Response to Notice of Revised Determination

Response to Notice of Revised Determination

SSA-765 - Updated PA Statement

Response to Notice of Revised Determination

OMB: 0960-0347

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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) and 1631(e) 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 prevent us from making an accurate and timely decision regarding Social
Security benefits.
We will use the information to determine eligibility for benefits. We may also share your
information for the following purposes, called routine uses:
•

To third party contacts, where necessary, to establish or verify information provided by
representative payees or payee applicants; and

•

To contractors and other Federal agencies, as necessary, for the purpose of assisting
Social Security Administration 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 Notices
(SORN) 60-0089, entitled Claims Folders System, as published in the Federal Register (FR) on
April 1, 2003, at 68 FR 15784 and 60-0320, entitled Electronic Disability Claim File, as
published in the FR on December 22, 2003, at 68 FR 71210. Additional information, and a full
listing of all of our SORNs, is available on our website at www.ssa.gov/privacy.


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File Modified2019-01-25
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