Form Ssa-1724-F4 - Claim For Amounts Due In The Case Of A Deceased Social Security Recipient Page 3
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3PRIVACY ACT NOTICE
Section 204 (d) of the Social Security Act, as amended, authorizes us to collect this information. We will use this information
to help us determine the beneficiary's payment.
Furnishing us the information is voluntary. However, failing to provide us with all or part of the requested information may
prevent us from making an accurate and timely decision on your claim, which may result in the loss of payments.
We rarely use the information you supply for any purpose other than for determining problems in Social Security programs.
However, we may use it for the administration and integrity of Social Security programs. We may also disclose information to
another person or to another agency in accordance with approved routine uses, which include, but are not limited to the
following:
1)
To contractors and other Federal agencies, as necessary, for the purpose of assisting the Social Security
Administration in the efficient administration of its programs;
2)
To comply with Federal laws requiring the release of information from Social Security records (e.g., to the
Government Accountability Office and Department of Veteran's Affairs);
3)
To make determinations for eligibility in similar health and income maintenance programs at the Federal, State,
and local level; and,
4)
To facilitate statistical research, audit, or investigatory activities necessary to assure the integrity and
improvement of Social Security programs.
We may also use the information you provide in 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 matching programs
to establish or verify a person's eligibility for federally-funded and administered benefit programs and for repayment, incorrect
payments or delinquent debts under these programs.
A complete list of routine uses for this information is available in our Privacy Act Systems of Records Notices, 60-0089,
Claims Folder Systems, and 60-0090, Master Beneficiary Record. These notices, additional information regarding our
programs and systems, are available on-line at
or at any local Social Security office.
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 (OMB) control number. We estimate that it will take about 10 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-1724-F4 (01-2010) EF (10-2012)
Page 3
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