Completing Form SSA-89

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

Sections 205(a) and 1106 of the Social Security Act, as amended, allow us to collect this
information. Furnishing this information is voluntary. However, failing to provide all or part of
the information may prevent us from releasing information to a designated company or
company’s agent.
We will use the information to verify your name and Social Security Number (SSN). We may
also share your information for the following purposes, called routine uses:
•

To contractors and other Federal agencies, as necessary, to assist us in efficiently
administering our programs; and

•

To student volunteers, persons working under a personal services contract, and others,
when they need access to information in our records in order to perform their assigned
agency duties.

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) 60-0058, entitled Master Files of SSN Holders and SSN Applications, as published in
the Federal Register (FR) on December 29, 2010, at 75 FR 82121. Additional information, and a
full listing of all of 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.