Electronic SSA-120 - Current

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 (OMB) control number. The OMB control number for this
collection is 0960-0791. We estimate that it will take about 2 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.

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
44 U.S.C. § 3543 of the Federal Information Security Management Act of 2002, and
Section 205(a) of the Social Security Act, as amended, authorize us to collect this
information. We will use the information you provide to grant and limit access to SSA
computer-based information resources.
The information you furnish on this form is voluntary. However, failure to provide us
with the requested information could prevent us from providing you access to SSA
computer systems.
We rarely use the information you supply for any purpose other than for determining
access to SSA computer systems. 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 statistical research, audit, or investigative 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.
A complete list of routine uses for this information is available in our System of Records
Notices entitled, Identity Management System, 60-0361; and, Personal Identification
Number File, 60-0214. These notices, additional information regarding this form, and
information regarding our programs and systems, are available on-line at
www.socialsecurity.gov or at your local Social Security office.