Pre-1957 Military Service Federal Questionnaire

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 217(a) through (e) 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 making an accurate and timely determination on your claim,
and could result in loss of benefits.
We will use the information you provide to determine entitlement eligibility or the amount of
Social Security benefits based on your military service. We may also share your information for
the following purposes, called routine uses:
•

To the Office of Personnel Management (OPM) the fact that a veteran is, or is not,
eligible for retirement insurance benefits under the Social Security program for OPM's
use in determining a veteran's eligibility for a civil service retirement annuity and the
amount of such annuity; and

•

To contractors and other Federal agencies, as necessary, for the purpose of assisting the
Social Security Administration (SSA) in the efficient administration of its programs. We
will disclose information under this routine use only in situations in which SSA may
enter a contractual or similar agreement with a third party to assist in accomplishing an
Agency function 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 Notices
(SORNs) 60-0059, entitled Earnings Recording and Self-Employment Income System, as
published in the Federal Register (FR) on January 11, 2006, at 71 FR 1819; 60-0089; Claims
Folders System, as published in the FR on October 31, 2019, at 84 FR 58422; 60-0103, entitled
Supplemental Security Income Record and Special Veterans Benefits, as published in the FR on
January 11, 2006, at 71 FR 1830; and 60-0118, entitled Non-Contributory Military Service
Reimbursement System, as published in the FR on January 11, 2006, at 71 FR 1834. 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 10 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.