Document
SSA-8010-BK - Intranet Submissions (SSI Claims System)
ICR 202609-0960-014 · OMB 0960-0124 · Object 174328500.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | SSA-8010-BK - Intranet Submissions (SSI Claims System) |
| Author | Zhou, Yvette LP Law |
| Last Modified By | Writer |
| File Modified | 2026-10-29 |
| File Created | 2026-10-30 |
| Conversion State | complete |
Extracted Text
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 1612(a), 1613(a), 1614(f), 1621, and 1631(e) of the Social Security Act, as amended, allow us to collect this information, which we will use to make an initial or continuing Supplemental Security Income (SSI) eligibility determination. Providing the information is voluntary, but not providing all or part of the information may prevent an accurate and timely decision on the 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.