Application for Parent's Insurance Benefits - Paper SSA-7-F6 (Upload Documents)

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SSA will insert the following Privacy Act Statement into the form as soon as
possible:
Privacy Act Statement
Collection and Use of Personal Information

Sections 202, 205, 223, 226, and 806 of the Social Security Act, as amended, allow us to collect
this information, which we will use to determine your eligibility for Social Security benefits.
Providing the information is voluntary, but not providing all or part of the information may
prevent us from making an accurate and timely decision on your entitlement to Social Security
benefit payments. 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 60-0059, 60-0089, 60-0090, and 60-0321, 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.