Authorization to Obtain Earnings Data from the Social Security Administration

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

Section 205(c)(2)(A) of the Social Security Act, as amended, allows 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 (1) identify the wage earner; (2) establish the period of earnings
information requested; (3) verify the wage earner authorized SSA to release this information to
the requesting party; and (4) produce the Itemized Statement of Earnings (SSA-1826). 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 (or agents on their behalf) for the purpose of
validating Social Security numbers used in administering cash or non-cash income
maintenance programs or health maintenance programs (including programs under the
Social Security Act).
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) 60-0059, entitled Earnings Recording and Self-Employment Income System.
Additional information and a full listing of all our SORNs are available on our website at
www.socialsecurity.gov/foia/bluebook.