Letter to Employer Requesting Wage Information

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 1611(c), 1612(a), and 1631(e)(1) 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 benefit eligibility or could result in loss of benefits of the named claimant.
We will use the information to verify wages of the named Supplemental Security Income
applicant or recipient to determine eligibility and benefit amount. We may also share your
information for the following purposes, called routine uses:
1. To contractors and other Federal agencies, as necessary, for the purpose of assisting 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 a contractual or similar agreement with a third party to assist in accomplishing an
Agency function relating to this system of records; and
2. To third party contacts (e.g., employers and private pension plans) in situations where the
party to be contacted has, or is expected to have, information relating to the individual's
capability to manage his/her affairs or his/her eligibility for, or entitlement to, benefits
under the Social Security program when the data are needed to establish the validity of
evidence or to verify the accuracy of information presented by the individual, and it
concerns one or more of the following his/her eligibility for benefits under the Social
Security program; the amount of his/her benefit payment; or any case in which the
evidence is being reviewed as a result of suspected fraud, concern for program integrity,
quality appraisal, or evaluation and measurement activities.
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) 60-0089, entitled Claims Folders Systems, 60-0090, entitled Master Beneficiary Record,
and 60-0103, entitled Supplemental Security Income Record and Special Veterans Benefits.
Additional information and a full listing of all our SORNs are available on our website at
www.ssa.gov/privacy/sorn.html.