Information Collection

Government to Government Services Online Website Account Modification/Deletion Form SSA-119

IC 180142 under ICR 200705-0960-006 · OMB 0960-0757.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0757 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Guidelines for eData Acct Modification-Deletion Form 05-2007.doc	Instruction
GSO Screen Shots for OMB.doc s044a90.ssa.gov/acu/iresear/login?YRL=/apps8/websuite/EDATA_home.xfm	Other-Screen Shots
SSA-119 Government to Government Services Online Website Account eData Account Modification-Deletion Form 05-2007.doc	Form
PRA Statement.doc PRA Statement	IC Document

IC Title:

Government to Government Services Online Website Account Modification/Deletion Form SSA-119

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 401.45

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Guidelines for eData Acct Modification-Deletion Form 05-2007.doc		Yes	Yes	Fillable Fileable
Form	SSA-119	Government to Government Services Online Website Account Modification/Deletion Form	eData Account Modification-Deletion Form 05-2007.doc		Yes	Yes	Fillable Fileable
Other-Screen Shots			GSO Screen Shots for OMB.doc	https://s044a90.ssa.gov/acu/iresear/login?YRL=/apps8/websuite/EDATA_home.xfm	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,575

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,575	1,575
Annual IC Time Burden (Hours)	394	394
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
PRA Statement	PRA Statement.doc	05/14/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.