Electronic Records Express Third-Party Registration and Request Screens

Access to Claimant’s Electronic Folder Screens

Appointed Representative Homepage

1

Access to Claimant’s Electronic Folder Screens

Acknowledgement Screen

2

Access to Claimant’s Electronic Folder Screens

Case Documents Screen

3

Access to Claimant’s Electronic Folder Screens

Exhibit List Screen

4

Access to Claimant’s Electronic Folder Screens

Multimedia Files Screen

5

Access to Claimant’s Electronic Folder Screens

Pickup Files Screen

6

Access to Claimant’s Electronic Folder Screens

Access Denied (Unsuccessful) Screen

7

Access to Claimant’s Electronic Folder Screens

Access Denied (Access Blocked) Screen

8

Access to Claimant’s Electronic Folder Screens

Unable to Process Your Request Screen

9

Privacy Act Notice

Electronic Records Express
Privacy Act Notice
Sections 205(a), 223(d), and 1631(e)(1) of the Social Security
Act, as amended, authorize us to collect this information. The
information you provide will be used to make a decision on the
named claimant’s claim. While giving us this information is
voluntary, failure to provide
all or part of the requested
See revised
information could prevent
an accurate
or timely decision on the
Privacy
Act
named claimant’s claim.
We
generally
use
the information you
Statement below
supply for the purpose of making decisions regarding claims.
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 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 about Social Security records (e.g., to the
Government Accountability Office and the 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
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 Federallyfunded or administered benefit programs and for repayment of
payments or delinquent debts under these programs.
Additional information regarding routine uses of information and
our programs and systems, is available on-line at
www.socialsecurity.gov or at any local Social Security office.
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Privacy Act Statement
Appointed Representative
Electronic Records Express
Collection and Use of Personal Information
Sections 205(a) [42 U.S.C. § 405], 223(d) [42 U.S.C. § 423], and 1631(e)(1)
[42 U.S.C. § 1383] of the Social Security Act, as amended, authorize us to collect this
information. We will use the information you provide to make a decision on the named
claimant’s claim.
Providing this information is voluntary. However, failing to provide the requested
information could prevent us from making an accurate and timely decision on the named
claimant’s claim.
We rarely use the information you provide for any purpose other than to make a decision
on a claimant’s claim. 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 us in establishing rights to Social
Security benefits and/or coverage;
2. To comply with Federal laws requiring the release of information from our
records (e.g., to the General Services Administration and National Archives
Records Administration);
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
ensure 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 our Privacy Act
Systems of Records Notices entitled, Claims Folder System (60-0089) and Electronic
Disability (60-0320). These notices, additional information about this collection, and any
other information regarding our systems and programs, are available on-line at
www.socialsecurity.gov or at your local Social Security office.

Electronic Records R\.rpress

'in The Paperwork Reduction Act Statement
\o\

Thsinformaliion co!ledi'onrneets the requi"rEJfllefis of44U.S.C. §3507. asameoded by
section 2 of the P~RedudionAct 011995. You dO not need to answer these
questions.uBess wecisplaya valid Office-ofManagement and Budget 'controll'UTlber, We
'estimete that:it wUltak'8abott 1 mirUe to read the instructions. gattlerthefacts, and answer
the questions,
You may send comments on our'ttme estimate above to:· SSA. 6401 SecootyB1vd..
Balimore. twfD 21235-6401_ Send onlY comments relating to ourtlmeeltlmate to this
addre ••..
See revised PRA ~:J
statment below.

SSA will insert the following revised PRA Statement into the collection
instrument 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 (OMB) control number. The OMB control number for this
collection is 0960-0767. We estimate that it will take about 1 minute 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.