Marriage Certification

Marriage Certification

Revised PA Statement - SSA-3

Marriage Certification

OMB: 0960-0009

Document [pdf]
Download: pdf | pdf
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(b) and (c), 205(a), and 216(h)(1) 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 eligibility for spousal benefits.
We will use the information to make a determination of eligibility for spousal benefits. We may
also share your information for the following purposes, called routine uses:
1. To student volunteers and other workers, who technically do not have the status of
Federal employees, when they are performing work for the Social Security
Administration (SSA) as authorized by law, and they need access to personally
identifiable information in SSA records in order to perform their assigned Agency
functions; and
2. To contractors and other Federal agencies, as necessary, for the purpose of assisting
SSA in the efficient administration of its 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
(SORN) 60-0089, entitled Claims Folders Systems and 60-0090, entitled Master Beneficiary
Record. Additional information and a full listing of all our SORNs are available on our website
at www.socialsecurity.gov/foia/bluebook.


File Typeapplication/pdf
File TitleMicrosoft Word - SSA-3 Revised PA Statement.doc
Author177717
File Modified2017-06-09
File Created2017-06-09

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