Identifying Information for Possible Direct Payment of Authorized Fees

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 206(a) and 1631(d) 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 could result in nonpayment for your service.

We will use the information to facilitate direct payment of authorized fees and meet any requirement to issue a Form 1099-MISC, pursuant to 26 United States Code (USC) 6041 and 26 USC 6045(f), under the Internal Revenue Service (IRS). We may also share your information for the following purposes, called routine uses:

• To the Department of the Treasury, IRS, as necessary, for the purpose of auditing the Social Security Administration’s compliance with safeguard provisions of the Internal Revenue Code of 1986, as amended; and

• To a third party, as necessary, information relating to the qualifications and suitability of representative payees or representative payee applicants to serve as representative payees, or their use of the benefits paid to them under section 205(j) or section 1631(a) of the Social Security 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 Notices (SORN) 60-0003, entitled Attorney Fee File as published in the Federal Register (FR) on January 11, 2006, at 71 FR 1803 and 60-0222, entitled Master Representative Payee File as published in the FR on April 22, 2013, at 78 FR 23811. Additional information and a full listing of all our SORNs are available on our website at www.ssa.gov/privacy.