NBS General Waves Round 3 Representative Sample

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

Section 1110 of the Social Security Act allows us to collect this information. Furnishing us this
information is voluntary. We will not use the information to make any determination about your
eligibility for benefits and your responses will in no way affect any current benefits you may be
receiving from the Social Security Administration (SSA).
We will use the information to learn more about disability beneficiaries, how well our programs
are working, and to design new programs. We will use the information for research and
statistical purposes only. We may also share your information for the following purpose, called
a routine use:


To a contractor under contract to SSA, or under contract to another agency with funds
provided by SSA, for the performance of research and statistical activities directly related
to this system of records.

In addition, we may share this information in accordance with the Privacy Act and other Federal
laws.
A list of additional routine uses is available in our Privacy Act System of Records Notice
(SORN) 60-0199, entitled Extramural Surveys (Statistics). Additional information and a full
listing of all our SORNs are available on our website at www.socialsecurity.gov/foia/bluebook.