Application for a Social Security Card - with a name change (iSSNRC Internet Modality)

Privacy Act Statement
Collection and Use of Personal Information
Sections 202, 205(c), and 702 of the Social Security Act (Act), as amended, allow us to collect
this information, which we will use to assign a Social Security number, issue a Social Security
card, and make a timely determination concerning eligibility for Social Security
benefits. Providing the information is voluntary, but not providing all or part of the information
may prevent us from assisting you. 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 Notices (SORN) 60-0058, 60-0090, 60-0103, 60-0104, and 600373, 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. The Act also allows us to collect race and ethnicity
information, which we will use for research and statistical purposes. Furnishing us this
information is voluntary and will not be used in decisions about your application.