Effective Date: July 25, 2006
(71 F.R. 42159)
SOCIAL SECURITY ADMINISTRATION NOTICE OF SYSTEM OF RECORDS REQUIRED BY
THE PRIVACY ACT OF 1974
System Number: 60-0321
System Name:
Medicare
Database (MDB) File, Social Security Administration, Deputy Commissioner for
Disability and Income Security Programs.
Security Classification:
None.
System Location:
Social Security
Administration
Office of
Systems
Other authorized
Federal and State agencies that generally have access to information in SSA
systems will also have access as needed to the MDB File. Contact the system manager for address
information.
Categories of Individuals Covered by the System:
Claimants,
applicants, beneficiaries, ineligible spouses and potential claimants for
Medicare Part A, Medicare Part B, Medicare Advantage Part C, Medicare Part D
and for Medicare Part D prescription drug coverage subsidies.
Categories of Records in the System:
This file
contains the name, Social Security number (SSN) and income and resource data of
the claimant or potential claimant for Part D subsidy; the subsidy application;
supporting evidence and documentation for eligibility; documentation for income
and resource verification; supporting evidence and documentation for appeal
requests; premium payment documentation; correspondence to and from claimants
and/or personal representatives; and leads information from third parties such
as social service agencies and hospitals.
Further, separate files may be maintained of certain actions which are
entered directly into the MDB file.
These relate to reports of changes of income and resources and other
post-adjudicative reports. Separate data
are also maintained for statistical purposes (e.g., subsidy denial, and
demographic and statistical information relating to subsidy decisions).
This file also
contains information about Medicare Part A, Part B, Medicare Advantage Part C,
and non-subsidy Medicare Part D beneficiaries.
The information maintained in this system of records is collected from
beneficiaries for Medicare Part A, Part B, Medicare Advantage Part C, Medicare
Part D, and other source systems maintained by SSA. The information maintained for Part B also
include: the individual’s name and SSN;
enrollment information; premium surcharge information; information from the
Internal Revenue Service about such individual’s modified adjusted gross income
(MAGI) from his/her Federal tax return, including adjusted gross income (AGI),
and other tax-exempt income, and tax filing status for each year that the MAGI
exceeds a statutory income threshold.
Also included is information about MAGI provided by a claimant or
beneficiary; supporting evidence and documentation for new initial
determinations and appeal requests; Medicare Part B income-related monthly
adjustment amount determinations; reconsiderations and appeals of Medicare Part
B income-related monthly adjustment amount determinations; information
essential to the deduction of premiums from Title II monthly benefits from
Railroad Retirement annuities, Civil Service retirement benefits and direct
billing by the Centers for Medicare & Medicaid Services; and data necessary
to providing fiscal accounting of premiums withheld.
The file may
also contain data collected as a result of inquires or complaints, and
evaluation and measurement studies of the effectiveness of Medicare
Prescription Drug Improvement and Modernization Act (MMA) policies.
Authority for Maintenance of the System:
Sections
202-205, 223, 226, 228, 1611, 1631, 1818, 1836, 1839, 1840 and 1860D-1-1860D-15
of the Social Security Act (42 U.S.C. §§ 402-405, 423, 426, 428, 1382, 1383,
1395i-2, 1395o, 1395r-1, 1395s and 1395w-101-1395w-115).
Purpose(s):
The MDB File is
used for the collection and maintenance of material related to Medicare Part A,
Part B, Medicare Advantage Part C, and Medicare Part D, including, but not
limited to: Part D participation and premium deductions, and where applicable,
subsidized prescription drug coverage eligibility information; Medicare Part B
enrollment, surcharge and premium reduction information for participants in
certain Medicare Advantage plans and for maintaining information necessary to
set income-related monthly adjustment amounts to Part B premiums for certain
individuals who exceed an income threshold; and Part C premium deduction
authorized by the MMA. The information
in this file is used throughout SSA for the purposes of collecting,
documenting, organizing and maintaining information and documents for making
determinations about eligibility for subsidized benefits, premium reductions
and deduction under the MMA.
Routine uses of records maintained in the system, including categories
of users and the purposes of such uses:
Disclosures may
be made for routine uses as indicated below.
However, any information defined as “return or return information” under
26 U.S.C. 6103 of the Internal Revenue Code (IRC) will not be disclosed unless
authorized by the IRC, the Internal Revenue Service (IRS), or IRS regulations.
1) To the Office of the President for the
purpose of responding to an individual pursuant to an inquiry received from
that individual or from a third party on his or her behalf.
2) To a congressional office in response to an
inquiry from that office made at the request of the subject of a record
3) To the Department of Justice (DOJ), a court
or other tribunal, or another party before such tribunal when:
a) 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 the operations of
SSA or any of its components is party to 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 such 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.
4) Information may be disclosed to DOJ for:
a) investigating and
prosecuting violations of the Social Security Act to which criminal penalties
attach;
b) representing the
Commissioner; or
c) investigation
issues of fraud by agency officers or employees, or violation of civil rights.
5) To applicants, claimants, prospective
applicants or claimants (other than the data subjects and their authorized
representatives) to the extent necessary for the purpose of pursuing Medicare
Part D and Part D subsidy entitlement or appeal rights.
6) To Federal, State, or local agencies (or
agents on their behalf) for administering cash or non-cash income maintenance
or health maintenance programs (including programs under the Social Security
Act). Such disclosures include, but are
not limited to, release of information to:
a) The Railroad Retirement Board for
administering provisions of the Railroad Retirement and Social Security Acts
relating to railroad employment and for administering the Railroad Unemployment
Insurance Act;
b) The Department of Veterans Affairs (VA) for
administering 38 U.S.C. 412, and upon request, information needed to determine
eligibility for, or amount of, VA benefits or verifying other information with
respect thereto;
c) The Department of Labor for administering
provisions of Title IV of the Federal Coal Mine Health and Safety Act, as
amended by the Black Lung Benefits Act;
d) State agencies for making determinations of
Medicaid eligibility; and
e) State agencies for making determinations of
food stamp eligibility under the food stamp program;
f) State audit agencies for auditing Medicaid
eligibility considerations; and
g) State welfare departments pursuant to
agreements with SSA for administration of State supplementation payments; for
enrollment of welfare recipients for medical insurance under section 1843 of
the Act; and for conducting independent
quality assurance reviews of Supplemental Security Income recipient records,
provided that the agreement for Federal administration of the supplementation
provides for such an independent review.
7) To the Internal Revenue Service, Department
of the Treasury, for the purpose of auditing SSA’s
compliance with the safeguard provisions of the Internal Revenue Code of 1986,
as amended.
8) To the Centers of Medicare and Medicaid Services
(CMS), for the purpose of administering Medicare Part D enrollment and premium
collection and Medicare Advantage Part C premium collections, as well as
Medicare Part B income-related monthly adjustment amounts.
9) To Federal and State agencies administering
Medicare Part D and Part D subsidy under the MMA of 2003. For example, release of information to:
a) The Bureau of Public Debt, Department of the
Treasury;
b) The Internal Revenue Service;
c) The Office of Personnel Management;
d) The Railroad Retirement Board;
e) The Veterans Administration; and
f) The Office of Child Support Enforcement for
the purpose of assisting in the verification of eligibility for the
prescription drug subsidy.
10) To a Federal, State, or Congressional
support agency (e.g. the Congressional Budget Office and the Congressional
Research Service in the Library of Congress) for research, evaluation, or
statistical studies. Such disclosures
include, but are not limited to, release of information in assessing the extent
to which on can predict eligibility for Supplemental Security Income (SSI)
payments or Social Security disability insurance benefits; examining the
distribution of Social Security benefits by economic and demographic groups and
how these differences might be affected by possible changes in policy;
analyzing the interaction of economic and non-economic variables affecting
entry and exit events and duration in the Title II Old Age, Survivors, and
Disability Insurance and the Title XVI SSI disability programs; and analyzing
retirement decisions focusing on the role of Social Security benefit amounts,
automatic benefit recomputation, the delayed
retirement credit, and retirement test, if SSA:
a) Determines that the routine use does not violate
legal limitations under which the record was provided, collected, or obtained;
b) Determines that the purpose for which the
proposed uses is to be made:
(i) Cannot reasonably
be accomplished unless the record is provided in a form that identifies individuals;
(ii) Is of
sufficient importance to warrant the effect on, or risk to, the privacy of the
individual which such limited additional exposure of the record might bring;
(iii) Has reasonable probability that the objective of the
use would be accomplished;
(iv) Is of importance to the Social Security program of the
Social Security beneficiaries or is for an epidemiological research project
that relates to the Social Security program or beneficiaries,
c) Requires the recipient of information to:
(i) Establish
appropriate administrative, technical, and physical safeguards to prevent
unauthorized use or disclosure of the record and agree to on-site inspection,
by SSA’s personnel, its agents, or by independent
agents of the recipient agency, of those safeguards;
(ii) Remove or
destroy the information that enables the individual to be identified at the
earliest time at which removal or destruction can be accomplished consistent
with the purpose of the project, unless the recipient receives written authorization
from SSA that it is justified, based on research objectives, for retaining such
information;
(iii) Make no further use of the records
except:
a. Under emergency circumstances affecting the
health or safety of an individual following written authorization from SSA;
b. For disclosure to an identified person
approved by SSA for the purpose of auditing the research project;
(iv) Keep the data as a
system of statistical records. A
statistical record is one which is maintained only for statistical and research
purposes and which is not used to make any determination about an individual;
d) Secures a written statement by the recipient
of the information attesting to the recipient’s understanding of, and
willingness to abide by, the provisions.
11) The Department of Homeland
Security, Bureau of Citizenship and Immigration Services, upon request, to
identify and locate aliens in the United States pursuant to section 290(b) of
the Immigration and Natinonality Act (8 U.S.C.
1360(b)).
12) To contractors and other Federal
agencies, as necessary, for the purpose of assisting SSA in the efficient
administration of its programs. We
contemplate disclosing information under this routine use only in situations in
which SSA may enter a contractual or similar agreement with a third party to
assist in accomplishing an agency function relating to this system of records.
13) Addresses of beneficiaries who are
obligated on loans held by the Secretary of Education or a loan made in
accordance with 20 U.S.C. 1071, et seq. (the Robert T. Stafford Student Loan
Program) may be disclosed to the Department of Education as authorized by
section 489A of the Higher Education Act of 1965.
14) To student volunteers and other
workers, who technically do not have the status of Federal employees, when they
are performing work for SSA as authorized by law, and who need access to
personally identifiable information in SSA records in order to perform their
assigned Agency functions.
15) To Federal, State, and local law
enforcement agencies and private security contractors, as appropriate,
information necessary:
a) to enable them to
protect the safety of SSA employees and customers, the security of the SSA workplace
and the operation of SSA facilities; or
b) to assist
investigations or prosecutions with respect to activities that affect such
safety and security or activities that disrupts the operation of SSA
facilities.
16) To the General Services Administration
(GSA) and the National Archives Records Administration (NARA) under 44 U.S.C.
2904 and 2906, as amended by the NARA Act of 1984, non-tax return information
which is not restricted from disclosure by Federal law for the use of those
agencies in conducting records management studies.
17) To applicants, claimants,
prospective applicants or claimants (other than the data subjects and their
authorized representatives) to the extent necessary for the purpose of pursuing
Medicare Part B Premium Reduction based on participation in a Medicare
Advantage Part C Plan.
18) To applicants, claimants,
prospective applicants or claimants (other than the data subjects and their
authorized representatives) to the extent necessary for the purpose of
administering Medicare Part A, Part B, Medicare Advantage Part C, and Medicare
Part D, including, but not limited to pursuing Medicare Part B, Part C, and
Part D premium collection.
19) To the Centers for Medicare and
Medicaid Services, for the purpose of administering Medicare Part A, Part B,
Medicare Advantage Part C, and Medicare Part D, including but not limited to:
Medicare Part C enrollment and premium collection processes; Part D enrollment
and premium collection processes; Medicare Part B premium reduction based on
participation in a Part C plan and Medicare Part B enrollment and
income-related monthly adjustment amount determinations, appeals of
determinations, and premium collection.
20) To the Centers for Medicare and
Medicaid Services, the Railroad Retirement Board and the Office of Personnel
Management for the purpose of administering Medicare Part A, Part B, Medicare
Advantage Part C, and Medicare Part D, including, but not limited to,
collecting Medicare Part B premiums, some of which include an income-related
monthly adjustment amount.
21) To the Office of Medicare Hearings
and Appeals and to the Medicare Appeals Council in the Department of Health and
Human Services for purposes of appeals of determinations of Medicare Part B
income-related monthly adjustment amount determinations made by SSA.
We will disclose information to the
Office of Medicare Hearings and Appeals and to the Medicare Appeals Council
under this routine use only for the purpose of assisting that office with
appeals of Medicare Part B income-related monthly adjustment amount decisions.
** 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.
Disclosure to
Consumer Reporting Agencies:
Disclosure
pursuant to 5 U.S.C. 552a(b)(12) may be made to
consumer reporting agencies as defined in the Fair Credit Reporting Act (15
U.S.C. 1681a(f)) or the Federal Claims Collection Act of 1966 (31 U.S.C. 3701,
et seq.), as amended. The disclosure will
be made in accordance with 31 U.S.C. 3711(e) when authorized by sections
204(f), 808(e), or 1631(b)(4) of the Social Security Act (42 U.S.C. 404(f),
1008(e), or 1383(b)(4)). The purpose of
this disclosure is to aid in the collection of outstanding debts owed to the
Federal government, typically, to provide an incentive for debtors to repay
delinquent Federal government debts by making these debts part of their credit
records. The information to be disclosed
is limited to the individual's name, address, SSN, and other information
necessary to establish the individual's identity, the amount, status, and
history of the debt and the agency or program under which the debt arose.
Policies and Practices for Storing, Retrieving, Accessing, Retaining,
and Disposing of Records in the System:
Storage:
Records are
maintained electronically. Any manually
maintained records will be kept in locked cabinets or in otherwise secure
areas.
Retrievability:
Records are retrieved
electronically by SSN and alphabetically by name.
Safeguards:
The MDB File is
protected through limited access to SSA records. Access to the records is limited to those
employees who require such access in the performance of their official
duties. All employees are instructed
about SSA confidentiality rules as a part of their initial orientation
training.
Safeguards for
automated records have been established in accordance with the Systems Security
Handbook. For computerized records,
electronically transmitted between SSA's central office
and field office locations (including organizations administering SSA programs
under contractual agreements), safeguards include a lock/unlock password
system, exclusive use of leased telephone lines, a terminal oriented
transaction matrix, and an audit trail.
Retention and Disposal:
Pursuant to 36
CFR 1228.26, SSA will submit to
System Manager(s) and Address:
Deputy
Commissioner
Disability and
Income Security Programs
Social Security
Administration
Notification Procedure:
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 for
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 mother's maiden name)
and ask for his/her consent to 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:
Same
as Notification procedures. Requesters should also reasonably specify
the information they are seeking. These
procedures are in accordance with SSA regulations (20 CFR 401.40(c)).
Contesting Record Procedures:
Same
as Notification procedures.
Requesters should also reasonably identify the record, specify the
information they are contesting and state 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 is obtained from claimants, beneficiaries, applicants and
recipients; accumulated by SSA from reports of employers or self-employed
individuals; various local, State, and Federal agencies; claimant
representatives and other sources to support factors of entitlement and continuing
eligibility or to provide leads information.
Systems Exempted From Certain Provisions of the Privacy Act:
None.