AUTHORIZATION FOR THE SOCIAL SECURITY ADMINISTRATION

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Form SSA-8510 (08-2023) UF
Social Security Administration

Page 1 of 2
OMB No. 0960-0801

AUTHORIZATION FOR THE SOCIAL SECURITY ADMINISTRATION
TO OBTAIN PERSONAL INFORMATION
Authorizing Person (Person about whom information is being requested)

Social Security Number

Claimant/Beneficiary (If other than authorizing person)

Claimant's/Beneficiary's Social Security Number

I authorize any public or private custodian of records to disclose to the Social Security Administration any records or information
about me. In the case of a minor or incapable person, I, as guardian or representative, authorize the same disclosure of records
about the person I represent.
Authorizing Person's Signature
Mailing Address

Date
City and State

ZIP Code

Your authorization does not ordinarily have to be witnessed. However, if you have signed by mark (X), two witnesses to the
signing who know you must sign below giving their full addresses.
1. Signature of Witness

2. Signature of Witness

Address (Number, Street, City, State, ZIP Code)

Address (Number, Street, City, State, ZIP Code)

Form SSA-8510 (08-2023) UF

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Privacy Act Statement
Collection and Use of Personal Information
Sections 205(a) and 1631(e) 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 an accurate and timely decision for
Social Security benefits.
We will use the information you provide to request evidence, information or proofs that may support your benefit application or
payment continuation. We may also share your information for the following purposes, called routine uses:
• To third party contacts, where necessary, to establish or verify information provided by representative payees or
representative payee applicants; and
• To specified business and other community members and Federal, State and local agencies for verification of eligibility for
benefits under section 1631(e) of the Social Security Act.
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. Additional information, and a full listing
of all 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 (OMB) control number. We estimate that it will take about 5 minutes to read the instructions, gather the
facts, and answer the questions. Send only 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.