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Generally, area numbers were assigned in ascending order beginning in the northeast and then moving westward. For the most part, people on the east coast have the lowest area numbers and those on the west coast have the highest area numbers. However, area numbers did not always reflect the worker's residence. During the initial registration in 1936 and 1937, businesses with branches throughout the country had employees return their SS-5 Application for Account Number to their national headquarters, so these SSNs carried the area number where the headquarters were located. As a result, the area numbers assigned to big cities, such as New York, Philadelphia, Boston, and Chicago, were used for workers in many other parts of the country (McKinley and Frase 1970, 373). Also, a worker could apply in person for a card in any Social Security office, and the area number would reflect that office's location, regardless of the worker's residence.
The group number (the fourth and fifth digits of the SSN) was initially determined by the procedure of issuing numbers in groups of 10,000 to post offices for assignment on behalf of the Social Security Board's Bureau of Old-Age Benefits. The group numbers range from 01 to 99 (00 is not used), but for administrative reasons, they are not assigned consecutively. Within each area number allocated to a state, the sequence of group number assignments begins with the odd-numbered group numbers from 01 to 09, followed by even group numbers 10 through 98, then even numbers 02 through 08, and finally odd numbers 11 through 99.4
The Social Security Board also enlisted the Treasury Department to assure employer cooperation. Final Treasury regulations, published in the Federal Register on November 6, 1936, required employers to file Form SS-4 (employer's application for an EIN) with the post office not later than November 21, 1936, and employees to file Form SS-5 (employee's application for an SSN) not later than December 5 (McKinley and Frase 1970, 15 and 360). However, delays in getting registration started made these deadlines moot.
Beginning November 16, 1936, the post offices sent Form SS-4s to employers based on the lists they had compiled earlier that month. Along with information about the business establishment, employers were asked for the number of workers they employed. The mail carriers collected the completed SS-4s a week or two later. Based on SS-4 information, the post offices delivered Form SS-5s to the employers the following week for distribution to employees (McKinley and Frase 1970, 368).
Effective July 1937, Bureau field offices, still numbering only 175 with 1,702 total employees, took over the enumeration workload from the post offices (Zwintscher 1952, 90; SSA 1965, 25). By that time, some 35 million SSNs had been issued at a cost of $5.7 million (SSA 1990, 1; McKinley and Frase 1970, 372).
The Baltimore Records Office used a nine-step process to create a permanent master record and to establish an earnings record for each individual.10 One hundred applications and office record cards, numbered consecutively, were sent through each operation together with a control unit of nine cards (one for each step). The appropriate control card was removed at the end of a step and sent to a control file to track the status of each block (McKinley and Frase 1970, 375).
Also, prior to 1961 SSA field offices issued new SSNs. Only a fraction of these SSN assignments were screened at the central office for a previously assigned SSN, and then only manually (Long 1993, 84). Thus, issuing duplicate SSNs was possible. Beginning in 1961, the central office in Baltimore issued all new SSNs, but it was not until 1970 that an electronic method of checking for previously issued SSNs (called "EVAN" for "electronic verification of alleged numbers") was devised (SSA 1990, 4). Today, automated systems with sophisticated matching routines screen for previously issued SSNs.
Beginning in 2002, SSA began another pilot program referred to as Enumeration at Entry (EaE) that allows noncitizens admitted for permanent residence to obtain SSNs and Social Security cards based on data collected as part of the immigration process. This pilot was expanded worldwide in early 2003. EaE is a joint effort involving the Department of State (DoS), DHS, and SSA. Under EaE, a person aged 18 or older can apply for both an immigrant visa and an SSN at a DoS office in his or her home country. If the visa is granted, then DoS transmits the identifying data from the person's visa/SSN application to DHS. If and when the person is physically admitted to the United States, DHS updates certain data, if necessary, and sends it to SSA for the SSN to be assigned and the card to be issued. All noncitizens enumerated through EaE receive an SSN in the special area number series 729 through 733. As of January 20, 2009, SSA had issued 429,959 original and 114,714 replacement SSNs through the EaE process. SSA is currently working with DoS and DHS on expanding the EaE process to additional noncitizens.
Federal survey-takers are also finding that as respondents have become more aware of the risk of identity theft, they are less willing to supply SSNs that are useful in linking the agency's survey data with administrative records from other agencies. For the Census Bureau's Survey of Income and Program Participation, the share of respondents who did not provide their SSN increased from 12 percent in 1996 to 35 percent in 2004. Likewise, the share of respondents who did not provide an SSN for the Census Bureau's Current Population Survey increased from 10 percent in 1994 to almost 23 percent in 2003 (Bates 2004, 4). The National Center for Health Statistics reports a similar problem.
Business Associate Contract. When a covered entity uses a contractor or other non-workforce member to perform "business associate" services or activities, the Rule requires that the covered entity include certain protections for the information in a business associate agreement (in certain circumstances governmental entities may use alternative means to achieve the same protections). In the business associate contract, a covered entity must impose specified written safeguards on the individually identifiable health information used or disclosed by its business associates.10 Moreover, a covered entity may not contractually authorize its business associate to make any use or disclosure of protected health information that would violate the Rule. Covered entities that had an existing written contract or agreement with business associates prior to October 15, 2002, which was not renewed or modified prior to April 14, 2003, were permitted to continue to operate under that contract until they renewed the contract or April 14, 2004, whichever was first.11 See additional guidance on Business Associates and sample business associate contract language.
Permitted Uses and Disclosures. 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 Object; (4) Incident to an otherwise permitted use and disclosure; (5) Public Interest and Benefit Activities; and (6) Limited Data Set for the purposes of research, public health or health care operations.18 Covered entities may rely on professional ethics and best judgments in deciding which of these permissive uses and disclosures to make.
(3) Uses and Disclosures with Opportunity to Agree or Object. Informal permission may be obtained by asking the individual outright, or by circumstances that clearly give the individual the opportunity to agree, acquiesce, or object. Where the individual is incapacitated, in an emergency situation, or not available, covered entities generally may make such uses and disclosures, if in the exercise of their professional judgment, the use or disclosure is determined to be in the best interests of the individual.
Reasonable Reliance. If another covered entity makes a request for protected health information, a covered entity may rely, if reasonable under the circumstances, on the request as complying with this minimum necessary standard. Similarly, a covered entity may rely upon requests as being the minimum necessary protected health information from: (a) a public official, (b) a professional (such as an attorney or accountant) who is the covered entity's business associate, seeking the information to provide services to or for the covered entity; or (c) a researcher who provides the documentation or representation required by the Privacy Rule for research.
Access. Except in certain circumstances, individuals have the right to review and obtain a copy of their protected health information in a covered entity's designated record set.55 The "designated record set" is that group of records maintained by or for a covered entity that is used, in whole or part, to make decisions about individuals, or that is a provider's medical and billing records about individuals or a health plan's enrollment, payment, claims adjudication, and case or medical management record systems.56 The Rule excepts from the right of access the following protected health information: psychotherapy notes, information compiled for legal proceedings, laboratory results to which the Clinical Laboratory Improvement Act (CLIA) prohibits access, or information held by certain research laboratories. For information included within the right of access, covered entities may deny an individual access in certain specified situations, such as when a health care professional believes access could cause harm to the individual or another. In such situations, the individual must be given the right to have such denials reviewed by a licensed health care professional for a second opinion.57 Covered entities may impose reasonable, cost-based fees for the cost of copying and postage. 2b1af7f3a8