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 807(a) and 807(h) 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 continuing to send the beneficiary’s payments to you.
We will use the information to determine appropriate use of the beneficiary’s payments, and if the beneficiary’s current needs are being met. We may also share your information for the following purposes, called routine uses:
Disclosure to representative payees, when the information pertains to individuals for whom they serve as representative payees, for the purpose of assisting Social Security Administration in administering its representative payment responsibilities under title VIII and assisting the representative payees in performing their duties as payees, including receiving and accounting for benefits for individuals for whom they serve as payees; and
To a claimant or other individual authorized to act on his or her behalf information concerning the status of his or her representative payee or the status of the application of a person applying to be his or her representative payee, and information pertaining to the address of a representative payee applicant or a selected representative payee when this information is needed to pursue a claim for recovery of misapplied or misused benefits.
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) 60-0058, entitled Master Files of
Social Security Number (SSN) Holders and SSN Applications, as
published in the Federal Register (FR) on December 29, 2010, at 75 FR
82121, 60-0089, entitled Claims Folders Systems, as published in the
FR on April 1, 2003, at 68 FR 15784, 60-0103, entitled Supplemental
Security Income Record and Special Veterans Benefits, as published in
the FR on January 11, 2006, at 71 FR 1830, 60-0222, entitled Master
Representative Payee File, as published in the FR on April 22, 2013,
at 78 FR 23811, and 60-0273, entitled Social Security Title VIII
Special Veterans Benefits Claims Development and Management
Information System, as published in the FR on March 14, 2000, at 65
FR 13803. Additional information and a full listing of all our SORNs
are available on our website at www.ssa.gov/privacy.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | PA Statement Template |
Author | 889123 |
File Modified | 0000-00-00 |
File Created | 2021-01-21 |