Completing Form SSA-89

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

Sections 205(a) and 1106 of the Social Security Act, as amended, allow us to collect this
information. Furnishing us this information is voluntary. However, failing to provide all or part
of the information may prevent us from releasing information to a designated company or
company’s agent.
We will use the information to verify your name and Social Security number (SSN). In addition,
we may share this information in accordance with the Privacy Act and other Federal laws. For
example, where authorized, we may use and disclose this information in computer matching
programs, in which our records are compared with other records to establish or verify a person’s
eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts under
these programs.
A list of routine uses is available in our Privacy Act System of Records Notice (SORN) 60-0058,
entitled Master Files of SSN Holders and SSN Applications. Additional information and a full
listing of all our SORNs are available on our website at www.socialsecurity.gov/foia/bluebook.