e8508

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(a), 1611(c)(1), and 1631 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 any
claim filed.
We will use the information to make a determination on eligibility for benefits. We may also
share this information for the purposes, called routine uses:
•

To specified Federal and State agencies to prepare information for verification of benefit
eligibility under section 1631(e) of the Social Security Act; and

•

To a contractor for the purpose of collating, evaluating, analyzing, aggregating or
otherwise refining records in this system when Social Security Administration contracts
with a private firm.

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) 60-0040, entitled Quality Review System, as published in the Federal Register (FR) on
October 13, 1982, at 47 FR 45606, 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.