SSA-159 Government to Government Services Online Website Registr

Form Approved
OMS No. 0960-0757

Social Security Administrat ion

GSO Website Registration Form

Complete the following information to obtain access to GSQ services. SSA Sponsors should email thecompletedformto UIT.eOata.Mailb [email protected]. Each new
user will receive an email containing the Username , and a phone call to provide the password.
Please tab from field to field.
SSA SPONSOR VERIFICATION (FOR COMPLETION BY SPONSOR
ONLY):

GSO USER - CONTACT INFORMATION

-

- -

Name:

.

-

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Organization Name:

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- -_. - - - ­

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-

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-

Sponsor Email address:

-

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Street Address (Line 2):
City:

-

- - ._. -_.

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---­

State:

-

-

Email Address:

- -

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Phone (Include area code):

-

Sponsor Comments:

Zip
Code:

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-

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FOR DATA EXCHANGE, SHEL TERED WORKSHOP, AND SECURE
MESSAGING ONLY: list all Trading partners with whom the user
will exchange data.
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Name
User 10
Organization/State

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For SSA internal users only:
Select user type:

I

Select One

(Include area code)

Sponsor Organization (Office/Division/Branch):

Organization 10 or RID:
Street Address (Line 1):

Phone:

Sponsor Name:

-~--~~--

SELECT UTILITIES THE NEW USER WILL NEED TO ACCESS:
I

I

Select Utilities

I

Select Utilities

I

-

-

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-

Select Utilities

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-

-

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For UIT use only.

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Select Utilities
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Fonn SSA-159 (07-20 10)

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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
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 .
See Revised Paperwork

Reduction Act

SSA will insert the following revised Privacy Act Statement into the form at its
next scheduled reprinting:
Privacy Act Statement
Collection and Use of Personal Information
Section 205(a), of the Social Security Act, as amended, 5 U.S.C. 552a(e)(10), and the
Government Paperwork Elimination Act, authorize us to collect this information. We will
use the information you provide to determine eligibility to access Government Services
Online (GSO).
The information you furnish on this form is voluntary. However, failure to provide the
requested information may prevent us from granting access to GSO.
We rarely use the information you supply for any purpose other than for determining
eligibility for access. However, we may use it for the administration and integrity of
Social Security programs. We may also disclose information to another person or to
another agency in accordance with approved routine uses, which include but are not
limited to the following:

1. To comply with Federal laws requiring the release of information from Social
Security records (e.g., to the Government Accountability Office and
Department of Veterans Affairs);
2. To facilitate investigative and audit activities necessary to assure the integrity
of Social Security programs.
We may also use the information you provide in computer matching programs. Matching
programs compare our records with records kept by other Federal, State, or local
government agencies. Information from these matching programs can be used to establish
or verify a person’s eligibility for Federally-funded or administered benefit programs and
for repayment of payments or delinquent debts under these programs.
Additional information regarding this form, routine uses of information, and our
programs and systems, is available on-line at www.socialsecurity.gov or at your local
Social Security office.

SSA will insert the following revised PRA Statement into the form at its
next scheduled reprinting:
Paperwork Reduction Act Statement - 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 to read the instructions, gather the facts, and answer the questions. Send only
comments relating to our time estimate above to: SSA, 6401 Security Blvd, Baltimore,
MD 21235-6401.

Privacy Act Statement
Collection and Use of Personal Information
Section 205(a), of the Social Security Act, as amended, and the Government Paperwork
Elimination Act, authorize us to collect this information. We will use the information you
provide to determine eligibility to access Government Services Online (GSO).
The information you furnish on this form is voluntary. However, failing to provide the
requested information may prevent us from granting access to GSO.
We rarely use the information you supply for any purpose other than for determining
eligibility for access. However, we may use it for the administration and integrity of
our programs. We may also disclose information to another person or to another
agency in accordance with approved routine uses, including, but are not limited to the
following:
1. To comply with Federal laws requiring the release of information from
Social Security records (e.g., to the Government Accountability Office and
Department of Veterans Affairs);
2. To facilitate statistical research, audit, and investigatory activities
necessary to assure the integrity of our programs (e.g., to the Bureau of the
Census and to private entities under contract with us).
We may also use the information you provide in computer matching programs. Matching
programs compare our records with records kept by other Federal, State, or local
government agencies. We use the information from these programs to establish or verify a
person’s eligibility for federally funded or administered benefit programs and for
repayment of incorrect payments or delinquent debts under these programs.
Additional information regarding this form, routine uses of information, and our
programs and systems, is available on-line at www.socialsecurity.gov or at your local
Social Security office.