Form SSA-L3231 Employer Verification of Records for Children Under Age

See Revised Privacy Act Statement Attached

See Revised PRA Statement Attached

SSA will insert the following revised Privacy Act and PRA Statements into the form as
soon as possible:
PRIVACY ACT STATEMENT
Collection and Use of Personal Information
Sections 205(b) and 205(c)(2)(A) of the Social Security Act, as amended, allow us to
collect this information. We will use the information you provide to verify and properly
credit the reported income of children under age seven.
Furnishing us this information is voluntary. However, failing to provide all or part of the
information may cause incorrect entitlement to, or denial of, future Social Security
benefits.
We rarely use the information you supply for any purpose other than what we state
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); and,
2. To facilitate statistical research, audit, or investigative activities necessary to
ensure the integrity and improvement of our programs (e.g., to the Bureau of
the Census and to private entities under contract with us).
A list of when we may share your information with others, called routine uses, is
available in our Privacy Act System of Records Notice, 60-0059, entitled Earnings
Recording and Self-Employment Income System. Additional information about this and
other system of records notices and our programs is available from our Internet website at
www.socialsecurity.gov or at your local Social Security office.
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 incorrect payments or delinquent debts under these
programs.
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. We estimate that it will take about
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.