Certificate of Support

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

Section 202(h) 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 a timely and accurate decision on your eligibility for parent’s or spousal benefits.

We will use the information you provide to determine if you meet the eligibility requirements for benefits. We may also share your information for the following purposes, called routine uses:

• To Federal, State, or local agencies (or agents on their behalf) for administering cash or non-cash income or health maintenance programs (including programs under the Act); and

• To third party contacts (including private collection agencies under contract with SSA) for the purpose of their assisting SSA in the recovering of overpayments.

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 System, as published in the Federal Register (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.

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