Privacy Act

The law sometimes requires us to give out the facts on this form without your consent.  The information must be released to another person or government agency if Federal law requires the information for research and audits in order to administer or improve our representative payee program.

We may also use the information you give us when we match records by computer.  Matching programs compare our records with those of other Federal, State, or local government agencies.  Many agencies may use matching programs to find or prove that a person qualifies for benefits paid by the Federal government.  The law allows us to do this even if you do not agree to it.  Explanations about these and other reasons why information you provide us may be used or given out are available in Social Security offices.  If you want to learn more about this, contact any Social Security office.

Paperwork Reduction Act

This information collection meets the requirements of 44  U.S.C. 3507, as amended by section 2 of the Paperwork Reduction Act of 1995.  You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number.

You may send comments on our time estimate to:

Social Security Administration,
6401 Security Blvd,
Baltimore, MD 21235-0001.

Send only comments on our time estimate to this address, not the completed form.