Form SSA-7156 Farm Self-Employment

See Revised Privacy Act Statement Attached

See Revised PRA Statement Attached

SSA will insert the following revised Privacy Act and PRA Statements into the form at
its next scheduled reprinting:
Privacy Act Statement
Collection and Use of Personal Information

Section 211(a) of the Social Security Act, as amended, authorizes us to collect the
information requested on this form. The information that you provide on this form
will be used to determine if you are self-employed as a farmer, and it may affect
your eligibility for Social Security benefits. Your response is voluntary. However,
failure to provide the requested information may prevent an accurate and timely
decision on any claim filed, or could result in the loss of benefits.
We rarely use the information you supply for any purpose other than for
determining self-employment as a farmer. We may, however, disclose the
information provided on this form in accordance with approved routine uses of the
Privacy Act (5 U.S.C. § 552a(b)), which include but are not limited to the
following:
1.

To enable a third party or an agency to assist Social Security in
establishing rights to Social Security benefits and/or coverage;

2.

To make determinations for eligibility in similar health and
income maintenance programs at the Federal, State, and local
level;

3.

To comply with Federal laws requiring the disclosure of the
information from our records; and,

4.

To facilitate audit or investigative activities necessary to assure
the integrity of Social Security programs.

We may also use the information you provide in computer matching programs.
Matching programs compare our records with records kept by other Federal, State,
or local government agencies. Information from these matching programs can be
used to establish or verify a person’s eligibility for Federally-funded or
administered benefit programs and for repayment of payments or delinquent debts
under these programs.
A complete list of routine uses for this information is available in Systems of
Records Notices 60-0044, 60-0059, 60-0089 and 60-0103. The notices, additional
information regarding this form, and information regarding our programs and
systems, are available on-line at www.socialsecurity.gov or at your local Social
Security Office.

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. Send only comments relating to our time estimate above to:
SSA, 6401 Security Blvd, Baltimore, MD 21235-6401