Application for Access to SSA Systems

Forms and Documents

Document Name	Status
Form SSA-120 Application for Access to SSA Form and Instruction	Modified
Supporting Statement - 0791.docx Supporting Statement A	2018-05-03
Addendum - 0791.docx Supplementary Document	2017-09-14

IC Document Collections

IC ID	Document Title	Status
212360	SSA-120 Internet Version Application for access to SSA Systems Other-Screens	Modified
198898	Application for Access to SSA Form and Instruction	Modified

ICR Details

OMB Control No: 0960-0791	ICR Reference No: 201705-0960-003
Status: Active	Previous ICR Reference No: 201407-0960-002
Agency/Subagency: SSA	Agency Tracking No:
Title: Application for Access to SSA Systems
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/08/2018
	Date Received in OIRA: 09/15/2017
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved for three years.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2021	36 Months From Approved	05/31/2018
Responses	2,167	0	3,253
Time Burden (Hours)	60	0	109
Cost Burden (Dollars)	0	0	0

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Abstract: SSA uses the Form SSA-120 to provide a personal identification number for access to SSA's information technology resources. SSA only uses Form SSA-120 for obtaining access to SSA systems. The request must adhere to the minimum access necessary for respondents to perform job duties. SSA requires supervisor approval, and local or component security officer review prior to granting the requested access. The respondents are SSA employees and non-Federal employees (contractors) needing access to SSA systems.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 24767	05/30/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 41085	08/29/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
SSA-120 Internet Version Application for access to SSA Systems
Application for Access to SSA	SSA-120	Application For Access to SSA Systems

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,167	3,253	0	0	-1,086	0
Annual Time Burden (Hours)	60	109	0	0	-49	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The decrease in burden hours from 109 to 60 hours stems from a decrease in the number of contractors hired by SSA. We decreased the number of respondents for this ICR from 3,253 to 2,167, as we are hiring fewer contractors due to budget constraints. The estimate of burden per response has not changed.

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Annual Cost to Federal Government: $1,027

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/15/2017

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