Request for Correction of Earnings Record (Paper)

SSA will insert the following revised Privacy Act Statement into the form as soon
as possible:
Privacy Act Statement
Collection and Use of Personal Information

Sections 205(a), (c)(4), (5) and 233 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 affect your future eligibility for benefits and the amounts of benefits
to which you may become entitled.
We will use the information to correct your earnings record where any discrepancy exists. We
may also share your information for the following purposes, called routine uses:
•

To the Department of the Treasury for: (a) Investigating the alleged forgery, or unlawful
negotiation of Social Security checks; and (b) Tax administration as defined in 26 U.S.C.
6103 of the Internal Revenue Code;

•

To the Department of Justice (Federal Bureau of Investigation and United States
Attorneys) for investigating and prosecuting violations of the Social Security Act; and

•

To contractors and other Federal agencies, as necessary, for the purpose of assisting the
Social Security Administration in the efficient administration of its programs.

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) 60-0059, entitled Earnings Recording and Self-Employment Income System, as
published in the Federal Register (FR) on January 11, 2006, at 71 FR 1819. Additional
information, and a full listing of all of our SORNs, is available on our website at
www.ssa.gov/privacy.