Form SSA-263-U2 Waiver of Supplemental Security Income Payment Continuat

See Revised Privacy Act
Statement Attached

SSA will insert the following revised Privacy Act Statement into the form as soon
as possible:
PRIVACY ACT STATEMENT
Collection and Use of Personal Information
Sections 205(a), 1631(a)(7), and 1631(e)(1)(A) of the Social Security Act, as amended, and CFR
20 § 416.1336(c) authorize us to collect this information. We will use the information you
provide to further document your claim and make a determination regarding your Social
Security benefits.
Furnishing us this information is voluntary. However, failing to provide us with all or part of the
information may prevent us from making an accurate and timely decision on any claim filed.
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 60-0103, entitled Supplemental Security Income
Record and Special Veterans Benefits. 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.