Letter to Employer Requesting Information About Wages Earned by Beneficiary 20 CFR 404.703, 404.801

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 223(d) 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 making an accurate and timely decision on any claim
filed or could result in the loss of benefits.
We will use the information to verify wages or resolve wage discrepancies, and evaluate and
determine if the individual named on this form meets eligibility requirements for benefits. We
may also share your information for the following purposes, called routine uses:
1. To employers or former employers, including State Social Security administrators, for
correcting and reconstructing State employee earnings records and for Social Security
purposes; and
2. To third party contacts (e.g., employers and private pension plan) in situations where the
party to be contacted has, or is expected to have, information relating to the individual’s
capability to manage affairs or eligibility for or entitlement to benefits under the Social
Security program when the data are needed to establish the validity of evidence or to
verify the accuracy of information presented by the individual, and it concerns the
individual’s eligibility for benefits under the Social Security program.
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 additional routine uses is available in our Privacy Act System of Records Notices
(SORN) 60-0059, entitled Earnings Recording and Self-Employment Income System, 60-0089,
entitled Claims Folders Systems, and 60-0090, entitled Master Beneficiary Record. Additional
information and a full listing of all our SORNs are available on our website at
www.ssa.gov/privacy/sorn.html.