Form SSA-2032-BK Request for Waiver of special veterans Benefit (SVB) Ove

See Revised Privacy Act Statement Attached

SSA will insert the following revised Privacy Act Statement into the form at its next
scheduled reprinting:
Privacy Act Statement
Collection and Use of Personal Information
42 U.S.C. 404, 1008, 1383(b), 1395gg, the Social Security Protection Act of 2004 (P.L.
108-203) and the Federal Coal Mine Health and Safety Act of 1969, authorize us to
collect this information. We will use the information you provide on this form to decide
if we can waive collection of the overpayment or change the amount you must pay us
back each month.
Completion of this form is voluntary; however, failure to provide all or part of the
requested information could prevent us from waiving collection of the overpayment or
change the amount you must repay us each month. Failure to report all events, which can
cause suspension of benefits, may also cause the loss of additional benefits.
We rarely use the information you supply for any purpose other than for determining
continuing eligibility. However, we may use it for the administration and integrity of
Social Security programs. We may also disclose information to another person or to
another agency in accordance with approved routine uses, 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 comply with Federal laws requiring the release of information from Social
Security records (e.g., to the Government Accountability Office and Department
of Veterans’ Affairs);
3. To make determinations for eligibility in similar health and income maintenance
programs at the Federal, State, and local level; and,
4. To facilitate statistical research, audit, or investigative activities necessary to
assure the integrity and improvement 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.
Complete lists of routine uses for this information are available in our System of Records
Notices entitled, the Master Beneficiary Record (60-0090) and the Recovery of
Overpayments, Accounting and Reporting/Debt Management System (60-0094). These

notices, additional information regarding this form, routine uses of information, and our
programs and systems are available on-line at www.socialsecurity.gov or at your local
Social Security office.