Form Ssa-581-Op65 - Authorization To Obtain Earnings Data From The Social Security Administration Page 2
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1
2IMPORTANT INFORMATION
Privacy Act Statement
Collection and Use of Personal Information
Section 205(c)(2)(A) of the Social Security Act, as amended, authorizes us to collect this information. We
will use the information you provide to obtain earnings data. Furnishing us this information is voluntary.
However, failing to provide us with all or part of the information may prevent an accurate and timely
decision on any claim filed. We rarely use the information you supply us for any purpose other than to
produce an itemized statement of earnings. However, we may use the information for the administration
of our programs including sharing information:
1. To comply with Federal laws requiring the release of information from our records (e.g., to the
Government Accountability Office and Department of Veterans Affairs); and,
2. To facilitate statistical research, audit, or investigative activities necessary to ensure the integrity
and improvement of our programs (e.g., to the Bureau of the Census and to private entities
under contract with us).
A complete list of when we may share your information with others, called routine uses, is available in our
Privacy Act System of Records Notice 60-0059, entitled, Earnings Recording and Self-Employment
Income System. Additional information about this and other system of records notices and our programs
is available online at
or at your local Social Security office.
We may share the information you provide to other health agencies through computer matching
programs. Matching programs compare our records with records kept by other Federal, State or local
government agencies. We use the information from these programs to establish or verify a person’s
eligibility for federally funded or administered benefit programs and for repayment of incorrect payments
or delinquent debts under these programs.
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 2 minutes to read the instructions, gather the facts, and answer the
questions. Send only comments relating to our time estimate above to: SSA, 6401 Security Blvd,
Baltimore, MD 21235-6401.
Form SSA-581-OP65 (11-2014)
Page 2
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