Railroad Employment Questionnaire

SSA will insert the following revised Privacy Act and PRA Statements into
the form as soon as possible:
Privacy Act Statement
Collection and Use of Personal Information
Sections 205(i) and 205(o) 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 us from making an accurate and timely decision
on any claim filed.
We will use the information to coordinate Social Security claims processing with the
Railroad Retirement Board (RRB) and to make a determination of eligibility for benefits.
We may also share your information for the following purposes, called routine uses:
1. To RRB for administering provisions of the Act relating to railroad
employment; and
2. To Federal, State, or local agencies (or agents on their behalf) for
administering cash or non-cash income maintenance or health maintenance
programs (including programs under the Act).
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 Notice
(SORN) 60-0089, entitled Claims Folders Systems. Additional information and a full
listing of all our SORNs are available on our website at
www.socialsecurity.gov/foia/bluebook.

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
20 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.