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Addendum - 0293

ICR 202201-0960-009 · OMB 0960-0293 · Object 118024700.

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Addendum to the Supporting Statement for Form SSA‑4641‑F4

Authorization for the Social Security Administration to Obtain

Account Records from a Financial Institution

20 CFR 416.200, 416.203, 416.207, 404.508, and 416.553

OMB No. 0960-0293


Minor Revisions to the Collection Instrument


SSA is making the following revisions:


  • Change #1: We are revising the PRA statements on this collection.


Justification #1: We are revising the PRA statements to reflect our current boilerplate language.  The current language, which dates back to the last reprint of the form, is now outdated.


  • Change #2: We are revising the Privacy Act Statements on this collection.


Justification #2: 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 Statements on this collection.





File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleSupporting Statement For Form HA-539, Notice Regarding Substitution of Party Upon Death of Claimant
Author689830
File Modified0000-00-00
File Created2022-06-01