Pain Report - Child

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 1614 and 1631 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 our determination of eligibility for and the amount of Supplemental Security Income (SSI) benefits for a child who is claiming a disability.

We will use the information to determine a child’s eligibility for SSI benefits. We may also share the child’s disability information for the following purposes, called routine uses:

• Information may be disclosed to contractors and other Federal agencies, as necessary,

for the purpose of assisting SSA in the efficient administration of its programs. We contemplate disclosing information under this routine use only in situations in which

SSA may enter a contractual or similar agreement with a third party to assist in accomplishing an agency function relating to this system of records; and

• To State agencies to enable them to assist in the effective and efficient administration of the Supplemental Security Income program.

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 two of our Privacy Act System of Records Notices (SORN) 60-0089, entitled Claims Folders Systems, as published in the Federal Register (FR) on April 1, 2003, at 68 FR 15784 and 60-0103, entitled Supplemental Security Income Record and Special Veterans Benefits as published in the FR on January 11, 2006, at 71 FR 1830. Additional information, and a full listing of all of our SORNs, is available on our website at www.ssa.gov/privacy.