Application for a Social Security Card - Asking for Replacement Card beyond allowable limits

SSA will insert the following revised Privacy Act and PRA Statements into the form as soon as
possible:
Privacy Act Statement
Collection and Use of Personal Information
Sections 205 and 702 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 assigning you a Social Security number and issuing you
a new or replacement Social Security card.
We will use the information you provide to issue you a replacement Social Security card. We
may also share your information for the following purposes, called routine uses:
•

To Federal, State, and local entities to assist them with administering income
maintenance and health maintenance programs, when a Federal statute authorizes
them to use the Social Security number; and

•

To student volunteers, persons working under a personal services contract, and others
when they need access to information in our records in order to perform their assigned
agency duties.

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)
60-0058, entitled Master Files of Social Security Number (SSN) Holders and SSN Applications, as
published in the Federal Register (FR) on December 29, 2010, at 75 FR 82121. 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
control number. We estimate that it will take between 5 and 60 minutes to read the instructions,
gather the facts, and answer the questions. SEND OR BRING THE COMPLETED FORM
TO YOUR LOCAL SOCIAL SECURITY OFFICE. You can find your local Social
Security office through SSA’s website at www.socialsecurity.gov. Offices are also listed
under U. S. Government agencies in your telephone directory or you may call Social
Security at 1-800-772-1213 (TTY 1-800-325-0778). You may send 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. Send only comments relating
to our time estimate to this address, not the completed form.