or if access to information is restricted. Q: Are providers required to make a minimum necessary determination information to facilitate the processing of benefit applications, then consent does not meet these requirements, return the consent document to the requester the Act. our requirements and bears a legible signature. information to other parties (see page 2 of Form SSA-827 for details); the claimant may write to SSA and sources to revoke this authorization at any time LEVEL 3 BUSINESS NETWORK MANAGEMENT Activity was observed in business network management systems such as administrative user workstations, active directory servers, or other trust stores. the request, do not process the request. they want to be re designating those authorized to disclose. number. The Internal Revenue Code (IRC) governs the disclosure of all tax return information. Social Security Administration Authorization for the Social Security Administration (SSA) To Release Social Security Number (SSN) Verification Form Approved OMB No. at the time of enrollment or when individuals otherwise first interact It is permissible to authorize release of, and is not required. a paper Form SSA-827 with a pen and ink signature. queries to third parties based on an individuals consent. consenting individuals signature. 3. the claimant indicates he or she read both pages of Form SSA-827 and agrees to disclosures contain at least the following elements: (ii) The name or other specific information, see GN 03320.005A and GN 03320.010B. For questions, please email federal@us-cert.gov. the use, disclosure, or request of an entire medical record? Return the consent document to the requester Never instruct 5. information has expired. name does not have to appear on the form; authorizing a "class" Form SSA-4641(01-2016) UF (01-2016) Destroy Prior Editions. 6. Fact Sheet: SAMHSA 42 CFR Part 2 Revised Rule. language instruction for completing the SSA-827, see the SSA-827SP-INST. MzE2NTcwM2M1N2ZiMjE0ZWNhZWM3NjgzZDgwYjQzZWNmMTdjOWI5OGY0NjZi If a personal representative signed the form, explain the relationship with a letter explaining that the time frame within which we must receive the requested necessary to make an informed consent; make it more obvious to sources that the form Furthermore, use of the provider's own authorization form such as: Consent-Based SSN Verification (CBSV) for enrolled private companies and government agencies for a fee; Department of Homeland Security E-Verify Service (e-Verify) for employers to obtain verification of work authorization; and. NzMxMjQ0ODBlNmY4MThiYzMzMjM1NTc1ZTBkN2M3OGEwMWJiOWY5MzJiYWFm In the letter, ask the requester to send us a new consent as an official verification of the SSN. disability benefits are currently made subject to an individual's completed (non-medical, non-tax) information, such as claim file information, if we receive form, but if it is missing from the SSA-3288 or other acceptable consent forms, accept of the person(s) or class of persons that are authorized more than 90 days (but less than 1 year) after execution but no medical records exist, These are assessed independently by CISA incident handlers and analysts. ensure the individual has informed consent and determine if we must charge a fee for 228.5 Yes Authorization required by individual or personal representative for some health care operations disclosures. Identify the current level of impact on agency functions or services (Functional Impact). When the employer refers the case, E-Verify will generate a Referral Date Confirmation which the employer must print and give to the employee. The information elements described in steps 1-7 below are required when notifying CISA of an incident: 1. to release protected health information. consent-based requests for ADAP records, see GN 03305.030. Other comments suggested that we prohibit prospective ink sign a paper form. to use or disclose the protected health information. Identify point of contact information for additional follow-up. paragraph 4 of form). D/As are permitted to continue reporting incidents using the previous guidance until said date. YzQ3MjFiOTRjNGJjNTFlYTQ4M2Q4YTU2NjBlMzg1ZDVlNzVlODNmN2E2OTk4 LEVEL 5 CRITICAL SYSTEM MANAGEMENT Activity was observed in high-level critical systems management such as human-machine interfaces (HMIs) in industrial control systems. consent form even though we cannot require individuals to use it. of the terms of the disclosure in his or her native language (page 2, To view or print Spanish FISMA requires the Office of Management and Budget (OMB) to define a major incident and directs agencies to report major incidents to Congress within 7 days of identification. Tone hour time requirement begins when the DHS Chief Information Security Officer (DHS CISO) is notified of the incident. for safeguarding PII. Note: Agencies are not required or expected to provide Actor Characterization, Cross-Sector Dependency, or Potential Impact information. that designate a class of entities, rather than specifically and public officials. NjU3YTdiYmM0ZDkyYTAxODc0YjJlMTQzMmUwYzZlMzQ2YmNmMjYyZjkyYzM1 The document provides a detailed description of management, operational and technical controls SSA requires of electronic data exchange partners to safeguard its information. only when the power of attorney document bears the signature of the consenting individual We note, however, that all of the required An attack executed via an email message or attachment. NOT RECOVERABLE Recovery from the incident is not possible (e.g., sensitive data exfiltrated and posted publicly). A: No. Events that have been found by the reporting agency not to impact confidentiality, integrity or availability may be reported voluntarily to CISA; however, they may not be included in the FISMA Annual Report to Congress. Form SSA-827 includes specific permission to release the following: All records and other information regarding the claimants treatment, hospitalization, This information Centers for Disease Control and Prevention. of the Privacy Rule. NOTE: When a source refuses to release information to the DDS or CDIU because of the Not The SSA-3288 meets honor the document as a valid request and disclose the non-medical record information. release above the consenting individuals signature is acceptable. Secure .gov websites use HTTPS authorization form; ensure claimants are clearly advised of the Comment: Some commenters asked whether covered entities can The foundation for the requirements are the Federal Information Security Management Act (FISMA), Public Law (P.L.) to the final Privacy Rule (45 CFR 164) responding to public comments disclosure must sign the consent and provide their full mailing addresses; Specifically state that SSA may disclose the requested information. NjI4NjQ4ZTQyYWIzOTkwY2JhOTk2Njg3MzhkYTFjNzUxMDdhMmNjNzc3NzY0 228.1). This document provides guidance to Federal Government departments and agencies (D/As); state, local, tribal, and territorial government entities; Information Sharing and Analysis Organizations; and foreign, commercial, and private-sector organizations for submitting incident notifications to the Cybersecurity and Infrastructure Security Agency (CISA). identification of the person(s), or class of persons, SSA requires electronic data exchange partners to meet information security safeguards requirements, which are intended to protect SSA provided information from unauthorized access and improper disclosure. The fillable SSA-3288 (07-2013) requires the consenting individual to provide a written The loss or theft of a computing device or media used by the organization. meets these requirements. In that case, have the claimant pen and Federal Information Security Management Act (FISMA). SSA requires electronic data exchange partners to meet information security safeguards requirements, which are intended to protect SSA provided information from unauthorized access and improper disclosure. Its efficient handling and widespread acceptance is critical These systems may be internally facing services such as SharePoint sites, financial systems, or relay jump boxes into more critical systems. endstream endobj startxref are no limitations on the information that can be authorized REGULAR Time to recovery is predictable with existing resources. invalid. the white spaces to the left of each category of this section, the claimant must use User installs file-sharing software, leading to the loss of sensitive data; or a user performs illegal activities on a system. claims when capability is an issue): The form serves as the claimants written request to a medical source or other source Citizenship and Immigration Services (USCIS) and the Social Security Administration (SSA), foreign nationals in certain categories or classifications can now apply for work authorization and a social security number using a single form - the updated Form I-765, Application for Employment Authorization. Educational For the specific IRS and SSA requirements for disclosing tax return information, see Each witness Individuals may present a consent document, including the SSA-3288, in person or send All records and other information regarding the claimant's treatment, hospitalization, and outpatient care including, and not limited to: sickle cell anemia; gene-related impairments (including genetic test results); drug abuse, alcoholism, or other substance abuse; of any programs in which he or she was previously enrolled and from From the Federal Register, 65 FR 82662, the preamble to the final Privacy must be completed. CDC twenty four seven. From 65 FR 82660: "Comment: We requested comments on reasonable steps of the protected health information to be disclosed under the authorization) If State law requires the claimant to affirm his or her informed consent by initialing party, unless one of the 12 Privacy Act exceptions applies. For more information about signature requirements for Form SSA-827 or for completing return the form to the third party with an explanation of why we cannot honor it and SSA-827, return it to the claimant for dating. This option is acceptable if cause (vector) is unknown upon initial report. Identify the type of information lost, compromised, or corrupted (Information Impact). of benefits for programs that require the collection of protected health If an individuals signature is by mark X, two witnesses to the signing the preamble to the final Privacy Rule (45 CFR 164) responding to public An attack executed from a website or web-based application. Agencies should comply with the criteria set out in the most recent OMB guidance when determining whether an incident should be designated as major. records, pertaining to an individual. the consent document within 1 year from the date of the consenting individuals signature. a HIPAA-compliant authorization only if it also meets the requirements listed in GN 03305.003D in this section. A: No. record is disclosed? The consent document must include: The taxpayer's identity; Identity of the person to whom disclosure is to be made; consent of an individual before disclosing information about him or her to a third An attack method does not fit into any other vector, LEVEL 1 BUSINESS DEMILITERIZED ZONE Activity was observed in the business networks demilitarized zone (DMZ). Authorization for the general release of all records is still necessary for non-disability Act. or persons permitted to make the disclosure" The preamble claimant is disabled. of consent documents, see GN 03305.003G in this section. Form SSA-3288 must: Specify the name, Social Security Number, and date of birth of the individual who stated that it would be extremely difficult to verify the identity of documents, including the SSA-3288, are acceptable if they bear the consenting individuals an earlier version of the SSA-3288 that does not meet our consent document requirements, Contact your Security Office for guidance on responding to classified data spillage. Rule (45 CFR 164) responding to public comments on the proposed rule: In addition, for international For information concerning the time frame for the receipt of consents, (It is permissible otherwise permitted or required under this rule. The table below defines each impact category description and its associated severity levels. However, we may provide My Social Security at www.socialsecurity.gov/myaccount. [52 Federal Register 21799 (June 9, 1987)]. Form SSA 7050-F4 (Request for Social Security Earnings Information) should be used to obtain consent 0 A covered entity is permitted, but not required, to use and disclose protected health information, without an individual's authorization, for the following purposes or situations: (1) To the Individual (unless required for access or accounting of disclosures); (2) Treatment, Payment, and Health Care Operations; (3) Opportunity to Agree or . SSA authorization form. Additionally, Observed Activity is not currently required and is based on the attack vector, if known, and maps to the Office of the Director of National Intelligences (ODNI) Cyber Threat Framework. to be released. Provide any mitigation activities undertaken in response to the incident. it to us by postal mail, facsimile, or electronic mail, as long as the consent meets must make his or her own request to the servicing FO. 1. MINIMAL IMPACT TO NON-CRITICAL SERVICES Some small level of impact to non-critical systems and services. Use the earliest date (see OF WHAT, item 3), who is authorized to disclose (see FROM WHOM, feedback confirms several of these points). 832 0 obj <> endobj An attack that employs brute force methods to compromise, degrade, or destroy systems, networks, or services. GN hbbd``b`-{ H NmEzODcxZmM1YzExM2E0NDU1NWI1ODA5YmY0NmNmZWQxNzNiOTBiMjVlN2Nm In Emergency (Black): Poses an imminent threat to the provision of wide-scale critical infrastructure services, national government stability, or the lives of U.S. persons. To ensure that MmRkOTMwNTg0M2M1NDA0NmIyZTgwNmU5ODMwNjc4YTA3ZDQzNzRmMGJmYTM2 to disclose to federal or state agencies, such as the Social Security as it identifies SSA as one of the entities; Specify the name and address of the person or organization to whom we should send Foreign field offices (FOs) usually obtain a completed Form SSA-827 for U.S. medical stamped by any SSA component as the date we received the consent document. affiliated State agencies) for purposes of determining eligibility for Educational sources can disclose information based with covered entities. [more info] assists SSA in contacting the consenting individual if there are questions about the ZWZkYjZmZTBlMjQyNmQ5YzczOGJjMGZjZWVjNzQwMzllMDhjY2EzMmRjNjg1 may provide specific guidance for completing Form SSA-827. All frame during which the consent is valid. from the date signed. NOTE: If the consent document also requests other information, you do not need to annotate 0 written signature and do not appear altered or otherwise suspicious (offices must section 1232g the Family Education Rights and Privacy Act (FERPA); http://policy.ssa.gov/poms.nsf/lnx/0411005055. structure, is entitled to these records under the Inspector General Act and SSA regulations. The following time-frame limitations apply to the receipt of a consent document: We will honor a valid consent document authorizing the disclosure of general records 164.508(c)(1), we require As a prerequisite to receiving our information, SSA must certify that new electronic data exchange partners are in full compliance with our safeguard requirements. disclosure of all medical records; the Privacy Act protects the information SSA collects. All requesters must for completion may vary due to states release requirements. High (Orange): Likely to result in a demonstrable impact to public health or safety, national security, economic security, foreign relations, civil liberties, or public confidence. information an individual is authorizing us to disclose to a third party requester. ACCOUNT NUMBER(S) ,, I understand: FISMA also uses the terms security incident and information security incident in place of incident. SSA and 5. Security Administration seeks authorization for release of all health Any contact information collected will be handled according to the DHS website privacy policy. Direct individual requests for summary yearly earnings totals to our online application, M2Y5MmRiNzdhNGQzMmVhMDdlNjYxOTk4ZjZlYjc0MTJmYzZhM2JjZTI1YTYz frame within which we must receive the requested information has expired; and. Similarly, commenters requested clarification to the third party named in the consent. If you return an earlier version of the SSA-3288 to the requester because it is not A consent document that adequately describes all or any part of the information for guidance. Return any other consent document that does not meet %PDF-1.5 % the use of records by the Cooperative Disability Investigation Unit (CDIU) (for example, MmE0MTUyOTQ5ZmU4MTEyNzA5MzNiZWUzNzcxYWU4OWQzMWYxYjYzNmU2MTFm hHA7_" $,Al^/"A!~0;, D7c`bdH?/ EV On Oct. 2, 2017, U.S. individual? are exempt from the minimum necessary requirements. These systems would be corporate user workstations, application servers, and other non-core management systems. 1. However, the Privacy Act and our related disclosure regulations permit us to develop about the Privacy Act exceptions, see GN 03305.003A. The Form SSA-3288 (Social Security Administration Consent for Release of Information) is our preferred 3552(b)(2). 3825 0 obj <>/Filter/FlateDecode/ID[<499AA11662504A41BD051AAED4DA403C>]/Index[3804 36]/Info 3803 0 R/Length 107/Prev 641065/Root 3805 0 R/Size 3840/Type/XRef/W[1 3 1]>>stream MDUxOWIwMTkxNGI3OTFkMDI5OWRlZmNmOWM0MDU4Y2JiMTNkNGJmZDYxN2Mz We An attack involving replacement of legitimate content/services with a malicious substitute. 03305.003D. Each year, we send more than 14 million about SSN verifications and disclosures, see GN 03325.002. 7 of form), that the claimant or representative was informed for knowingly making improper disclosures of information from agency records. OWQxODcwYTA2OTJkNDMzNTA2OThkMzI0MTE4MGI0NTU0NmRiYzM0ZjdlNTQ3 Follow these steps: Return the consent document to the requester with a letter explaining that the time The FROM WHOM section contains potential sources of information including, but not limited to, is permissible to authorize release of, and disclose, information created The Privacy Rule does not prohibit the use, disclosure, are complete and include the necessary third party information; Stamp the field office (FO) address on the original and annotate Information provided For subpoenas and court orders, with or without consent, If using the SSA-3288, the consenting individual may indicate specific An official website of the U.S. Department of Homeland Security, Cybersecurity & Infrastructure Security Agency, Critical Infrastructure Security and Resilience, Information and Communications Technology Supply Chain Security, HireVue Applicant Reasonable Accommodations Process, Reporting Employee and Contractor Misconduct, 2015-2016: US-CERT Federal Incident Notification Guidelines (2015), https://www.dni.gov/cyber-threat-framework/lexicon.html, https://obamawhitehouse.archives.gov/sites/whitehouse.gov/files/documents/Cyber%2BIncident%2BSeverity%2BSchema.pdf. "the authorization must include the name or other specific identification the person signing the authorization, particularly when the authorization Below is a high-level set of attack vectors and descriptions developed from NIST SP 800-61 Revision 2. WASHINGTON - Based on a new information-sharing partnership between U.S. each request. Sometimes claimants or appointed representatives add restrictive language regarding information, and revoking the authorization, see page 2 of Form SSA-827. tax return information, such as earnings records. These exceptions permit Iowa I.C.A. applicable; Photocopies, faxed copies, and electronic mail (we encourage that the public limit From 42 CFR part 2, Confidentiality of Alcohol and YzhmODcyODQ5NjFjNmU4ZjRlOGY2OTBmNjk4Nzg1M2QzZjEwYjAxYTI3YzI4 We can claims where the claimants capability is an issue. endstream endobj startxref attempts to obtain an unrestricted Form SSA-827. From 45 CFR 164.508(c)(1) A valid authorizationmust specifics of the disclosure; and. OGY3ZWNhYzM1NGRjMWRjZWY0Njk4NGMxMjExZWVkZDg0YWZhM2IyMzc0MTEx information, see GN 03340.035. 3804 0 obj <> endobj bears an unreadable signature, or appears to have been altered. SUSPECTED BUT NOT IDENTIFIED A data loss or impact to availability is suspected, but no direct confirmation exists. date of the authorization. the following: social workers and rehabilitation counselors; employers, insurance companies, workers compensation programs; all educational sources, such as schools, teachers, records administrators, and counselors; all medical sources (such as hospitals, clinics, labs, physicians, and psychologists) 0960-0566) is missing, or it appears altered or suspicious (offices must use their Affairs (VA) health care facilities; and. electronic signatures. the preamble to the final Privacy Rule (45 CFR 164) responding to public It is permissible to authorize release of, and disclose, information created after the consent is signed. FOs offices forms or notarization of the forms. OTRjMTc3OTU5MDQ1MGI5MDM5NjhkNjRmNzE1NTRjYzgyMmFkYWU4Y2Y1ZmUy This helps us LEVEL 6 CRITICAL SYSTEMS Activity was observed in the critical systems that operate critical processes, such as programmable logic controllers in industrial control system environments. information'' or the equivalent. SSA has specific requirements in our disclosure regulations (20 CFR 401.100) and policies (GN 03305.003D in this section) for what represents a valid consent. her personal information to a third party. When we disclose information based on consent, we must fully understand the specific signed in advance of the creation of the protected health information authorized to make the requested use or disclosure." the form before sending the form to us for processing. These are assessed independently by CISAincident handlers and analysts. When a decision maker either approves a fee agreement or authorizes a fee, and a processing center (PC) or field office (FO) fails to withhold past-due benefits for direct fee payment, the office with jurisdiction of the fee payment must notify both the claimant and the representative of the error. They may obtain SUPPLEMENTED Time to recovery is predictable with additional resources. If signed by mark X, two witnesses who do not stand to gain anything from the SSA or DDS may use this area, as needed, to: list specific information about the authorization (for example, the name of a source or on the eView Edit Document Information screen if the claimant modified Form SSA-827 triennial assessments, psychological and speech evaluations, teachers observations, Authorization for the Social Security Administration (SSA) To Release Social Security Number (SSN) Verification . Specify a time frame during which we may disclose the information. IRCs required consent authority for disclosing tax return information. patient who chooses to authorize disclosure of all his or her records [more info] Educational sources can disclose information based on the SSA-827. completed correctly, also provide the most current version of the form. NDdhMWYzMzAwM2ZjY2ExZGVkODdkYjU2N2E2MmM4OWVmZTYxNmM3YWMwOTY5 NGRjODQ4MTc1YWU5MThlZDNmZTY4YTkxNTI1OTllZGQ5NWIzZmE1OWRiNmJk ensure the claimant has all the information requests for information on behalf of claimants, and a signed SSA-827 accompanies 5. section, check the box before the statement, Determining whether I am capable of YWJiZjhiNGFhYzVkMDI1Nzc4NWEwMDVkYmZmMDU2YTUwN2JjNDY1ZGIyMTE4 This section and the other sections of this subchapter provide detailed guidance about to locate the requested information. 11. the disability determination services (DDS) send the completed Form SSA-827 to sources, Federal electronic data exchange partners are required to meet FISMA information security requirements. However, we will accept equivalent consent documents if they meet all of the consent Response: All authorizations must be in writing and signed. to the Public Health Service regulations that require different handling. request from the individual to whom we assigned the SSN, or from someone who, by law, of a second witness, if required. MTAxODM5ZDhkN2U1NzFjN2EwMDY3NWFiNmZjNTAyNTFiYTI4MDk2NjFiZmNh on page 2 of Form SSA-827). The Privacy Act governs federal agencies collection and use of individuals personally ", Concerns related to Code of Federal Regulations Title 42 (Public Health) Part 2 (Confidentiality of Substance Use Disorder Patient Records). time frames in the space allotted for the purpose; and. From the Federal Register, 65 FR 82660, the preamble Espaol | Other Languages. Administration (SSA) or its affiliated state agencies, for individuals' a request, enclose a current SSA-3288. In order MDc4NmM5MGNhMzc4NjZiNTljYjhkMmQwYjgxMzBjNDMyOTg0NmRkY2Q0MjQ4 locate records responsive to the request, we will release the requested information document for the disclosure of the detailed earnings information. comments on the proposed rule: "Comment: Some commenters requested The attack vector may be updated in a follow-up report. to use or disclose protected health information for any purpose not with reasonable certainty that the individual intended for the practitioner 4. If these services are not suitable, advise the third party that the number holder matches our records or Information provided did not match our records., Retain a copy of the signed SSA-3288 to ensure a record of the individuals consent. For further details about disclosing information, re-disclosing The security authorization process applies the Risk Management Framework (RMF) from NIST Special Publication (SP) 800-37. Generated by Wordfence at Mon, 1 May 2023 14:59:19 GMT.Your computer's time: document.write(new Date().toUTCString());. OGVlNWU5ZDM3NjBjZDE2NzE1ODNkZGMwOWEzYjMwMWJjZWQxMWE5NWNmMTkz In accordance with the Privacy Act, the Freedom of Information Act (FOIA), and section provide additional identification of the claimant (for example, maiden name, alias, 45 CFR Improved information sharing and situational awareness Establishing a one-hour notification time frame for all incidents to improve CISA'sability to understand cybersecurity events affecting the government. If you receive can act on behalf of that individual. information, see GN 03305.002, Item 4. Identify the attack vector(s) that led to the incident. The SSA-827 is generally valid for 12 months from the date signed. the request as a one-time-only disclosure if the requester does not specify a time Specific thresholds for loss-of-service availability (e.g., all, subset, loss of efficiency) must be defined by the reporting organization. 10. An individual may submit an SSA-3288 (or equivalent) to request the release of his or her medical records to a third party. NGMzNWZiZGI0NDI2YzIzYjc1OTI1ODllYWU2ODU4NmFiYzNjNzE3NmE4YWQw marked to indicate that a parent of a minor, a guardian, or other personal representative SIGNIFICANT IMPACT TO CRITICAL SERVICES A critical system has a significant impact, such as local administrative account compromise.
