Information Collection

SSA-120 Internet Version Application for access to SSA Systems

IC 212360 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⚠️ Notice: This information collection may be referencing outdated material.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
Electronic SSA-120 - Revised.pdf	Other-Screens
Electronic SSA-120 - Current.pdf Electronic SSA-120 - Current	IC Document

IC Title:

SSA-120 Internet Version Application for access to SSA Systems

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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

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
Other-Screens			Electronic SSA-120 - Revised.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,482

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,482	377	1,105
Annual IC Time Burden (Hours)	37	0	37
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Electronic SSA-120 - Current	Electronic 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.