Application for Supplemental Security Income--SSI Claims System/Signature Proxy and Preliminary Claims System (PCS)

Privacy Act Statement
Collection and Use of Personal Information
Sections 202, 226, and 1611 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 discovering and establishing which benefits are possible for
you.
We will use the information to determine your initial eligibility for benefits and to efficiently
administer the Social Security Act. We may also share your information for the following purposes,
called routine uses:

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Information may be disclosed to contractors and other Federal agencies, as necessary,
for the purpose of assisting SSA in the efficient administration of its programs. We
contemplate disclosing information under this routine use only in situations in which
SSA may enter a contractual or similar agreement with a third party to assist in
accomplishing an agency function relating to this system of records; and

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To State agencies to enable them to assist in the effective and efficient administration of
the Supplemental Security Income program.

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 are available in our Privacy Act System of Records Notices
(SORN) 60-0089, entitled Claims Folders Systems, as published in the Federal Register (FR) on
April 1, 2003 at 68 FR 15784; 60-0058, entitled Master Files of Social Security Number (SSN)
Holders and SSN Applications as published in the FR on December 29, 2010 at 75 FR 82121;
60-0315, entitled Reasonable Accommodation for Persons with Disabilities as published in the
FR on October 25, 2005 at 70 FR 62157; and 60-0103, entitled Supplemental Security Income
Record and Special Veterans Benefits as published in the FR on January 11, 2006, at 71 FR
1830. Additional information, and a full listing of all of our SORNs, is available on our website
at www.ssa.gov/privacy.