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(b), 1155, 1631(c), and 1869 of the Social Security Act, as amended, allow us to collect your information, which we will use to process your request for a hearing by administrative law judge. Providing this information is voluntary, but not providing all or part of the information may prevent us from making an accurate and timely decision. As law permits, we may use and share the information you submit, including with other Federal agencies, contractors, and others, as outlined in the routine uses within System of Records Notices 60-0009, 60-0089, and 60-0320, available at www.ssa.gov/privacy. Your information may also be used in computer matching programs for Federal benefits eligibility and to recoup debts under these programs.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Bellitto, Melissa M. OGC |
| File Created | 2025:05:22 23:28:30Z |