Work Activity Report--Employee

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 223(d) and 1633 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 an accurate and timely decision on any claim filed or could result
in an overpayment of benefits.
We will use the information to make a determination of eligibility for benefits. We may also
share your information for the following purposes, called routine uses:
•

To employers or former employers for correcting or reconstructing earnings records and
for Social Security tax purposes only; and

•

To contractors and other Federal agencies, as necessary, for the purpose of assisting
Social Security Administration in the efficient administration of its programs.

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, as
published in the Federal Register (FR) on January 11, 2006, at 71 FR 1819, 60-0320, entitled
Electronic Disability Claim File, as published in the FR on December 22, 20013, at 68 FR
71210, and 60-0330, entitled eWork, as published in the FR on September 15, 20013, at 68 FR
54037. Additional information, and a full listing of all our SORNs, is available on our website at
www.ssa.gov/privacy.