Supplemental Security Income-Quality Review Case Analysis

See Revised Privacy Act
Statement

See Revised PRA

Paperwork Reduction Act Statement

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. We estimate
that it will take about 60 minutes to provide the needed
information to complete the form. This includes the time it will
take to discuss the purpose for gathering the information,
gathering the necessary facts and fill out the form.

SSA will insert the following revised Privacy Act Statement into the form at its next
scheduled reprinting:
Privacy Act Statement
Request for Administrative Information
Collection and Use of Personal Information
Sections 205(a) and 1631(d)(1) and (e) of the Social Security Act, as amended, authorize
us to collect this information. We will use the information you provide, along with the
information we obtain from other people we interview, to help us identify problems in the
programs for which the Social Security Administration (SSA) is responsible. It also
helps us to resolve these problems and recommend changes in the law.
Providing us this information is voluntary; however, your cooperation will aid in the
review process.
Information we obtain about possible changes in your situation will be sent to your Social
Security office. The people at your local Social Security office will decide if your
payments will be affected. However, we may also use this information 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.
A complete list of routine uses for this information is available in our System of Record
Notice entitled, the Quality Review Case Files (60-0042). Additional information about this
and other systems of records notices and our programs are available from our Internet website at
www.socialsecurity.gov or at your local Social Security office.

SSA will insert the following revised PRA Statement into the form at its
next scheduled reprinting:
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 60
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.