Partnership Questionnaire

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

Sections 205(b) and 205(c) 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 any claim
filed.
We will use the information to make a determination of eligibility for benefits. We may also
share your information for the following purposes, called routine uses:
1. To the Department of Treasury for: (a) collecting Social Security taxes or as otherwise
pertinent to tax and benefit payment provisions of the Social Security Act, or (b)
investigating alleged theft, forgery, or unlawful negotiation of Social Security checks;
and
2. To contractors and other Federal agencies, as necessary, for the purpose of assisting the
Social Security Administration 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 Systems and 60-0090, entitled Master Beneficiary
Record. Additional information and a full listing of all our SORNs are available on our website
at www.ssa.gov/privacy/sorn.html.