Revised PA & PRA Statements

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

Section 233(a) 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 an accurate and timely decision on any claim filed
and may result in the loss of benefits.
We will use the information you provide to determine eligibility for benefits under an
international agreement. 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 between the United States and the
other country, pursuant to section 233 of the Social Security Act; and

•

To student volunteers, individuals working under a personal services contract, and
other workers who technically do not have the status of Federal employees, when
they are performing work for SSA, as authorized by law, and they need access to
personally identifiable information in SSA records in order to perform their
assigned agency functions.

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) 60-0089, entitled Claims Folders System, as published in the Federal
Register (FR) on October 31, 2019, at 84 FR 58422; and 60-0090, entitled Master
Beneficiary Record, as published in the FR on January 11, 2006, at 71 FR 1826.
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
20 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.