TN 45 (11-11)

GN 00205.120 Retirement, Survivor, Disability Insurance (RSDI) Applications Tear-Off Sheet

A. Process

1. Pre-printed paper applications

All pre-printed RSDI applications (i.e., SSA-1-BK, SSA-2-BK, etc.) have a tear-off sheet that has the Collection and Use of Information From Your Application – Privacy and Paperwork Reduction Act notice (with the computer matching statement) and Reporting Instructions. Provide claimants with the sheet upon receipt of their application(s).

2. Modernized Claims System (MCS) applications

Claimants filing applications via MCS must be given the appropriate instruction form (i.e., SSA-1-INST, SSA-2-INST, etc.) containing the Privacy Act Notice/Paperwork Reduction Act (with the computer matching statement) and Reporting Instructions.

3. Modernized Supplemental Security Income Claims System (MSSICS) applications

Give claimants filing through MSSICS form SSA-5000 (Collection and Use of Information by the Social Security Administration) and Form SSA-3157 (Facts About Computer Matching).

4. Internet applications

Privacy Act Notice information is presented on the Internet application's security page (i.e., the page that follows the Benefit Application Home Page). Reporting Instructions are included on the printed Internet application.

B. References

  • GN 00203.004 Taking the Claim

  • GN 00204.055D.6. Internet Claim (iClaim) Application

  • GN 03360.015 Privacy Act Administration Collecting Personal Information

  • SI 00604.001 Application for Supplemental Security Income, Form SSA-8000-BK


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0200205120
GN 00205.120 - Retirement, Survivor, Disability Insurance (RSDI) Applications Tear-Off Sheet - 11/24/2009
Batch run: 12/11/2023
Rev:11/24/2009