State Mental Institution Policy Review

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(j) and 1631(a) of the Social Security Act, as amended, allow us to collect this
information. Furnishing us this information is voluntary. However, failing to provide all or part
of the information may prevent an accurate and timely decision on your onsite review and could
result in the selection of another representative payee.
We will use the information to determine if a beneficiary’s needs are being met. We may also
share this information for the following purposes, called routine uses:
1. To contractors and other Federal agencies, as necessary, to assist the Social Security

Administration (SSA) in the efficient administration of its programs. We will disclose
information under this routine use only in situations in which SSA may enter into a
contractual or similar agreement to obtain assistance in accomplishing an SSA function.
2. To student volunteers, persons working under a personal services contract, and other

workers who technically do not have the status of Federal employees, when they are
performing work for SSA, as authorized by law, and they need access to personally
identifiable information in SSA records in order to perform their assigned agency
functions.
In addition, we may share this information in accordance with the Privacy Act and other Federal
laws. For example, where authorized, we may use and disclose this information in computer
matching programs, in which our records are compared with other records to establish or verify a
person’s eligibility for Federal benefit programs and for repayment of incorrect or delinquent
debts under these programs.
A list of additional routine uses is available in our Privacy Act System of Records Notices
(SORN) 60-0222, entitled Master Representative Payee File. Additional information and a full
listing of all our SORNs are available on our website at www.socialsecurity.gov/foia/bluebook.