Form SSA-753 Statement Regarding Marriage

See Revised
Privacy Act and
PRA Statement

SSA will insert the following revised Privacy Act Statement into the form at its
next scheduled reprinting:
Privacy Act Statement
Collection and Use of Personal Information
Section 216(h)(1)(A) of the Social Security Act, as amended, allows 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 the individual’s claim.
We will use the information you provide to establish an individual’s marital relationship and to
make an eligibility determination for Social Security benefits. We may also share the
information for the following purposes, called routine uses:
1. To contractors and other Federal agencies, as necessary, for the purpose of assisting SSA
in the efficient administration of its programs; and,
2. To student volunteers, individuals 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
(SORNs) 60-0089, entitled Claims Folders Systems and 60-0320, entitled Electronic Disability
(eDIB) Claim File. Additional information and a full listing of all our SORNs are available on
our website at www.socialsecurity.gov/foia/bluebook.

5/10/2017 9:30 AM

SSA will insert the following revised PRA Statement into the form at its
next scheduled reprinting:
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 9
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.