Plan to Achieve Self-Support (PASS)

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 1612(b), 1613(a) and 1631(e) 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 limit your ability to participate in the Plan to Achieve
Self-Support (PASS) Supplemental Security Income (SSI) program.
We will use the information to evaluate your PASS and determine eligibility under the
provisions of the SSI program. We may also share your information for the following purposes,
called routine uses:




To third-party contacts when the party to be contacted has, or is expected to have,
information relating the individual’s PASS, when:
(a) the individual is unable to provide the information being sought; or
(b) the data are needed to establish the validity of evidence or to verify the accuracy
of information presented by the individual in connection with his or her PASS; or
the Social Security Administration is reviewing the information as a result of
suspected abuse or fraud, concern for program integrity, quality appraisal, or
evaluation and measurement activities; and
To a contractor or another Federal agency, 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) 60-0255, entitled PASS Management Information System, as published in the Federal
Register (FR) on January 1, 2006, at 71 FR 1867. Additional information, and a full listing of all
our SORNs, is available on our website at www.ssa.gov/privacy.