Paperwork Reduction Act Statement
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 control number. We estimate that it will
take about 5 minutes to read the instructions, gather the facts, and answer the questions.
You may send comments on our time estimate above to: SSA, 6401 Security Blvd., Baltimore,
MD 21235-6401. Send only comments relating to our time estimate to this address, not the
completed report.
The OMB control number for the Supplemental Security Income Telephone Wage Reporting
and the associated instructions package is 0960-0715; expiration date 05/31/2026.
Privacy Act Statement
Collection and Use of Personal Information
Sections 205(a) and 1631(e) of the Social Security Act, as amended, allow us to collect this
information. Furnishing us this information is voluntary. However, failing to provide all or part
of the information may prevent us from making an accurate and timely decision on eligibility for
Supplemental Security Income (SSI) benefits.
We will use the information you provide to make a determination of eligibility for SSI benefits.
We may also share your information for the following purposes, called routine uses:
• To third party contacts such as private collection agencies and credit reporting
agencies under contract with the Social Security Administration (SSA) and State
motor vehicle agencies for the purpose of their assisting SSA in recovering
overpayments; and
• To contractors and other Federal agencies, as necessary, for the purpose of
assisting SSA in the efficient administration of its programs.
•
In addition, we may share this information in accordance with the Privacy Act and other Federal
laws. For example, where authorized, we may use and disclose this information in computer
matching programs, in which our records are compared with other records to establish or verify a
person’s eligibility for Federal benefit programs and for repayment of incorrect or delinquent
debts under these programs.
A list of additional routine uses is available in our Privacy Act System of Records Notices
(SORN) 60-0089, entitled Claims Folders System, as published in the Federal Register (FR) on
April 01, 2003, at 68 FR 15784 and 60-0103, entitled Supplemental Security Income Record and
Special Veterans Benefits, as published in the FR on January 11, 2006, at 71 FR 1830.
Additional information, and a full listing of all of our SORNs, is available on our website at
www.ssa.gov/privacy/.
OMB 0960-0715