Current iClaim Privacy Act Statements

Privacy Act Statement

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Social Security
The Official Website of the U.S. Social Security Administration

Privacy Act Statement
Collection and Use of Information From the Application
If you are the applying for yourself

For The Applicant
We are authorized to collect the information on this form under sections 202(a),
205(a), and 1872 of the Social Security Act, as amended (42 U.S.C. 402(a), 405
(a), and 1395(ii)). While it is voluntary, except in the circumstances explained
below, we may not pay benefits unless we receive an application. Your response
is mandatory where the refusal to disclose certain information affecting your right
to payment would reflect a fraudulent intent to secure benefits not authorized by
the Social Security Act. We need the information on this form to determine if you
and your dependents are entitled to insurance coverage and/or monthly benefits.
If you do not provide all or part of this information, it could prevent us from
making an accurate and timely decision on your claim or your dependent's claim,
and could result in the loss of some benefits or insurance coverage.
The information you furnish on this form is almost never used for any purpose
other than to determine if you and your dependents are entitled to insurance
coverage and/or monthly benefits. However, there is a possibility that for the
administration of the Social Security programs or for the administration of
programs requiring coordination with the Social Security Administration, we may
disclose information to another person or to another agency as follows:
1. To enable a third party or an agency to assist Social Security in
establishing rights to Social Security benefits and/or coverage;
2. To comply with federal laws requiring the release of information from
Social Security records (e.g., to the General Accountability Office and
Department of Veterans' Affairs); and
3. To facilitate statistical research and audit activities necessary to assure
the integrity and improvement of the Social Security programs (e.g., to
the Bureau of the Census and private concerns under contract to Social
Security).
We may also use the information you provide without your consent in automated
matching programs. These matching programs are computer comparisons of our
records with records kept by other Federal agencies or State or local

http://www.socialsecurity.gov/info/isba/privacyact.htm

7/1/2013

Privacy Act Statement

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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 payments or delinquent debts under
these programs.
Explanations about these and other reasons why information you provide us
may be used or given out are available in Social Security offices. If you want to
learn more about this, contact any Social Security office.
If you are helping someone

For the Third Party Filer
The Social Security Administration (SSA) is allowed to collect the information
you provide about yourself as a third party filer on this application under Section
205 of the Social Security Act. We need this information to identify who you are
as the third party filer and to provide it to the claimant on the summary sheet of
the application. Giving us this information is voluntary. However, without it we
may not be able to process the application.
While the information you furnish on this form would almost never be used for
any purpose other than the intended use of this form, such information may be
disclosed by SSA as generally permitted under 5 U.S.C. § 552a(b) of the Privacy
Act of 1974, as amended. This includes using the information as necessary for
administrative purposes or as authorized by routine uses in the applicable
Privacy Act system of records.
Explanations about possible reasons why information you provide us may be
used or given out are available upon request from any Social Security office.

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Last reviewed or modified 10/22/2012

http://www.socialsecurity.gov/info/isba/privacyact.htm

7/1/2013