Application for Survivor's Benefits

Application for Survivor's Benefits

0062 Privacy Act Statement (revised)

Application for Survivor's Benefits

OMB: 0960-0062

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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(o) 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 us from making an accurate and timely decision on your request for benefits.

We will use the information to determine your eligibility for benefits. We may also share this information for the following purposes, called routine uses:



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


  • To contractors and other Federal Agencies, as necessary, for the purpose of assisting us in the efficient administration of our 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 Notices (SORN) 60-0089, entitled Claims Folders System, as published in the Federal Register (FR) on October 31, 2019, at 84 FR 58422; and 60-0090, entitled Master Beneficiary Record, as published in the FR on January 11, 2006, at 71 FR 1826. Additional information, and a full listing of all of our SORNs, is available on our website at www.ssa.gov/privacy.






File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorTookes, Anthony
File Modified0000-00-00
File Created2021-01-13

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