- 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 9 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.
Privacy Act Statement
Page 3Form SSA-753 (07-2015) uf (07-2015)
Collection and Use of Personal Information
Paperwork Reduction Act Statement
Section 216(h)(1)(A) of the Social Security Act, as amended, authorizes us to collect this information. We will use the information
you provide to establish an individual's marital relationship and to make an eligibility determination for Social Security benefits.
Furnishing us this information is voluntary. However, failing to provide us with all or part of the information may prevent an
accurate and timely decision on any claim filed.
We rarely use the information you supply us for any purpose other than to make a determination regarding benefits eligibility.
However, we may use the information for the administration of our programs including sharing information:
1. To comply with Federal laws requiring the release of information from our records (e.g., to the Government
Accountability Office and the Department of Veterans Affairs); and,
2. To facilitate statistical research, audit, or investigative activities necessary to ensure the integrity and improvement of
our programs (e.g., to the Bureau of the Census and to private entities under contract with us).
A complete list of when we may share your information with others, called routine uses, is available in our Privacy Act System of
Records Notices 60-0089, entitled, Claims Folders Systems; and, 60-0320, entitled, Electronic Disability (eDIB) Claim File.
Additional information about these and other system of records notices and our programs are available online at
www.socialsecurity.gov
or at your local Social Security Office.
We may share the information you provide to other health agencies through computer matching programs. Matching programs
compare our records with records kept by other Federal, State or local government agencies. We use the information from these
programs to establish or verify a person's eligibility for federally funded or administered benefit programs and for repayment of
incorrect payments or delinquent debts under these programs.