SSA-8240 (paper)

SSA will insert the following revised Privacy Act & PRA Statements into the
form as soon as possible:
Privacy Act Statement
Collection and Use of Personal Information

Sections 205(a), 225, 1184, and 1631(e) 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 an accurate and timely decision regarding your
Social Security benefits.
We will use the information to obtain information about you from payroll data providers. We
will use the payroll data provider information to administer the Social Security Act, such as
determining your eligibility for Social Security benefits. We may also share your information for
the following purposes, called routine uses:
•

To employers, current or former, for correcting or reconstructing earnings records and for
Social Security tax purposes; and

•

To contractors and other Federal agencies, as necessary, for the purpose of assisting the
Social Security Administration (SSA) in the efficient administration of its programs. We
will disclose 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.

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, as published in the Federal Register (FR) on
October 31, 2019, at 84 FR 58422, 60-0090, entitled Master Beneficiary Record, as published in
the FR on January 11, 2006, at 71 FR 1826, 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.

Paperwork Reduction Act Statement - This information collection meets the requirements of
44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not
need to answer these questions unless we display a valid Office of Management and Budget
(OMB) control number. We estimate that it will take about 6 minutes to read the instructions,
gather the facts, and answer the questions. Send only comments regarding this burden estimate
or any other aspect of this collection, including suggestions for reducing this burden to: SSA,
6401 Security Blvd, Baltimore, MD 21235-6401.