Application for Access to SSA Systems

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-120 Application For Access to SSA Systems	Form and Instruction	Removed	Available
Form SSA-120 Application for Access to SSA	Form and Instruction	Modified	Missing upstream
Supporting Statement - 0791 (Clean Copy).docx	Supporting Statement A	Uploaded 2023-04-26	Available
Supporting Statement - 0791.docx	Supporting Statement A	Uploaded 2021-04-29	Missing upstream
Addendum - 0791.docx	Supplementary Document	Uploaded 2021-04-28	Available
Addendum - 0791.docx	Supplementary Document	Uploaded 2021-04-28	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
212360	SSA-120 Internet Version Application for access to SSA Systems	Other-Screens	Modified
198898	Application for Access to SSA	Form and Instruction	Removed	Application For Access to SSA Systems
198898	Application for Access to SSA	Form and Instruction	Modified
198898	Application for Access to SSA	Other-Privacy Act Statement	Removed

ICR Details

OMB Control No: 0960-0791	ICR Reference No: 202103-0960-004
Status: Active	Previous ICR Reference No: 201705-0960-003
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: 07/20/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/29/2021
Terms of Clearance: The agency now allows this collection to be fully signed, completed, and submitted electronically. The agency modified the supporting statement to reflect this.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2026	36 Months From Approved	07/31/2023
Responses	2,167	0	2,167
Time Burden (Hours)	72	0	60
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:
	86 FR 8246	02/04/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 22510	04/28/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

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

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ICR Summary of Burden

table that charts list 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	2,167	0	0	0	0
Annual Time Burden (Hours)	72	60	0	0	12	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: When we last cleared this IC in 2017, the burden was 60 hours. However, we are currently reporting a burden of 72 hours. This change stems from an increase in the completion time from 1.5 minutes to 2 minutes. We are using whole number to calculate the burden hours. In addition, we also removed the IC for the paper form as we now request respondents use the electronic version to submit the information to us, and only keep the paper form available for times when our electronic system is down.

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Annual Cost to Federal Government: $1,476,730

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? No

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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: 04/29/2021

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