Document
Function Report - Adult Third Party
ICR 202608-0960-010 · OMB 0960-0635 · Object 171861000.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Function Report - Adult Third Party |
| Author | Zhou, Yvette LP Law |
| Last Modified By | Writer |
| File Modified | 2026-09-11 |
| File Created | 2026-09-25 |
| Conversion State | complete |
Extracted Text
Privacy Act Statement Collection and Use of Personal Information Sections 205(a), 223(d), and 1631 of the Social Security Act, as amended, allow us to collect this information, which we will use to determine 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 any disability 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 Notices 60-0089 and 60-0320, 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.