Disability Update Report

Disability Update Report

SSA-455 - Revised PA Statement for Fillable Version

Disability Update Report

OMB: 0960-0511

Document [pdf]
Download: pdf | pdf
SSA will insert the following revised PRA Statement into the form at its next scheduled
reprinting:
Privacy Statement
Collection and Use of Personal Information

Sections 205(a) and 1631(e)(1)(A) and (B) of the Social Security Act, as amended, and Social
Security regulations at 20 C.F.R. 404.1589 and 416.989 authorize us to collect this information.
We will use the information you provide to further document your claim and permit a
determination about continuing disability.
Furnishing us this information is voluntary. However, failing to provide us with all or part of the
information may prevent an accurate and timely decision on any claim filed.
We rarely use the information you supply us for any purpose other than for the reasons explained
above. However, we may use the information for the administration of our programs including
sharing information:
1. To comply with Federal laws requiring the release of information from our records
(e.g., to the Government Accountability Office and Department of Veterans Affairs);
2. To facilitate statistical research, audit, or investigative activities necessary to assure
the integrity and improvement of our programs (e.g., to the Bureau of the Census and
to private entities under contract with us).
A complete list of when we may share your information with others, called routine uses, is
available in our Privacy Act Systems of Records Notices entitled, Claims Folders Systems
(60-0089) and the Master Beneficiary Record (60-0090). Additional information about this and
other system of records notices and our programs are available online at www.socialsecurity.gov
or at your local Social Security office.
We may share the information you provide to other health agencies through computer matching
programs. Matching programs compare our records with records kept by other Federal, State or
local government agencies. We use the information from these programs to establish or verify a
person’s eligibility for federally funded or administered benefit programs and for repayment of
incorrect payments or delinquent debts under these programs.


File Typeapplication/pdf
File TitleMicrosoft Word - PA Disability Update Rpt.doc
Author177717
File Modified2014-05-01
File Created2014-05-01

© 2024 OMB.report | Privacy Policy