Disability Report - Child (Paper)

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), 1631(e)(1), and 223(d)(5)(A) 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 affect the decision on the claim.
We will use the information to make a decision regarding if a child is eligible for benefit
payments. We may also share your information for the following purposes, called routine uses:
1. To Federal, State, or local agencies that conduct business with the Social Security
Administration (SSA) and the release of records is determined to be relevant and
necessary; and disclosure is compatible to the reason why the records were collected;
2. To third party contacts when additional information about the child is needed or
verification of eligibility for benefits; and
3. To workers who are performing work for SSA as authorized by law and who technically
do not have the status of Federal employees; and other Federal agencies for assisting SSA
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 Notice
(SORN) 60-0089, entitled Claims Folders Systems. Additional information and a full listing of
all our SORNs are available on our website at www.socialsecurity.gov/foia/bluebook.