Application for Benefits Under the Italy-U.S. International Social Security Agreements

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 205 and 233 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 determination of your
claim for benefits from the United States under an international agreement with Italy.
We will use the information to determine your eligibility for any Social Security Administration
(SSA) provided benefits. We may also share your 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 the 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). The first SORN is 60-0090, entitled Master Beneficiary Record, as published in the
Federal Register (FR) on January 11, 2006, at 71 FR 1826 and the second SORN is 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.