Document
SSA-3193 (Physician)
ICR 202606-0960-011 · OMB 0960-0624 · Object 171125100.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | SSA-3193 (Physician) |
| Author | SSA Response |
| Last Modified By | Writer |
| File Modified | 2026-07-20 |
| File Created | 2026-08-01 |
| Conversion State | complete |
Extracted Text
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 The Federal Property and Administrative Services Act of 1949, as amended, 63 Statute 377, 390 (40 U.S.C. 471 and 41 CFR 101-20.104-2); and section 501(g) of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 791(g), allow us to collect this information, which we will use to help us determine reasonable accommodations. Providing the information is voluntary, but not providing all or part of the information may make it impossible for us to process your request. 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 60-0230 and 60-0315, available at www.ssa.gov/privacy. The information you submit may also be used in computer matching programs for Federal benefits eligibility or to recoup debts under these programs.