Ssa-2935

SSA will insert the following Privacy Act and PRA Statements into the forms as soon as
possible:
Privacy Act Statement
Collection and Use of Personal Information
Sections 205(a), 228(a), 1614(a) and 1836 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 on your claim.
We will use the information to review your claim. We may also share your information for the
following purposes, called routine uses:
• To contractors and other Federal agencies, as necessary, for the purpose of assisting
the Social Security Administration (SSA) in the efficient administration of its
programs. We will disclose information under the routine use only in situations in
which SSA may enter into a contractual or similar agreement with a third party to
assist in accomplishing an agency function relating to this system of records; 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 Notice
(SORN) 60-0089, entitled Claims Folders System, as published in the Federal Register (FR) on
October 31, 2019, at 84 FR 58422. 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 __ 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.