PRIVACY ACT PAPERWORK ACT NOTICE: The information requested on this form is authorized by the Social Security Act, Sections 205 (a) and 1631 (c) (1) (A) and (B),and regulations at 20 CUR 404.1589 and 416.889. The information provided will be used to further document your claim and permit a determination about your continuing disability. Information requested on this form is voluntary. However, ifyou do not provide the required information, a decision based on the eviden ce in your file can result in a determination th at your period of disability is ceased. Wh ile the information you furnish on this form would almost never be used tor any purpose than in making a detennination about your disability, such information may be disclosed by SSA for the following purposes: (l)To assist SSA in determining the right to Social Security benefits for yourself or another person, (2) To facilitate statistical research and audit activities necessary to assure the integrity and improvement of programs administered by the Social Security Administration and another agency. Explanations about these and other reasons why information you provide us may beused or given out are available in the Social Security offices. If you want to leam more about this, contact any Social Security office.
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