State Mental Institution Policy Review

SSA will insert the following revised Privacy Act & PRA Statements into the
form as soon as possible:
Privacy Notice for Collection of Information
Sections 205(j) and 1631(a) 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 conducting an onsite review and could result in a change
in representative payee.
We will use the information to determine whether the representative payee needs guidance or if a
change in representative payee is required. We may also share this information for the following
purposes, called routine uses:
•

To state protection and advocacy systems, that have a written agreement with Social
Security Administration to conduct reviews of representative payees, for the purpose of
conducting additional reviews that the protection and advocacy systems have reason to
believe are warranted; and

•

To agencies or entities with responsibility for investigating or addressing possible
financial exploitation of, an immediate health or safety threat to, or other serious risk to
the well-being of the beneficiary, for referral, when these issues are identified during a
representative payee review.

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.
Additional information is available in our Privacy Act System of Records Notice (SORN) 600222, entitled Master Representative Payee File, as published in the Federal Register (FR) on
November 2, 2018, at 83 FR 55228. 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 60 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.