Statement of Self-Employment Income

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 205(a) and 205(c)(2) 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 an accurate and timely decision on your claim.
We will use the information to determine your eligibility for benefits. 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 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 Notices
(SORN) 60-0059, entitled Earnings Recording and Self-Employment Income, as published in the
Federal Register (FR) on January 11, 2006 at 71 FR 1819, and 60-0089, entitled Claims Folders
System, as published in the FR on April 1, 2003 at 68 FR 15784. Additional information and a
full listing of all our SORNs are available on our website at https://www.ssa.gov/privacy.