Certification by Religious Group

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
Section 211(c)(6) 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 tax exemption eligibility for the
religious group.
We will use the information to verify that members meet or continue to meet the criteria for
exemption. We may also share your information for the following purposes, called routine uses:


To officers and employees of Federal, State or local agencies upon written request in
accordance with the Internal Revenue Code (IRC) U.S.C. 6103(1)(7)), tax return
information (e.g., information with respect to net earnings from self-employment, wages,
payments of retirement income which have been disclosed to the Social Security
Administration, and business and employment addresses) for purposes of, and to the
extent necessary in, determining an individual's eligibility for, or the correct amount of,
benefits under certain programs listed in the IRC; and



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.

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) 60-00059, entitled Earnings Recording and Self-Employment Income System as
published in the Federal Register (FR) on January 11, 2006, at 71 FR 1819. Additional
information and a full listing of all our SORNs is available on our website at
https://www.ssa.gov/privacy.

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 15 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.