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Statement Regarding Marriage

Download and Print the SSA-753

Request may not be processed if the form is incomplete or illegible.

All questions must be answered or marked "Unknown." If you need more space for answers, continue them under "Remarks" on reverse side.

Privacy Act Statement:

Statement Regarding Marriage: Section 216(h)(1)(A) [42 U.S.C. 216(h)(1)(A)] of the Social Security Act, as amended, authorizes us to collect this information. We will use the information you provide to help establish the applicant’s eligibility to Social Security benefits. The information you provide is voluntary. However, failure to provide the requested information could prevent us from establishing if a marital relationship exists and from making an accurate and timely decision on the applicant’s claim. We rarely use the information provided on this form for any purpose other than for the reasons stated above. However, we may use it for the administration and integrity of Social Security programs. We may also disclose the information provided on this form in accordance with approved routine uses of the Privacy Act (5 U.S.C. § 552a), which include but are not limited to the following: 1. To enable a third party or an agency to assist Social Security in establishing rights to Social Security benefits and/or coverage; 2. To comply with Federal laws requiring the release of information from our records (e.g., to the Government Accountability Office, General Services Administration, National Archives Records Administration, and the Department of Veterans Affairs); 3. To make determinations for eligibility in similar health and income maintenance programs at the Federal, State, and local level; and 4. 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 or 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 Systems of Records Notice entitled, Claims Folder System, 60-0089; and Electronic Disability (eDIB) Claim File, 60-0320. These notices, 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 that it will take about 9 minutes to read the instructions, gather the facts, and answer the questions. SEND OR BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. You can find your local Social Security office through SSA’s website at Offices are also listed under U. S. Government agencies in your telephone directory or you may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You may send comments on our time

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