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| The Privacy Act of 1974 requires that you be furnished this statement because you are asked to provide your Social Security number on the claim forms given you. Your Social Security number is requested under the authority of the Internal Revenue Code of 1954 [26 U.S.C. 85, 6011 (a), 6050B, and 6109(a)]. Disclosure of your Social Security number for this purpose is mandatory and must be entered on the forms you submit to claim unemployment insurance. Should you decline to disclose your Social Security number, your claim for unemployment insurance will not be processed.
Your Social Security number will be used: