In compliance with Florida Statute 119.071(5), this document serves to notify you of the purpose for
the collection and usage of your Social Security number (SSN).
Pasco-Hernando State College (PHSC) collects and uses your SSN only for the following
purposes in performance of the college’s duties and responsibilities. To help protect your identity,
PHSC policies and procedures prohibit the release or disclosure of your SSN to unauthorized
parties contrary to state and federal law and assigns you a unique student or employee
identification number. This unique ID number is used for all associated employment and
educational purposes at PHSC.
Your SSN may be used to for the following:
Federal I-9 (Department of Homeland Security)
Federal W4, W2, 1099 (Internal Revenue Service)
Federal Social Security taxes (FICA)
Distributing Federal W2 (Internal Revenue Service
Unemployment reports (Florida Department of Revenue)
Florida Retirement Contribution reports (Florida Department of Revenue)
Workers Comp claims (FCSRMC and Department of Labor)
Direct deposit files
Supplemental individual retirement account contribution reports
Group health, life and dental coverage enrollment
Supplemental insurance and flexible benefit deduction reports
Work study work assignments
Background checks
Memberships in voluntary organizations where you authorize the release
Providing your Social Security card is a condition of employment at PHSC. For specific
references to legal authority that authorizes or requires collection and use of your Social Security
Number, please reference the attached chart.
I understand the above information and have been given a copy of collection and usage
_________________________ _________________________ ___________
Signature Employee Name Date
click to sign
click to edit
Notification of Legal Authority for Collection and Use of Social Security Numbers
Use of Social Security
Statutory or Regulatory
Mandatory or
Employment / Hiring
Verification, work eligibility,
and reporting for social
security and taxes.
Employment Application
W2 statement/reissue
Background checks
W9s (SSN or FEIN)
Alternative to Social
Enrollment form (SSA-
8 USC 1324a(b); (I9)
20 CFR 404.452 IRC
3402(f)(2)(A) (W4, W2)
URC 6051(a)(2) (FICA)
119.071(5) FS regarding
the collection, use and
disclosure of SSN’s
Collection is authorized and
mandatory, however subject
to the conditions of use in
the Privacy Act of 1974, 5
USC 552a (unlawful to deny
benefits upon refusal to
disclose SSN’s unless
authorized by federal
statue, or law enacted prior
to 1975)
Use of social security
numbers of employees
working on federal contracts
Executive Order 13465,
June 6, 2008
Mandatory, as applicable
Direct Deposit
SSN’s used to search and
verify against bank records.
119.071(5)(a) FS
RE. use and disclosure
If using direct deposit,
required for administrative
Workers’ Compensation
Required of employees to
process workers
compensation claims
Chp.440.185 FS
Dept. of Labor FCSRMC
Yes, required for
administrative use
Unemployment reports
Chp. 112 FS
Yes, required for
administrative use
Retirement Contributions
FL Retirement contribution
reports 403(b)Contribution
Chp. 112 FS
US Tax Code 501(C )
Yes, required for
administrative use
Health, Life, and Dental
Employee and dependents
of employee
COBRA forms (for
continuation of medical
119.071(5)(a)6.f permits
disclosure of SSN’s held by
agency for purpose of
administering health plan
for employees and
Notice of authorized
administrative use on HR
forms for employees and
employee’s dependents
Contracts and Grants
With respect to certain
federal contracts/grants
requires reports including
employee SSN’s for equal
employment opportunity
reports and reports to IRS
41 CFR 604.3 IRC 6109
Yes, mandated where
required reporting
Services Performed Form B
Independent contractor with
no Federal Employer ID No.
CFRS system requires
either a Federal ID No. or
Social Security No. to
process payment.
Yes, required for College
Finance System to process