Application for Search of Census Records for Proof of Age

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(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 search to establish proof of age and impact your claim for
benefits.
We will use the information to request Census Bureau records to establish proof of age. We may
also share your information for the following purposes, called routine uses:
1. To third party contacts in situations where the party to be contacted has, or is expected to
have, information relating to the individual’s capability to manage affairs or eligibility for
or entitlement to benefits under the Social Security program when the data are needed to
establish the validity of evidence or to verify the accuracy of information presented by
the individual, and it concerns the individual’s eligibility for benefits under the Social
Security program; and
2. To contractors and other Federal agencies, as necessary, for the purpose of assisting SSA
in the efficient administration of its programs relating to this system of records.
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. Additional information and a full listing of
all our SORNs are available on our website at www.socialsecurity.gov/foia/bluebook.