Revised Privacy Act Statment - SSA-L106 and SSA-L706

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 205(a) and 1631of 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 benefit
eligibility.
We will use the information you provide to make a determination of eligibility to receive, or the
right to continue receiving, Social Security benefits or Supplemental Security Income (SSI)
payments. We may also share your information for the following purposes, called routine uses:
•

To Federal, State, and local entities to assist them with administering income
maintenance and health maintenance programs, when a Federal statute authorizes them to
use the Social Security Number (SSN);

•

To third party contacts in situations where the party to be contacted has, or is expected to
have, information relating to the individual’s capability to manage his/her affairs or
his/her eligibility for or entitlement to benefits under the Social Security program; and

•

To third party contacts that may have information relevant to the Social Security
Administration’s establishment or verification of information provided by representative
payees or payee applicants.

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) 60-0058, entitled Master Files of SSN Holders and SSN Applications, as published in
the Federal Register (FR) on December 29, 2010, at 75 FR 82121; 60-0089, entitled Claims
Folders System, as published in the FR on April 1, 2003, at 68 FR 15784; and 60-0090, entitled
Master Beneficiary Record, as published in the FR on January 11, 2006, at 71 FR 1826.
Additional information, and a full listing of all of our SORNs, is available on our website at
www.ssa.gov/privacy.