Privacy Act Statement
(centered on the page)
Sections 204 and 1631 of the Social Security Act, as amended, allow us to collect
this information, which we will use to process your payment. Providing the information
is voluntary, but not providing all or part of the information may prevent us from
processing your payment. As law permits, we may use and share the information you
submit, including with banks enrolled in the Treasury credit card network, to collect
a payment or debt when the individual has given us his or her credit number for this
purpose, and third party contacts such as private collection agencies and credit reporting
agencies under contract with the Social Security Administration and other agencies,
for assistance with recovering program debt, as outlined in the routine uses within
System of Records Notice 60-0094, 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.