Form Ssa-1414 - Credit Card Payment Form (Page 2 of 2) in pdf

Privacy Act Statement

Section 204 of the Social Security Act, as amended, authorizes the Social Security Administration

(SSA) to collect this information. The information you furnish on this form is voluntary. It is only

necessary to provide this information if you are making payment by credit card.

We rarely use the information you supply for any purpose other than obtaining payment that is due

to SSA. We will provide this information to the banks handling your credit card account and SSA's

account. Additionally, we may use the information 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 banks enrolled in the Department of Treasury credit card network to collect a payment

or debt when the credit card has been submitted for payment purposes;

(2) To enable a third party or an agency to assist Social Security to effect a salary or an

administrative offset or to an agent of SSA that is a consumer reporting agency for

preparation of a commercial credit report in accordance with 31 U.S.C. §§ 3711, 3717

and 3718;

(3) To a consumer reporting agency or debt collection agent to aid in the collection of

outstanding debts to the Federal Government;

(4) To comply with Federal laws requiring the release of information from Social Security

records (e.g., to the Government Accountability Office or Department of Veteran Affairs);

(5) To facilitate statistical research, audit or investigative activities necessary to assure the

integrity 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.

Information from these matching programs can be used to establish or verify a person's eligibility for

Federally funded and administered benefit programs and for repayment of payments or delinquent

debts under these programs.

A complete list of routine uses for this information is available in System of Records Notice 60-0231

(Financial Transactions of SSA Accounting and Finances Offices). The notice, additional

information regarding this form, and information regarding our programs and systems, are available

on-line at

or at your 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 control

number. We estimate it will take about 5 minutes to read the instructions, gather the facts, and

answer the questions. Please send only comments relating to our time estimate above to:

SSA, 6401 Security Blvd, Baltimore, MD 21235-6401.

Form SSA-1414 (03-2014)

Form Ssa-1414 - Credit Card Payment Form Page 2