Revised PA & PRA Statements

Disability Report - Adult

Revised PA & PRA Statements

OMB: 0960-0579

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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), 223(d), 1614(a), and 1631 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 an accurate and timely decision on any claim filed.
We will use the information to determine eligibility for benefits. We may also share your
information for the following purposes, called routine uses:
•

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; and

•

To applications, claimants, prospective applications or claimants, other than the data
subject, their authorized representatives or representatives payees to the extent
necessary to pursue Social Security claims and to representative payees when the
information pertains to individuals for whom they serve as representative payees, for
the purpose of assisting SSA in administering its representative payment responsibility
under the Act and assisting the representative payees in performing their duties as
payees, including receiving and accounting for benefits for individuals for whom they
serve as payees.

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)
60-0089, entitled Claims Folders System, as published in the Federal Register (FR) on October
31, 2019, at 84 FR 58422; and 60-0320, entitled Electronic Disability Claim File, as published in
the FR on June 4, 2020, at 85 FR 34477. 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 90 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 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. Send only comments relating to our time estimate
or other aspects of this collection to this address, not the completed form.


File Typeapplication/pdf
AuthorCarcirieri, Pamela
File Modified2021-10-19
File Created2021-10-19

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