Privacy Act Statement 0731 (revised)

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

Sections 206(a) and 1631(d) 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 you from serving as an appointed representative and receiving direct payment of fees from SSA.

We will use the information to identify appointed representatives associated with a business entity as employees or partners, and to facilitate issuance of appropriate return information for reporting purposes. We may also share your information for the following purposes, called routine uses:

• To employers of claimants’ representatives (e.g., law firms, partnerships, or other business entities) in accordance with the requirements of sections 6041 and 6045(f) of the IRC as implemented by the IRS Regulations found at 26 CFR 1.6041-1, and as necessary for us to carry out the requirements for fee reporting to appointed representatives; and

• To contractors and other Federal agencies, as necessary, to assist us in efficiently administering our programs. We will disclose information under this routine use only in situations in which we 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 Notice (SORN) 60-0325, entitled Appointed Representative File, as published in the Federal Register (FR) on October 8, 2009, at 74 FR 51940. Additional information, and a full listing of all our SORNs, is available on our website at www.ssa.gov/privacy.