Non-Substantive Change 0960-0020

Justification for Non-Substantive Change for Form SSA-783

Statement Regarding Contributions

20 CFR 404.360 - 404.366 and 404.736

OMB No. 0960-0020

Background

The Social Security Administration (SSA) uses Form SSA-783 Statement Regarding Contributions to collect information about a child’s support and other regular or substantial contributions when determining if child applicants for Social Security benefits are entitled to payments.

Revisions to the Information Collection SSA-783:

• Change #1: In question 1.(a), we are replacing “FROM” with “PERIOD FROM” and “TO” with “PERIOD TO.”

Justification #1: We are making these changes for clarity.

• Change #2: In question 1.(a), we are adding check boxes for “Unknown” for responses to contributions began/ended, how often made, and average amount of contribution.

Justification #2: We are making this change to allow respondent to simply check the box if they do not know the information.

• Change #3: In question 1.b), we are adding an opening parenthesis before the “b.”

Justification #3: We are making this change to correct a typographical error.

• Change #4: In question 1.(d), we are adding check boxes for “Unknown” for responses to approximate value.

Justification #4: We are making this change to allow respondent to simply check the box if they do not know the information.

• Change #5: In question 2, we are adding check boxes for “Unknown” for response to how much per month.

Justification #5: We are making this change to allow respondent to simply check the box if they do not know the information.

• Change #6: In question 3.(a), we are removing the beginning quotation mark before the “If” in the following:

“If, “Yes,” answer (b), (c) and (d) below.

Justification #6: We are making this change to correct a typographical error.

• Change #7: In questions 3.(b), we are inserting “to” in this sentence: If “Yes,” how much did each contribute to the fund?

Justification #7: We are making this change to correct a typographical error.

Change #8: In questions 3.(b) and 3.(d), we are adding check boxes for “Unknown” for responses to how much each mother/father contributed and the monthly income of each mother/father.

Justification #8: We are making this change to allow respondent to simply check the box if they do not know the information.

• Change #9: On page 2, we are changing the date field with the Signature so that there is an option to pick a date.

Justification #9: We are making this change to simplify entering date.

• Change #10: We are changing the designation of page number on page 3 to Page 3 of 3.

Justification #10: We are making this change to correct page numbering.

SSA will implement these revisions upon OMB approval. These actions do not affect the public reporting burden.