Government to Government Services Online Website Registration (SSA-118)

Guidelines for Completing the

Government to Government Services Online Website Registration Form

MAIN CONTACT INFORMATION
Name	Enter the user’s full name. If this form is being completed for more than one user, enter one contact here and subsequent users’ names in the “Additional User Information” section.
Organization Name	Enter the name of the organization affiliation, if any. If this is an application for an organizational shared account, the organization name is mandatory.
Organization ID	Unique identifier required for all Data Reporting applicants (Birth/Death, Black Lung, Fugitive Felon, IAR, New Hire/Quarterly Wage, Prison, etc.) This identifier is used within the account naming format.
Street Address	Enter the user’s address.
City	Enter the user’s city.
State	Enter the user’s state.
Zip Code	Enter the user’s zip code.
Email Address	Enter the user’s email address.
Phone	Enter the user’s phone number. Include the area code.
WEBSITE USER INFORMATION
Name	Enter the name of each new user within your organization. Include the main contact’s name if an account also needs to be established for this person. Input each new user’s full name.
Email Address	Enter each new user’s email address.
Phone	Enter each new user’s phone number. Include the area code.
Office Use	Do not enter information in this section. This section will be completed by an EDATA ADMINISTRATOR.
SPONSOR VERIFICATION
This section is to be completed by the Sponsor after verification of the new website user information.
Sponsor Name	Enter the Sponsor contact’s full name.
Phone	Enter the Sponsor’s phone number. Include the area code.
Sponsor Comments	Enter any additional comments or details regarding the registration of these user(s). This field may also be used to identify a newly implemented utility for registration if not listed in the “Select Utilities field”.
Select the utilities the new user will need to access	There are several eData website utilities. Indicate which of these utilities the user will need to access:
	GOVERNMENT TO GOVERNMENT SERVICES ONLINE allows transferal of information to/from SSA via various utilities. Select the functions below that apply to every user on the application. Select all of the utilities that apply: B – State government agencies sending Birth records to SSA. BL – Federal/State government agencies sending Black Lung records to SSA. D – State government agencies sending Death records to SSA. DE – This user will exchange files via the Data Exchange application. FF – FBI, State government and law enforcement agencies send Fugitive Felon warrant information to SSA. IAR – State government agencies sending Interim Assistance Reimbursement files to SSA. OCSE – Federal government agencies sending New Hire, Quarterly Wage, and Federal Parent Locator System data to SSA for OCSE. Prisons – A Prison representative notifying SSA of incoming prisoners. SM – Secure Messaging users that require encryption of sensitive email messages. SW – Sheltered Workshops send payroll information to SSA Field Offices (FO). DD – Financial institutions submitting Direct Deposit information. OTHER – Select this item for a newly established utility not yet displayed on the registration form. Annotate the utility name in the Sponsor Comments field.
	Enter identifying information for all Trading Partners to which the new DE or SW users may need to forward files. List all that apply.
Once the Sponsor completes the information above, forward the form in WORD format to: [email protected]

05/07