SSA-632 - Request for Waiver of Overpayment Recovery

SSA will insert the following revised Privacy Act and PRA Statements into the
form as soon as possible:
Privacy Act Statement
Collection and Use of Personal Information
Sections 204, 1631, and 1879 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 overpayment waiver
request.
We will use the information to make a waiver determination and to obtain your financial account
information. We may also share your information for the following purposes, called routine
uses:


To student volunteers and other workers, who technically do not have the status of
Federal employees, when they are performing work for Social Security Administration
(SSA) as authorized by law, and they need access to personally identifiable information
in SSA records in order to perform their assigned agency functions; and



To third party contacts such as private collection agencies and credit reporting agencies
under contract with SSA and other agencies, including the Veterans Administration, the
Armed Forces, the Department of the Treasury, and State motor vehicle agencies, for the
purpose of their assisting SSA in recovering program debt.

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) 60-0094, entitled Recovery of Overpayments, Accounting and Reporting/Debt
Management System, as published in the Federal Register (FR) on August 23, 2005, at 70 FR
49354; 60-0231, entitled Financial Transactions of SSA Accounting and Finance Offices, as
published in the FR on January 11, 2006, at 71 FR 1849; and 60-0320, entitled Electronic
Disability Claims File, as published in the FR on July 25, 2006, at 71 FR 42159. Additional
information, and a full listing of all of our SORNs, is available on our website at
www.ssa.gov/privacy.

Paperwork Reduction Act Statement - This information collection meets the requirements of
44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not
need to answer these questions unless we display a valid Office of Management and Budget
control number. We estimate that it will take about 120 minutes to read the instructions, gather
the facts, and answer the questions. SEND OR BRING THE COMPLETED FORM TO
YOUR LOCAL SOCIAL SECURITY OFFICE. You can find your local Social Security
office through SSA’s website at www.socialsecurity.gov. Offices are also listed under U. S.
Government agencies in your telephone directory or you may call Social Security at 1-800772-1213 (TTY 1-800-325-0778). You may send comments on our time estimate above to: SSA,
6401 Security Blvd, Baltimore, MD 21235-6401. Send only comments relating to our time
estimate to this address, not the completed form.