Form SSA-711 (11-2018) Page 3 of 3
PRIVACY ACT STATEMENT
Collection and Use of Personal Information
The Freedom of Information Act (FOIA) (5 U.S.C. § 552) and our regulations at 20 CFR 402.130 allows us
to collect this information. Furnishing us this information is voluntary. However, failing to provide all or part
of the information may prevent us from accurately responding to your FOIA request.
We will us the information to verify the subject individual is deceased, access the correct Social Security
record, and process your request. We may also share your information for the following purposes, called
routine uses:
• To student volunteers, individuals working under a personal services contract, and other workers
who technically do not have the status of Federal employees, when they are performing work for
the Social Security Administration (SSA), as authorized by law, and they need access to personally
identifiable information in SSA records to perform their agency assigned functions; and
• To National Archives and Records Administration, Office of Government Information Services
(OGIS), to the extent necessary to fulfill its responsibilities in 5 U.S.C. 552(h) to review
administrative agency policies, procedures and compliance with the FOIA, and to facilitate OGIS'
offering of mediation services to resolve disputes between persons making FOIA requests and
administrative agencies.
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 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) 60-0340,
entitled FOIA and Privacy Act Record Request and Appeal System, as published in the Federal Register
(FR) on July 13, 2016, at 81 FR 45352. Additional information, and a full listing of all SORNs, is available on
our website at https://
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 7 minutes to read the instructions, gather the facts, and answer
the questions. Send only comments relating to our time estimate above to: SSA, 6401 Security Blvd,
Baltimore, MD 21235-6401.
