Student Reporting Form

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 202(d), 203 (h), and 205(a) 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 determine your entitlement and benefits. We may also share your
information for the following purposes, called routine uses:
1. To third party contacts where necessary to establish or verity information provided by
representative payees or payee applicants; and
2. To applicants, claimants, prospective applicants or claimants, other than the data subject,
their authorized 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 SSA 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 System. Additional information and a full listing of all
our SORNs are available on our website at www.socialsecurity.gov/foia/bluebook.