Request for Business Entity Taxpayer 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 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 may prevent you from serving as an appointed representative.

We will use the information to identify appointed representatives associated with a business entity as employees or partners, and to facilitate issuance of appropriate return information for reporting purposes. We may also share your information for the following purposes, called routine uses:

• To the Internal Revenue Service to permit its auditing of our compliance with the safeguard provisions of the Internal Revenue Code of 1986, as amended; and

• To contractors and other Federal Agencies, as necessary, for the purpose of assisting the Social Security Administration 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) 60-0325, entitled Appointed Representative File, as published in the Federal Register (FR) on October 8, 2009, at 74 FR 51940. Additional information, and a full listing of all of our SORNs, is available on our website at www.ssa.gov/privacy.