Current eFOIA

General Request for Social Security Records
Form OPD Internet Request
Form Approved: OMB No. 0960-0716
Expiration Date: 03/31/2012

News
Do not use this form to request a photocopy or a computer extract of a Social Security Number
application. Please use Form SSA-711.
Do not use this form to request birth or death certificates. The Social Security Administration
does not typically maintain these types of documents.
Do not use this form to request missing person information, letter forwarding or earnings
information. Please send these requests to:
Social Security Administration
OEO FOIA Workgroup
300 N. Greene Street
P.O. Box 33022
Baltimore, Maryland 21190-3022

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PAPERWORK/PRIVACY ACT STATEMENT

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PAPERWORK/PRIVACY ACT STATEMENT

Page 1 ofl

Electronic Freedom ofInfonnation Act

PAPERWORKIPRIVACY ACT
STATEMENT

PAPERWORK REDUCTION ACT STATEMENT: This
information collection meets the clearance requirements of 44
U.S.C. §3507, as amended by section 2 of the Paperwork Reduction
Act of t 995. You are not required to answer these questions unless
we display a valid Office of Management and Budget control
number. We estimate that it will take you about 7 minutes to read
the instructions, gather the necessary facts, and answer the
questions. You may send comments on our time estimate above to:
SSA, 6401 Security Blvd., Baltimore, MD 21235-6401. Send only
comments relating to our time estimate to this address, Dot the
completed form.
PRIVACY ACT STATEMENT: The Social Security
Administration (SSA) has the authority to collect the information
requested on this form under 5 U.S.C. § 552 and the applicable
regulations at 20 CFR § 402.130. The information you provide will
be used to respond to your request for information or records
maintained by SSA. You do not have to give us this information.
However, without the information we will be unable to respond to
your request.

Although the information we obtain with this form is almost never
used for any purpose other than the one stated above, the
information may be disclosed by SSA without your consent if
authorized by Federal laws such as the Privacy Act and the Social
Security Act. For example, SSA may disclose to a Congressional
office requesting information on your behalf; to the Department of
Justice (DOJ) for use in representing the Federal Government; and
to the General Services Administration and the National Archives
and Records Administration to conduct studies. Disclosure of any
information defined as "returns or return information" under 26
U.S.C. § 6103 ofthe IRC will not be disclosed unless authorized by
a statute, the IRS, or IRS regulations.
Explanations about these and other reasons why information you

provide may be used or given out are available in Social Security

offices. If you want to learn more about this, you may contact any

Social Security office.

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