Electronic SSA-120 - Current

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See Revised
Privacy Act
Statementinto the form as soon
SSA will insert the following revised Privacy Act Statement
as possible
Privacy Act Statement
Collection and Use of Personal Information
Section 205(a) of the Social Security Act, as amended, 5 U.S.C. § 552a(e)(10), and 44 U.S.C. §
3553 allow us to collect this information. Furnishing us this information is voluntary. However,
failing to provide all or part of the information may affect your ability to access the agency’s
information technology systems and resources.
We will use the information to authorize access to the agency’s information technology systems.
We may also share your information for the following purposes, called routine uses:
•

To notify another Federal agency when, or verify whether, a Personal Identity
Verification card is no longer valid; and

•

We may disclose information to appropriate Federal, State, and local agencies, entities,
and persons when (1) we suspect or confirm that the security or confidentiality of
information in this system of records has been compromised; (2) we determine that as
a result of the suspected or confirmed compromise there is a risk of harm to economic
or property interests, identity theft or fraud, or harm to the security or integrity of this
system or other systems or programs of SSA that rely upon the compromised
information; and (3) we determine that disclosing the information to such agencies
entities, and persons is necessary to assist in our efforts to respond to the suspected or
confirmed compromise and prevent, minimize, or remedy such harm. SSA will use
this routine use to respond only to those incidents involving an unintentional release of
its records.

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) 60-0214, entitled Personal Identification Number File, as published in the Federal
Register (FR) on September 8, 1994, at 59 FR 4639, and 60-0361, entitled Identity
Management System, as published in the FR on November 3, 2006 at 71 FR 64757, and
subsequently modified on December 10, 2007, at 72 FR 69723. Additional information, and a
full listing of all our SORNs, is available on our website at www.ssa.gov/privacy.