Document
Waiver of Supplemental Security Income Payment Continuation
ICR 202607-0960-005 · OMB 0960-0783 · Object 171323900.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Waiver of Supplemental Security Income Payment Continuation |
| 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), 1631(a)(7), and 1631(e)(1)(A) of the Social Security Act, as amended, and CFR 20 § 416.1336(c) allow us to collect this information, which we will use to further document your claim and make a determination regarding your Social Security benefits. Providing the information is voluntary, but not providing all or part of the information may prevent an accurate and timely decision on any claim filed. 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 Notice 60-0103, 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.