Claimant's Medications - ERE Internet Version

Privacy Act Statement
Collection and Use of Personal Information
Sections 205, 223, 702, 1614, 1631, and 1869 of the Social Security Act, as amended, allow us to
collect this information, which we will use to determine benefits eligibility. Providing this
information is voluntary, but not providing all or part of the information may prevent us from reevaluating the decision on your claim. As law permits, we may use and share the information
you submit, including with other Federal agencies, contractors, and others, as outlined in the
routine uses within System of Records Notices 60-0089, 60-0103, and 60-0320, available at
www.ssa.gov/privacy. The information you submit may also be used in computer matching
programs for Federal benefits eligibility and to recoup debts under these programs.