Letter to Employer Requesting Wage Information

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 1611(c), 1612(a), and 1631(e)(1) 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 benefit eligibility or could result in loss of benefits of the named claimant.
We will use the information to verify current wages of the named Supplemental Security Income
applicant or recipient to determine eligibility and benefit amount. We may also share the
information for the following purposes, called routine uses:
•

To contractors and other Federal Agencies, as necessary, for the purpose of assisting us in
the efficient administration of our programs. We will disclose information under this
routine use only in situations in which we may enter into a contractual or similar
agreement to obtain assistance in accomplishing an SSA function relating to this system
of records; and,

•

To third party contacts (e.g., employers and private pension plans) in situations where the
party to be contacted has, or is expected to have, information relating to the individual's
capability to manage his or her benefits or payments, or his or her eligibility for or
entitlement to benefits or eligibility for payments, under the Social Security program.

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 System, 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
control number. We estimate that it will take about 30 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 1-800772-1213 (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
or other aspects of this collection to this address, not the completed form.