SSA-160 (current)

Form Approved
OMB No. 0960-0757

Social Security Administration

GSO Website Account Modification/Deletion Form
Sponsors should complete this form to request modification or deletion of a GSO website user account. SSA sponsors should email the completed form
to [email protected]. Sponsors will receive email notification when the request has been processed.

Please tab from field to field.

USER ACCOUNT INFORMATION

REQUEST INFORMATION
User Name):

Date of Request:
Type of Request:

Select One

(Note: Deletion requests for organizational shared accounts will delete
the entire account where no one on that account will have access to the
website.)

User ID to be changed:
Explanation:

Select user type:

Select One

Organization Name:
Organization ID or RID:
Email Address:
Phone (Include area code):
SPONSOR INFORMATION

MODIFICATION REQUEST
Select the utilities to which the user will need access:
(select all that apply to this user)

Select Utilities

Sponsor Name:

Select Utilities

Comments:
Paperwork Reduction Act Notice: This information collection meets the requirements
of 44 U.S.C. §3507, as amended by Section 2 of the Paperwork Reduction Act of 1995.
You do not need to answer these questions unless we display a valid Office of
Management and Budget control number. We estimate that it will take about 15 minutes

Form SSA-160 (07-2010)

(Include area code)

Office:
Email:

Select Utilities
Select Utilities

Phone:

ACCOUNT STATUS - For Completion By UIT
Status: Request Submitted
Processed by:

Completion Date:
Phone:

(Include area code)

Comments:
to read the instructions, gather the facts, and answer the questions. You may send
comments on our time estimate above to: SSA, 6401 Security Blvd., Baltimore, MD
21235-6401. Send only comments relating to our time estimate to this address, not the
completed form.