Work Activity Report (Self-Employed Person)

Privacy Act Statement
Collection and Use of Personal Information

Sections 223(d) and 1633 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 an accurate and timely decision on any claim filed.
We will use the information to make a determination of eligibility for benefits. We may also
share your information for the following purposes, called routine uses:
1. To employers or former employers, including State Social Security administrators, for
correcting and reconstructing State employee earnings records and for Social Security
purposes; and
2. To Federal, State, or local agencies for the purpose of validating Social Security numbers
used in administering cash or non-cash income maintenance programs or health
maintenance 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
(SORNs) 60-0059, entitled Earnings Recording and Self-Employment Income System and 600089, entitled Claims Folders Systems. Additional information and a full listing of all our
SORNs are available on our website at www.socialsecurity.gov/foia/bluebook.