Vocaional Rehabilitation Provider Claim - Claiming Reimbursement SSA-199

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

Section 205(a), 222(d)(1), and 1615(d) of the Social Security Act, as amended, allows us to
collect this information. Furnishing us this information is voluntary. However, failing to
provide all or part of the information may create insufficient oversight of costs claims, lead to
inaccurate payment of claims, and unnecessarily delay reimbursement to State vocational
rehabilitation agencies for reasonable and necessary costs incurred.
We will use the information to make a determination regarding the reimbursement of costs
incurred for providing vocational rehabilitation services. We may also share your information
for the following purposes, called routine uses:
•

To a State vocational rehabilitation agency or alternate participant regarding the basis for
SSA's decision on its claim for reimbursement and the reason(s) costs were allowed or
denied; and

•

To contractors under contract to the Social Security Administration (SSA), or under
contract to another agency with funds provided by SSA, for the performance of research
and statistical activities directly relating to this system of records.

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) 60-0221, entitled Vocational Rehabilitation Reimbursement Case Processing System, as
published in the Federal Register (FR) on January 11, 2006, at 71 FR 1840, and 60-0090, entitled
Master Beneficiary Record, as published in the FR on January 11, 2006, at 71 FR 1826.
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 61 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.