L106, Letter to Custodian of School Records (Local/State/Tribal Government)

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 1631of 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 an accurate and timely decision on any claim filed.
We will use the information to determine your eligibility for benefits, and may use the
information for the administration of our programs. We may also share your information for the
following purposes, called routine uses:
1. To contractors and other Federal agencies, as necessary, for the purpose of assisting SSA
in the efficient administration of its programs. We will disclose information under this
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
2. To applicants or claimants, prospective applicants or claimants (other than the data
subject), their authorized representatives or representative payees to the extent necessary
to pursue Social Security claims, and to representative payees, when the information
pertains to individuals for whom they serve as representative payees, for the purpose of
assisting the Social Security Administration in administering its representative payment
responsibilities under the Act and assisting the representative payees in performing their
duties as payees, including receiving and accounting for benefits for individuals for
whom they serve as payees.
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 Systems, 60-0090, entitled Master Beneficiary Record,
and 60-0058, entitled Master Files of Social Security Number (SSN) Holders and SSN
Applications. Additional information and a full listing of all our SORNs are available on our
website at www.socialsecurity.gov/foia/bluebook.