Form SSA-1383 Student Reporting Form

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Privacy Act Statement

Collection and Use of Personal Information

See Revised Privacy Act &
PRA Statements attached.

Seciions 202(d), 203 (h), and 205(a) of the Sociai Securiry Ac1, as amended, aiiow us !O coiiec;: Inis miorrnarion. ;;u11 ,r-,1 m,=' ...,_
this information is voluntary. However, failing to provide all or part of the \nformation may prevent an accurate and timely decision
on any claim filed.
We will use the information to determine your entitlement and benefits. We may also share your information for the following
purposes, called routine uses:
1. To third party contacts where necessary to estal:ilish or verify information provided by representative payees or payee
applicants; and .
L
. To aoplicants, claimants, prospective applicants or claimants, other than the data subject, their authorized representative
payees to the extent necessary to pursue Social Security claims and to representative payees when the information
.
pertains to individuals for whom they serve as representative payees, for the purpose of assisting SSA in administering its
representative payment responsibilities under the Act and assisting the representative payees in performing their duties as
payees, including receiving and accounting for benefits for individuals for1whom they serve as payees.
\

m addition. we mav share this information in accordance with the Privacv Act and other Federal laws. For examole. where
authorized,
may use and disclose this information in computer matching programs, in which our records are �o,;,pared with
other records to establish or verify a person's eligibility for Federal benefit programs and for repayment of incorrect or delinquent
debts under tnese programs.

we

A list of additional routine uses is available in our Privacy Act System of Records Notice (SORN) 60-0089 entitled Claims Folders
System. Additional information and a full listing of all our SORNs are available on our website at

Paperwork keauct1on Act �1atem;;:_
This information collection meets the requirements-0144 U.S.C. § 3507, as amended by sectian 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 (OM8J
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 relating to our time estimate above to: SSA, 6401 Security Blvd., Baltimore, MD 21235-6401.

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 202(d), 203(h), and 205(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 an accurate and timely decision on any claim filed.
We will use the information to determine your entitlement and benefits. We may also share your
information for the following purposes, called routine uses:
•

To third party contacts, where necessary, to establish or verify information provided by
representative payees or representative payee applicants; and

•

To claimants, prospective claimants (other than the data subject), and their authorized
representatives or representative payees, to the extent necessary to pursue Social Security
claims; to representative payees, when the information pertains to individuals for whom
they serve as representative payees, for the purpose of assisting us in administering
representative payment responsibilities under the Social Security Act; and to
representative payees, for the purpose of assisting them in performing their duties as
payees, including receiving and accounting for benefits for individuals for whom they
serve as payees.

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 Notice
(SORN) 60-0089, entitled Claims Folders System, as published in the Federal Register (FR) on
October 31, 2019, at 84 FR 58422. Additional information, and a full listing of all 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.