Revised PA & PRA Statements

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(j) and 1631(a) 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 result in the termination of benefits or payments.
We will use the information to account for the use of benefits and payments and ensure the
beneficiary’s needs are met. We may also share your information for the following purposes,
called routine uses:
•

To a claimant, or other individual authorized to act on his or her behalf, information
concerning the status of his or her representative payee or the status of the application of
a person applying to be his or her representative payee, and information pertaining to the
address of a representative payee applicant or a selected representative payee, when this
information is needed to pursue a claim for recovery of misapplied or misused benefits;
and

•

To agencies or entities with responsibility for investigating or addressing possible
financial exploitation of, an immediate health or safety threat to, or other serious risk to
the well-being of the beneficiary, for referral, when these issues are identified during a
representative payee review.

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) 60-0222, entitled Master Representative Payee File, as published in the Federal Register
(FR) on November 2, 2018, at 83 FR 55228. Additional information, and a full listing of all 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 20 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.