Information Collection

Application for Access to SSA

IC 198898 under ICR 201705-0960-003 · OMB 0960-0791.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0791 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-120 Application for Access to SSA	Form and Instruction
SSA-120 - Revised Privacy Act Statement.docx	Other-Privacy Act Statement
SSA-120 Application For Access to SSA Systems SSA-120 - Revised.pdf	Form and Instruction
SSA-120 - Current.pdf Applicaiton For Access to SSA Systems	IC Document

IC Title:

Application for Access to SSA

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 31.6011(b)2 20 CFR 401.45 26 CFR 31.6109-1

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
Form and Instruction	SSA-120	Application For Access to SSA Systems	SSA-120 - Revised.pdf		No		Paper Only
Other-Privacy Act Statement			SSA-120 - Revised Privacy Act Statement.docx		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 685

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	685	-1,463	2,148
Annual IC Time Burden (Hours)	23	-49	72
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Applicaiton For Access to SSA Systems	SSA-120 - Current.pdf	08/28/2017

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