Revised PA & PRA Statements

SSA will insert the following revised Privacy Act & PRA Statements into the
form as soon as possible:
Privacy Act Statement
Collection and Use of Personal Information

Section 205(c)(2)(B)(i)(I) 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 prevent us from properly crediting your earnings record, which may
result in errors in benefit payment amounts to future beneficiaries.
We will use the information you provide to notify your employer of your assigned Social
Security number (SSN), for wage reporting purposes. We may also share your information for
the following purposes, called routine uses:
•

To the Social Security agency of a foreign country, to carry out the purpose of an
international Social Security agreement entered into between the United States and the
other country, pursuant to section 233 of the Social Security Act; and

•

To the Department of Justice (DOJ), Federal Bureau of Investigation and United States
Attorney’s Offices, and to the Department of Homeland Security, United States Secret
Service, for investigating and prosecuting violations of the Social Security Act.

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;
and 60-0059, entitled Earnings Recording and Self-Employment Income System, as published in
the FR on January 11, 2006, at 71 FR 1819. Additional information, and a full listing of all our
SORNs, is available on our website at www.ssa.gov/privacy.

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 5 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.