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YOU MUST HAVE A UNITED STATES SOCIAL SECURITY NUMBER TO APPLY FOR LICENSURE IN INDIANA. WITHOUT IT, YOUR APPLICATION WILL NOT BE PROCESSED. AN AIN NUMBER CANNOT SUBSTITUTE FOR THE SSN.
Mandatory disclosure of U.S. Social Security Number
Pursuant to Section 7 of the Privacy Act of 1974, you are hereby given notice that disclosure of your U.S. Social Security number on this application is mandatory for the purpose of complying with IC 25-1-5-8 and IC 4-1-8-1 which provide that the Indiana Department of Revenue may obtain Social Security numbers from the Professional Licensing Agency for tax enforcement purposes. In addition, disclosing such number is mandatory in order for the Physical Therapy Committee to comply with the requirements of the federal National Practitioner Data Bank and the Healthcare Integrity and Protection Data Bank 42 U.S.C. §1320(a)-7e(b), 5 USC §552a, 45 CFR Part 60.1, and 45 CFR Part 61.