SSA-9902 Confidentiality Agreement

OMB Control No 0960-0754
Expiration Date: XX/XX/XXXX

Confidentiality Agreement

Purpose: This form is for all users of SSA sensitive data to certify that they understand
SSA’s security, confidentiality and ethics requirements.
I understand the SSA security, confidentiality and ethics requirements and agree that:
1. I will comply with all the confidentiality and legal requirements as stated in the
contract, Memorandum of Agreement (MOA), or other documentation when using
SSA sensitive data.
2. I will follow all security and safeguard provisions as described in the SSA Data
Protection Plan when using SSA sensitive data.
3. I agree not to construct and maintain, for a period of time longer than stated in the
contract, MOA, or other documentation, any file containing SSA sensitive data unless
explicitly agreed to by SSA in writing.
4. I agree not to link any other data to the SSA sensitive data described in the contract,
MOA, or other documentation or any derived dataset (s) unless explicitly agreed to by
SSA in writing.
5. I will use proprietary software, i.e. computer software that complies with Federal
copyright laws and licensing agreements.
6. I agree to keep confidential any third-party proprietary information that may be
entrusted to me as part of the contract, MOA, or other documentation.
7. I will not release or disclose any information subject to the Privacy Act of 1974,
section 6103 of the Internal Revenue Code, SSA Regulation 1 (20 C.F.R. Part 401),
and section 1106 of the Social Security Act to any unauthorized person.
8. I understand that I may be subject to a site inspection (s) by SSA to ensure that
adequate security safeguards, controls and confidentiality are maintained as specified
in the SSA data protection plan and in the contract, MOA, or other documentation.
9. I understand that disclosure of any information to parties not authorized by SSA may
lead to civil or criminal prosecution under Federal law and/or regulations.

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10. I understand that I can be subject to a personnel security and suitability background
investigation.

________________________________________
User

________________
Date

See Revised Paperwork
Reduction Act Statement
Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. §
3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these
questions unless we display a valid Office of Management and Budget control number. We estimate that it
will take about 4 hours to read the instructions, gather the facts, and answer the questions.
If you have comments on our time estimate please send them to: SSA, 6400 Security Blvd. Baltimore, MD
21235-0001. Send only comments relating to our time estimate to this address, not the completed form.

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SSA will insert the following revised PRA Statement into the form at its
next scheduled reprinting:
Paperwork Reduction Act Statement - This information collection meets the
requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction
Act of 1995. You do not need to answer these questions unless we display a valid Office
of Management and Budget control number. We estimate that it will take about 4 hours
to read the instructions, gather the facts, and answer the questions. Send only comments
relating to our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD 212356401.

SSA will insert the following revised Privacy Act Statement into the form
at its next scheduled reprinting:
Privacy Act Statement
Collection and Use of Personal Information

Section 205(a) of the Social Security Act as amended, [42 U.S.C. § 405(a)], authorizes us
to collect this information. We will use information you provide to respond to your
request for information or records we maintain. Your response is voluntary. However,
failure to provide the requested information may result in your application being denied
or a delay in processing.
We rarely use the information you provide on this form for any purpose other than for the
reasons explained above. However, we may use it for the administration and integrity of
Social Security programs. We may also disclose information to another person or to
another agency on accordance with approved routine uses, which include but are not
limited to the following:
1. To comply with Federal laws requiring the release of information from Social
Security records (e.g., to the Government Accountability Office, General
Services Administration, and National Archives Records Administration);
2. To facilitate statistical research, audit, or investigative activities necessary to
assure the integrity and improvement of Social Security programs.
Additional information regarding this form, and information regarding our systems and
programs, is available on-line at www.socialsecurity.gov.