Sections 202(d), 202(h), and 216(e) 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 us from making an accurate and timely decision in determining the child applicant’s
eligibility for benefits.
We will use the information to make a determination for eligibility of benefits. We may also share your
information for the following purposes, called routine uses:
1. To third party contacts in situations where the party to be contacted has, or is expected to have,
information relating to the individual’s capability to manage affairs or eligibility for or entitlement to
benefits under the Social Security program when the data is needed to establish the validity of
evidence or to verify the accuracy of information presented by the individual, and it concerns the
individual’s eligibility for benefits under the Social Security program; and
2. To Federal, State, or local agencies (or agents on their behalf) for administering cash or non-cash
income maintenance or health maintenance programs (including programs under the Act).
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) 60-0089,
entitled Claims Folders Systems. Additional information and a full listing of all our SORNs are available on
our website at www.socialsecurity.gov/foia/bluebook
.
- 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 15 minutes to read the instructions, gather the facts, and answer the
questions. SEND OR BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE.
To find the nearest office, call 1-800-772-1213 (TTY 1-800-325-0778). Send only comments on our time
estimate above to: SSA, 6401 Security Blvd., Baltimore, MD 21235-6401.
Form SSA-783 (06-2019) UF Page 3 of 3
Privacy Act Statement
Collection and Use of Personal Information
Paperwork Reduction Act Statement