Form SSA-L5061 Letter to Landlord Requesting Rental Information

See Revised
Privacy Act
Statement

See Revised Paperwork
Reduction Act

The following revised Privacy Act Statement will be inserted into the form at its next
scheduled reprinting:
Letter to Landlord Requesting Rental Information, Form SSA-L5061
Privacy Act Statement
Collection and Use of Personal Information
Sections 205(a), 1611, and 1631 of the Social Security Act, as amended, [42 U.S.C.
405(a)], [42 U.S.C. 1382], and [42 U.S.C. 1383] authorize us to collect this
information. We will use the information you provide to help us determine the
individual’s eligibility for benefits. The information you provide on this form is
voluntary. However, failure to provide all or part of the requested information may
prevent us from making an accurate and timely decision on any claim for benefits.
We rarely use the information you provide on this form for any purpose other than for
the reasons explained above. 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, including but
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 Government Accountability Office, General Services
Administration, National Archives Records Administration, 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 and improvement of our programs (e.g., to the U.S.
Census Bureau and to private entities under contract with us).
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. 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.
A complete list of routine uses of the information you gave us is available in our
Privacy Act Systems of Records Notices entitled, Supplemental Security Income
Record and Special Veterans Benefits, 60-0103; Claims Folder System, 60-0089; and
Electronic Disability (eDIB) Claims File, 60-0340. The notices, additional
information regarding this form, and information regarding our systems and
programs, are available on-line at www.socialsecurity.gov or at any 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 (OMB) control number. The OMB control number for this
collection is 0960-0555. We estimate that it will take between 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.