Privacy Act Statement
Collection and Use of Personal Information
Sections 205(a) and 1631(d)(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 the
information may prevent an accurate and timely decision on any claim filed.
We will use the information to schedule your hearing. We may also share your information for the
following purposes, called routine uses:
• To applicants, claimants, prospective applicants or claimants, other than the data subject,
their authorized representatives or representative payees to the extent necessary to pursue
Social Security claims and to representative payees when the information pertains to
individuals for whom they serve as representative payees, for the purpose of assisting SSA in
administering its representative payment responsibilities under the Act and assisting the
representative payees in performing their duties as payees, including receiving and
accounting for benefits for individuals for whom they serve as payees; and
• To contractors and other Federal agencies, as necessary, for the purpose of assisting SSA in
the efficient administration of its programs. We contemplate disclosing 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 Notice (SORN)
60-0320, entitled Electronic Disability Claim File, as published in the Federal Register (FR) on
December 22, 2003, at 68 FR 71210. Additional information, and a full listing of all of 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 control number.
We estimate that it will take about 10 minutes to read the instructions, gather the facts, and answer
the questions. You may send 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. Send only comments relating to our time estimate to this address, not the
completed form.
