SSA will insert the following PRA Statement into the form as soon as possible:
Privacy
Act Statement
Collection and Use of Personal Information
Sections 205(j) and 1631(a) of the Social Security Act, as amended, allow us to collect your information, which we will use to account for the use of benefits, payments and to ensure the beneficiary’s needs are met. Providing the information is voluntary, but not providing all or part of the information may result in the termination of benefits or payments. As law permits, we may use and share the information you submit, including with other Federal agencies, contractors, and others, as outlined in the routine uses within System of Records Notice (SORN) 60-0222, available at www.ssa.gov/privacy. The information you submit may also be used in computer matching programs to establish or verify eligibility for Federal benefit programs and to recoup debts under these programs.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Scullark, Tyeebna OGC |
| File Modified | 0000-00-00 |
| File Created | 2024-07-22 |