Pre-1957 Military Service Federal Questionnaire

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 217(a) through (e) of the Social Security Act and Section 20 of the Code of Federal
Regulations 404.1301 through 404.1371, 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 prevent us from making an accurate and timely decision on your claim, and
could result in the loss of benefits.
We will use the information to determine entitlement eligibility or the amount of Social Security
benefits based on your military service. 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 maintenance or health maintenance programs (including programs
under the Social Security Act). Such disclosures include, but are not limited to, release of
information to the Veterans Administration (VA) for administering 38 U.S.C. 412, and
upon request, information needed to determine eligibility for or amount of VA benefits or
verifying other information with respect thereto; 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. We
will disclose information under this routine use only in situations in which SSA may
enter a contractual or similar agreement with a third party to assist in accomplishing an
Agency function relating to this system of records.

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, Claims Folders System, as published in the FR on April 1, 2003, at 68 FR
15784 and 60-0103, Supplemental Security Income Record and Special Veterans Benefits, as
published in the FR on January 11, 2006, at 71 FR 1830. Additional information, and a full
listing of all of our SORNs, is available on our website at www.ssa.gov/privacy.