record” in the sentence to “Name as shown on school records.”

Justification #2: We are updating the term “record” to “records” to align with the use of the term throughout the form.

• Change #3: Page 3, Part 4, remove the words “Age or”:

From: Age or Date of Birth as Shown on School Records

To: Date of Birth as Shown on School Records

Justification #3: We are removing “Age or” from the sentence as we are adding a new sentence to the form to address Age separately.

• Change #4: Page 3, Part 4, adding the new sentence “If Date of Birth is not available, provide age as shown on school records.” to the form to be placed after the sentence “Date of Birth as Shown on School Records.”

Justification #4: We are adding the following sentence to clarify that we can accept age as shown on school records in place of date of birth as necessary.

• Change #5: Page 3, Part 4, update the term “Record” in the sentence “Date of school records.”

Justification #5: We are updating the term “record” to “records” to align with the use of the term throughout the form.

• Change #6: Page 3, Part 4, add an additional fill in line for the “Signature and Title of Custodian of School Records.”

Justification #6: We are adding additional space in the block for Signature and Title information as some respondents may need extra space.

• Change #7: Page 3, Part 4, update the term “Record” in the sentence “Name of School or Agency Having Custody of Records.”

Justification #7: We are updating the term “record” to “records” to align with the use of the term throughout the form.

• Change #8: Page 3. We are revising the Privacy Act Statement on this form.

Justification #8: 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.