Protection and Advocacy for Beneficiaries of Social Security (PABSS)--Beneficiaries

See Revised Privacy
Notice and PRA
Statement Attached.

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

Section 1150 of the Social Security Act, as amended, allows us to collect this information.
Furnishing us this information is voluntary. However, failing to provide all or part of the
information may result in some loss of the beneficiary’s service. We will use the information
provide to evaluate the efficiency of the program and ensure beneficiaries receive quality service.
Additional information, and a full listing of all of our system of records notices, is available on
our website at www.ssa.gov/privacy.

SSA will insert the following revised PRA Statement into the form as soon
as possible:
Paperwork Reduction Act Statement - This information collection meets the
requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction
Act of 1995. You do not need to answer these questions unless we display a valid Office
of Management and Budget (OMB) control number. We estimate that it will take about
60 minutes to read the instructions, gather the facts, and answer the questions. Send only
comments regarding this burden estimate or any other aspect of this collection,
including suggestions for reducing this burden to: SSA, 6401 Security Blvd, Baltimore,
MD 21235-6401.