Request for Business Entity Taxpayer Information

SSA will insert the following revised Privacy Act and PRA Statements into the
form as soon as possible:
Privacy Act Statement
Collection and Use of Personal Information

Sections 206(a) and 1631(d) of the Social Security Act, as amended, authorize us to collect this
information. We will use the information you provide to identify appointed representatives
associated with a business entity as employees or partners and to facilitate issuance of
appropriate return information for reporting purposes.
Furnishing us this information is voluntary. However, failing to provide us with all or part of the
information could prevent us from sending you Form 1099-MISC.
We rarely use the information you supply for any purpose other than to identify appointed
representatives associated with a business entity as employees or partners and to facilitate
issuance of appropriate return information for reporting purposes. However, we may use the
information for the administration of our program including sharing information:
1. To comply with Federal laws requiring the release of information from our records (e.g.,
to the Government Accountability Office and Department of Veterans Affairs); and,
2. To facilitate statistical research, audit, or investigative activities necessary to ensure the
integrity and improvement of our programs (e.g., to the Bureau of the Census and to
private entities under contract with us).
A list of when we may share your information with others, called routine uses, is available in our
Systems of Records Notice entitled, Appointed Representative Payee File, 60-0325. Additional
information about these and other system of records notices and our programs are available
online at www.socialsecurity.gov or at your local Social Security office.
We may share the information you provide to other agencies through computer matching
programs. Matching programs compare our records with records kept by other Federal, State, or
local government agencies. We can use the information from these matching programs to
establish or verify a person’s eligibility for federally funded or administered benefit programs
and for repayment of payments or delinquent debts under these programs.

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 10 minutes to read the instructions, gather
the facts, and answer the questions. SEND OR BRING THE COMPLETED FORM TO
YOUR LOCAL SOCIAL SECURITY OFFICE. You can find your local Social Security
office through SSA’s website at www.socialsecurity.gov. Offices are also listed under U. S.
Government agencies in your telephone directory or you may call Social Security at 1-800772-1213 (TTY 1-800-325-0778). 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, not the completed form.