Vocaional Rehabilitation Provider Claim - Claiming Reimbursement SSA-199

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), 222(d)(1) and 1615(d) 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 proper reimbursement of costs incurred for
providing vocational rehabilitation (VR) services.
We will use the information you provide to reimburse State vocational agencies for the
reasonable and necessary costs of VR services to disabled beneficiaries. We may also share your
information for the following purposes, called routine uses:
•

To Rehabilitation Services Administration for use in its program studies of, and
development of enhancements for, State vocational rehabilitation programs; and

•

To a State vocational rehabilitation agency or alternate participant regarding the basis for
SSA’s decision on its claim for reimbursement and the reason(s) costs were allowed or
denied.

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) 60-0090, entitled Master Beneficiary Record, as published in the Federal Register (FR)
on January 11, 2006, at 71 FR 1826, and 60-0221, entitled Vocational Rehabilitation
Reimbursement Case Processing System, as published in the FR on January 11, 2006, at 71 FR
1840. Additional information, and a full listing of all of our SORNs, is available on our website
at www.ssa.gov/privacy.

2/18/2019 10:51 AM