Section 205 of the Social Security Act, as amended, allows us to collect this information, which we will use to process your request for a benefit verification letter. Providing this information is voluntary, but not providing all or part of the information may prevent us from providing the requested service. As law permits, we may use and share the information you submit, including with other Federal agencies, contractors, and others, as outlined in the routine uses within System of Records Notice 60-0089, available at www.ssa.gov/privacy. The information you submit may also be used in computer matching programs for Federal benefits eligibility or to recoup debts under these programs.

Section 205 of the Social Security Act, as amended, allows us to collect this information, which we will use to process your request for a change of address. Providing this information is voluntary, but not providing all or part of the information may prevent us from providing the requested service. As law permits, we may use and share the information you submit, including with other Federal agencies, contractors, and others, as outlined in the routine uses within System of Records Notices 60-0089, 60-0090, 60-0103, and 60-0320, available at www.ssa.gov/privacy. The information you submit may also be used in computer matching programs for Federal benefits eligibility or to recoup debts under these programs.

Section 205 of the Social Security Act, as amended, allows us to collect this information, which we will use to process your request for Claim Status. Providing this information is voluntary, but not providing all or part of the information may prevent us from providing the requested services. As law permits, we may use and share the information you submit, including with other Federal agencies, contractors, and others, as outlined in the routine uses within System of Records Notices 60-0089 and 60-0320, available at www.ssa.gov/privacy. The information you submit may also be used in computer matching programs for Federal benefits eligibility or to recoup debts under these programs.

The Social Security Act, as amended, allows us to collect this information, which we will use to determine eligibility or continuing eligibility for benefits.  Providing the information is voluntary, but not providing all or part of the information may prevent an accurate and timely decision on any claim filed, and could result in a denial or loss of benefits.  As law permits, we may disclose your information per routine uses in System of Records Notice 60-0320.  The information you submit may also be used in computer matching programs for Federal benefits eligibility and to recoup debts under these programs. This Privacy Act statement and all SORNs are available at www.ssa.gov/privacy.

Sections 221(j) and 1633 of the Social Security Act, as amended, allow us to collect this information, including your Social Security number and a valid photo ID. We will use this information to verify your identity, license, and credentials and to administer the Social Security Act. Providing this information is voluntary, but not providing such may result in delays to or inability to perform consultative examinations. As law permits, we may use and share the information you submit, including with other Federal agencies, contractors, and others, as outlined in the routine uses within System of Records Notice 60-0046, available at www.ssa.gov/privacy. Your information may also be used in computer matching programs for Federal benefits eligibility and to recoup debts under these programs.

The Social Security Act allows us to collect information you provide during this call to develop and decide claims for benefits. Providing the information is voluntary, but not providing such may delay an accurate decision on a claim. As law allows, we may share this information with government agencies and others as listed in routine uses in our System of Records Notices, such as 60-0320. Your information may also be used in computer matching programs for Federal benefits or to recoup debts under these programs. This Privacy Act statement and all SSA System of Records Notices are available at www.ssa.gov/privacy

Section 205(a) of the Social Security Act and Executive Orders 12862, 13571, 13707, 13985, and 14058 allow SSA to collect your information, which will be used to conduct research and improve services at SSA. Providing this information is voluntary; not providing such will not affect you. As law permits, SSA may disclose your information per routine uses in System of Records Notice 60-0276; available at www.ssa.gov/privacy. Your information may also be used in computer matching programs to establish or verify eligibility for Federal benefit programs and to recoup debts under these programs.

The Social Security Act, as amended, allows us to collect this information, which we will use to develop and decide your claim for benefits. Providing this information is voluntary, but not providing such may prevent an accurate and timely decision on your claim. As law permits, we may disclose your information per routine uses in System of Records Notice (SORN) 60-0320. Your information may also be used in computer matching programs for Federal benefits eligibility and to recoup debts under these programs. This Privacy Act statement and all SORNs are available at www.ssa.gov/privacy.

The Social Security Act allows us to collect information you provide during this call to develop and decide claims for benefits at the hearing level. Providing the information is voluntary, but not providing such may delay an accurate decision on a claim. As law allows, we may share this information with government agencies and others as listed in routine uses in our System of Records Notices, such as 60-0005 and 60-0009. Your information may also be used in computer matching programs for Federal benefits or to recoup debts under these programs. This Privacy Act statement and all SSA System of Records Notices are available at www.ssa.gov/privacy.

Social Security is authorized to collect your information under sections 1836, 1840, and 1872 of the Social Security Act, as amended (42 U.S.C. 1395o, 1395s, and 1395ii) for your enrollment in Medicare Part B. Social Security and the Centers for Medicare & Medicaid Services (CMS) need your information to determine if you’re entitled to Part B. While you don’t have to give your information, failure to give all or part of the information requested on this form could delay your application for enrollment.

Social Security and CMS will use your information to enroll you in Part B. Your information may be also be used to administer Social Security or CMS programs or other programs that coordinate with Social Security or CMS to:

1. Determine your rights to Social Security benefits and/or Medicare coverage.
2. Comply with Federal laws requiring Social Security and CMS records (like to the Government Accountability Office and the Veterans Administration).
3. Assist with research and audit activities necessary to protect integrity and improve Social Security and CMS programs (like to the Bureau of the Census and contractors of Social Security and CMS).

We may verify your information using computer matches that help administer Social Security and CMS programs in accordance with the Computer Matching and Privacy Protection Act of 1988 (P.L. 100-503).

Section 205 of the Social Security Act, as amended, allows us to collect this information, which we will use to process your request for a Medicare Replacement Card. Providing this information is voluntary, but not providing all or part of the information may prevent us from providing the requested service. As law permits, we may use and share the information you submit, including with other Federal agencies, contractors, and others, as outlined in the routine uses within System of Records Notice 60-0321, available at www.ssa.gov/privacy. The information you submit may also be used in computer matching programs for Federal benefits eligibility or to recoup debts under these programs.

The Social Security Act allows us to collect information you provide during this call to run our programs. Information you provide is voluntary, but not providing such may prevent us from providing requested services. As law allows, we may share this information with government agencies, employers, and others listed in routine uses in our System of Records Notices, such as 60-0058 and 60-0089. Your information may also be used in computer matching programs for Federal benefits and to recoup debts under these programs. This Privacy Act statement and all SSA System of Records Notices are available at www.ssa.gov/privacy.

Section 205 of the Social Security Act, as amended, allows us to collect this information, which we will use to process your request for the replacement Form SSA-1099 or 1042S. Providing this information is voluntary, but not providing all or part of the information may prevent us from providing the requested services. As law permits, we may use and share the information you submit, including with other Federal agencies, contractors, and others, as outlined in the routine uses within System of Records Notices, such as 60-0058 and 60-0089, available at www.ssa.gov/privacy. The information you submit may also be used in computer matching programs for Federal benefits eligibility or to recoup debts under these programs.

The Inspector General Act of 1978 allows us to collect information you provide during this call to investigate alleged fraud, waste, abuse, and misconduct related to Social Security Administration programs and operations. Information you provide is voluntary, but not providing such may limit our ability to conduct a complete investigation. As law allows, we may share this information with government agencies and others listed in routine uses in our System of Records Notices, such as OIG-001 and OIG-002. When appropriate, your information may also be provided to the Social Security Administration for use in computer matching programs for Federal benefits and to recoup debts under these programs. This Privacy Act statement and all OIG and SSA System of Records Notices are available at www.ssa.gov/privacy.

The Social Security Act allows us to collect this information, which we will use to schedule the consultative examination. Providing this information is voluntary, but not providing such will result in scheduling an in-person examination. As law permits, we may disclose this information per routine uses in System of Records Notice(s) (SORN) 60-0044 and 60-0320. We may also use it in computer matching programs to establish or verify eligibility for Federal benefit programs and to recoup debts under these programs. This Privacy Act statement and all SORNs are available at www.ssa.gov/privacy.

IRS Privacy Act and Paperwork Reduction Act Notice: We ask for the information on Form W-4V to carry out the Internal Revenue laws of the United States. You are required to provide this information only if you wish to have federal income tax withheld from certain payments for which withholding is not required by law. If you choose to request voluntary withholding of federal income tax, you’re required by Internal Revenue Code sections 3402(p) and 6109 and their regulations to provide the information requested on this form. If you don't provide a completed form that is signed, the payer can’t withhold federal income tax from your payment. Providing false or fraudulent information may subject you to penalties.

Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation, and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their tax laws.  We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal non-tax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.

You aren’t required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number.  Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law.  Generally, tax returns and return information are confidential, as required by Code section 6103.

The average time and expenses required to complete and file this form will vary depending on individual circumstances.  For estimated averages, see the instructions for your income tax return.

If you have suggestions for making this form simpler, we would be happy to hear from you.  See the instructions for your income tax return.

SSA Privacy Act Statement: Sections 205 and 702 of the Social Security Act, as amended, allow us to collect this information, which we will use to withhold Federal tax income from your benefits. Providing the information is voluntary, but not providing all or part of the information may prevent Federal tax withholding. As law permits, we may use and share the information you submit, including with other Federal agencies, contractors, and others, as outlined in the routine uses within System of Records Notices 60-0090 and 60-0383, available at www.ssa.gov/privacy. The information you submit may also be used in computer matching programs for Federal benefits eligibility and to recoup debts under these programs.