Privacy Act of 1974
Formal Notice of Title 5 U.S.C. 552
This “Privacy Notice” has been served on __________________________________________________:
You are hereby being formally and put on notice and advised of the following facts of law as pertains to the “Social Security Number” and the “Privacy Act of 1974, Title 5 USC 552;”
A judgement of $1,000.00, plus costs and attorney’s fees will be assessed against the individual, business, and/or government agency that denies an individual a right, service, benefit, or privilege for not providing a Social Security Number or other PIN (personal identification number) when the individual is not required to do so by law. A Social Security Number, or other personal identification number (PIN such as driver’s license) is required to be used only for the following benefits:
1. To receive public assistance benefits.
2. To pay Social Security taxes.
3. To receive Social Security benefits and refunds.
An individual may refuse to provide the Social Security Number (or PIN) for any other reason than those listed above, without any reprisals. No one may seek out the Social Security Number (or PIN) without the written permission of the individual, without being subject to the same penalties as for forcing the individual to give the number. Quote from the “Privacy Act.”
(A.) “Actual damages sustained by the individual as a result of the refusal, or failure, to provide a Social Security Number (or PIN) shall be entitled to recover not less than $1,000.00:
(B.) The cost of the action together with reasonable attorney’s fees as determined by the court. Guidelines and regulations for the maintenance of privacy and protection of records on individuals: Awards maybe recovered from the government agency, business, or individual who denies the right, benefit, service, or privilege. Federal court decisions forth below:
“The right of privacy is a personal right designed to protect persons from unwanted disclosure of personal information. Ref: CNA Financial Corp. v. Local 743, D.C. II, 1981 F SUPP. 942 III
The Act “was enacted for (the) purpose of curtailing the expanding use of the Social Security Number… and to eliminate the threat to individual privacy and confidentiality of information passed by common number identifiers.” Ref: Duly v. Wilson, D.C. Del. 1982, 529 F SUPP. 1343
(A.) (1) It shall be unlawful… to deny to any individual any right, service, benefit, or privilege provided by law because of such individual’s refusal to disclose his Social Security Number.” (Or PIN)
Therefore. I do hereby declare my specific right not to disclose a Social Security Number (or PIN) to tins individual, organization, business, or agency, or to have my Social Security Number (or PIN) placed on any records for reasons other than those stated above. I may commence litigation under the “Privacy Act” if services are denied as a result of my non-disclosure of said number, or if I am injured because of a Social Security Number (or PIN) being placed on your records of me.
By my presentation of this Notice to you, you have been duly advised and put on notice.
Dated this_____day of_____________, 2003 A.D.
Signed__________________________ Witness_________________________
Address__________________________ Witness__________________________
City, State, Zip______________________

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