Form SSA-4589 Credit Card Remittance

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 204(a)(1) and 1631(b)(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 this information may prevent us from collecting your one-time or recurring credit card
payment(s) for your overpayment of Social Security benefits.
We will use the information to process your one-time or recurring credit card payment(s). We
may also share your information for the following purposes, called routine uses:
•

To banks enrolled in the Treasury credit card network, to collect a payment or debt when
the individual has given his or her credit card number for this purpose; and

•

To third party contacts such as private collection agencies and credit reporting agencies
under contract with SSA and other agencies, including the Veterans Administration, the
Armed Forces, the Department of the Treasury, and State motor vehicle agencies, for the
purpose of assisting SSA in recovering program debt.

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) 60-0094, entitled Recovery of Overpayments, Accounting and Reporting/Debt
Management System (ROAR/DMS), as published in the Federal Register (FR) on August 23,
2005, at 70 FR 49354 and 60-0231, entitled Social Security Online Accounting and Reporting
System, as published in the FR on January 14, 2020, at 85 FR 2224. 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 5 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.