Effective Date: January 11, 2006
(71 F.R. 1854)
SOCIAL SECURITY ADMINISTRATION NOTICE OF SYSTEM OF RECORDS REQUIRED BY
THE PRIVACY ACT OF 1974
SYSTEM NUMBER: 60-0237
System name:
Employees'
Medical Records, Social Security Administration, Deputy Commissioner for Human
Resources, Office of Personnel, Center for Employee Services.
Security classification:
None.
System Location:
These records
are maintained on current Social Security Administration (SSA) employees
receiving health services at the SSA Health Units at the following addresses:
Social
Security Administration
Headquarters
Social
Security Administration
Northeastern
1
Social
Security Administration
Social
Security Administration
Social
Security Administration
Southeastern
3001
Social
Security Administration
Other SSA employees receive health services
through Interagency Agreements with the Public Health Service.
Addresses of
Interagency Agreement Health Units
HEADQUARTERS
Social
Security Administration
Social
Security Administration
Social
Security Administration
FIELD ADDRESSES
In the
Health
Unit
Thomas
P. O'Neill
Health
Unit
In the
Health Unit
26 Federal Plaza
In the
William
J. Green, Jr. Federal Building
Health Unit
Federal
Employee and
National Underground Storage
27S-221,
Health Unit
Boyers, PA
16020-0221
Housing
and Urban Development Building
Health Unit
In the
Health
Unit
In the
Health
Unit
Health
Unit
In the
Health
Unit
In the
Health
Unit
Health
Unit
500 Lead, SW.
In the
Health Unit
In the
Health
Unit, Room 443
50 United
In the
Health Unit
Bank
of
Health
Unit
Categories of individuals covered by the system:
Individuals
who have received health services from any of the SSA Health Units.
Categories of records in the system:
This system
consists of a variety of records relating to an individual's utilization of
services provided by SSA Health Units. Examples of information which may be
included in this system are, history of non-work
related injuries, illness or complaint presented to
Health Unit
staff, immunization records, medication administered by Health Unit staff,
referrals to other health care providers.
Authority for maintenance of the system:
5
U.S.C. 7901; OMB Circular No. A-72.
Purpose(s):
These records
document utilization of health services provided by SSA Health Units.
Routine uses of records maintained in the system, including categories
of users and the purposes of such uses:
Disclosure may
be made for routine uses as indicated below:
1. To the
appropriate Federal, State, or local agency responsible for investigation of an
accident, disease, medical condition, or injury as required by pertinent legal
authority.
2. To the Office of Worker's Compensation
Programs in connection with a claim for benefits filed by an employee.
3. To a congressional office from the
record of an individual in response to an inquiry from the congressional office
made at the request of that individual.
4. To
the Department of Justice (DOJ), a court or other tribunal, or another party
before such tribunal, when:
(a) The Social Security Administration
(SSA), or any component thereof; or
(b) Any SSA employee in his/her official
capacity; or
(c) Any SSA employee in his/her individual
capacity where DOJ (or SSA, where it is authorized to do so) has agreed to
represent the employee; or
(d) The United States or any agency thereof
where SSA determines that the litigation is likely to affect SSA or any of its
components, is a party to the litigation or has an interest in such litigation,
and SSA determines that the use of such records by DOJ, a court or other
tribunal, or another
party before the tribunal, is relevant and necessary to the litigation,
provided, however, that in each case, SSA determines that such disclosure is
compatible with the purpose for which the records were collected.
5. To student volunteers, individuals
working under a personal services contract, and other workers who technically
do not have the status of Federal employees, when they are performing work for
the Social Security Administration (SSA), as authorized by law, and they need
access to personally identifiable information in SSA records in order to
perform their assigned Agency functions.
6. To the General Services Administration
and the National Archives Records Administration (NARA) under 44 U.S.C. 2904
and 2906, as amended by the NARA Act of 1984, information which is not
restricted from disclosure by Federal law for the use of those agencies in
conducting records management studies.
7. To the Secretary of Health and Human
Services or to any State, the Commissioner shall disclose any record or
information requested in writing by the Secretary for the purpose of
administering any program administered by the Secretary, if records or
information of such type were so disclosed under applicable rules, regulations
and procedures in effect before the date of enactment of the Social Security
Independence and Program Improvements Act of 1994.
8. We
may disclose information to appropriate Federal, State, and local agencies,
entities, and persons when (1) we suspect or confirm that the security or
confidentiality of information in this system of records has been compromised;
(2) we determine that as a result of the suspected or confirmed compromise
there is a risk of harm to economic or property interests, identity theft or
fraud, or harm to the security or integrity of this system or other systems or
programs of SSA that rely upon the compromised information; and (3) we
determine that disclosing the information to such agencies, entities, and
persons is necessary to assist in our efforts to respond to the suspected or
confirmed compromise and prevent, minimize, or remedy such harm. SSA will use
this routine use to respond only to those incidents involving an unintentional
release of its records.
Policies and practices for storing, retrieving, accessing, retaining,
and disposing of records in the system:
Storage:
These records
are maintained as hard copy records.
Retrievability:
Records are
retrievable by name, date of birth, or Social Security Number (SSN) of the
individual to whom they pertain.
Safeguards:
During the
employment of the individual, medical records are maintained in files separate
from the Official Personnel Folder and are located in lockable metal cabinets
and/or in secured rooms with access limited to those whose official duties
require access. Access http://www.socialsecurity.gov/foia/bluebook/app_g.htm for additional
information relating to SSA data security measures.
Retention and disposal:
Records are maintained up to six years from
the date of the last entry. The records are shredded and appropriately disposed
of approximately three months after separation.
System manager(s) and address(es):
Social Security Administration
SSA
Medical Director
Office of Human Resources
Center
for Employee Services
Notification procedures:
An individual can determine if this system
contains a record about him/her by writing to the system manager(s) at the
above address and providing his/her name, SSN or other information that may be
in the system of records that will identify him/her. An individual requesting
notification of records in person should provide the same information, as well
as provide an identity document, preferably with a photograph, such as a
driver's license or some other means of identification. If an individual does
not have any identification documents sufficient to establish his/her identity,
the individual must certify in writing that he/she is the person claimed to be
and that he/she understands that the knowing and willful request for, or
acquisition of, a record pertaining to another individual under false pretenses
is a criminal offense.
If notification is requested by telephone,
an individual must verify his/her identity by providing identifying information
that parallels information in the record to which notification is being
requested. If it is determined that the identifying information
provided by telephone is insufficient, the individual will be required to
submit a request in writing or in person. If an individual is requesting
information by telephone on behalf of another individual, the subject
individual must be connected with SSA and the requesting individual in the same
phone call. SSA will establish the subject individual's identity (his/her name,
SSN, address, date of birth and place of birth, along with one other piece of
information, such as other's maiden name) and ask for his/her consent in
providing information to the requesting individual.
If a request for notification is submitted
by mail, an individual must include a notarized statement to SSA to verify
his/her identity or must certify in the request that he/she is the person
claimed to be and that he/she understands that the knowing and willful request
for, or acquisition of, a record pertaining to another individual under false
pretenses is a criminal offense. These procedures are in accordance with SSA Regulations
(20 CFR 401.40(c)).
Record access procedures:
An individual
requesting access to records should submit his/her request in writing to the
system manager or designated custodian of the records. An individual requesting
access via mail or telephone also must furnish an address. Any individual
requesting access must also follow the Office of Personnel Management's Privacy
Act regulations
regarding verification of
identity and access to records (5 CFR part 297). These procedures are in
accordance with SSA Regulations (20 CFR 401.40(c) and 401.55(b)).
Note: At the Headquarter's
SSA Health Units, the individual will be asked to complete Form SSA-3465,
Consent for Release of Personal Information. In other SSA Health Units the
SSA-3465 or equivalent will be required.
Contesting record procedures:
Same as Notification
procedures. Also, requesters should reasonably identify the record,
specify the information they are contesting and the corrective action sought,
and the reasons for the correction, with supporting justification showing how
the record is incomplete, untimely, inaccurate or irrelevant. These procedures
are in accordance with SSA Regulations (20 CFR 401.65(a)).
Record source categories:
Information in
this system of records is obtained from, the individual to whom the information
pertains, laboratory reports and test results, SSA Health Unit medical officer,
physicians, nurses and other medical technicians who have examined, tested, or
treated the individual, the individual's personal physician and other Federal
employee health units.
Systems exempted from certain provisions of the Privacy Act:
None.