Document
SSA-5665-BK (Teachers)
ICR 202607-0960-002 · OMB 0960-0646 · Object 171310400.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | SSA-5665-BK (Teachers) |
| Author | Sasha Nsafoah |
| Last Modified By | Writer |
| File Modified | 2026-07-28 |
| 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 Sections 205(a), 223(d), 1614(a), and 1631(d) of the Social Security Act, as amended, allow us to collect this information, which we will use to make a determination of eligibility for benefits. Providing the information is voluntary, but not providing all or part of the information may prevent an accurate and timely decision on the claimant’s eligibility for benefits. 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 60-0044 and 60-0089, 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.