Letter to Employer Requesting Information About Wages Earned by Beneficiary 20 CFR 404.703, 404.801

SSA will insert the following revised Privacy Act & PRA Statements into the
form as soon as possible:
Privacy Act Statement
Collection and Use of Personal Information

Sections 205(a) and 223(d) 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 us from making an accurate and timely decision on any claim
filed or could result in the loss of benefits.
We will use the information you provide to verify wages, resolve wage discrepancies, and
determine benefit eligibility. We may also share the information for the following purposes,
called routine uses:
•

To employers or former employers, including State Social Security administrators, for
correcting and reconstructing State employee earnings records and for Social Security
purposes; 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 into 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) 60-0059, entitled Earnings Recording and Self-Employment Income System, as
published in the Federal Register (FR) on January 11, 2006, at 71 FR 1819, 60-0089, entitled
Claims Folders System, as published in the FR on October 31, 2019, at 84 FR 58422, and 600330, entitled eWork, as published in the FR on September 15, 2003, at 68 FR
54037. 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
(OMB) control number. We estimate that it will take about 40 minutes to read the instructions,
gather the facts, and answer the questions. Send only comments regarding this burden estimate
or any other aspect of this collection, including suggestions for reducing this burden to: SSA,
6401 Security Blvd, Baltimore, MD 21235-6401.